Recognition and management of stroke in young adults and adolescents

Abstract

Approximately 15% of all ischemic strokes (IS) occur in young adults and adolescents. To date, only limited prior public health and research efforts have specifically addressed stroke in the young. Early diagnosis remains challenging because of the lack of awareness and the relative infrequency of stroke compared with stroke mimics. Moreover, the causes of IS in the young are heterogeneous and can be relatively uncommon, resulting in uncertainties about diagnostic evaluation and cause-specific management. Emerging data have raised public health concerns about the increasing prevalence of traditional vascular risk factors in young individuals, and their potential role in increasing the risk of IS, stroke recurrence, and poststroke mortality. These issues make it important to formulate and enact strategies to increase both awareness and access to resources for young stroke patients, their caregivers and families, and health care professionals. The American Academy of Neurology recently convened an expert panel to develop a consensus document concerning the recognition, evaluation, and management of IS in young adults and adolescents. The report of the consensus panel is presented herein.

Figure. Diagnostic tests in young adults with ischemic stroke

White bars show the percentage of patients who underwent the test, and black bars show the percentage of tests showing a “positive” result relative to stroke etiology (i.e., diagnostic yield). See Methods for individual tests included under each panel. Hypercoag = hypercoagulation panel; toxicology = serum/urine toxicology screening panel; vasc. labs = vasculitis panel. From Ji R, Schwamm LH, Pervez MA, Singhal AB. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis. JAMA Neurol 2013;70:51–57. Reprinted with permission of the American Medical Association.