Pathogenesis of Stroke in Young Adults

  • A. Anzini
  • M. Rasura
  • C. Fieschi
Conference paper


The lower and upper limits of age that define a young adult with stroke are rather arbitrary. By convention the age span in this situation is usually set in the range of 15–18 years up to 45–50 years of age. The definition of this range is useful and justified by differences in etiologies, evaluation and prognosis in this younger population as compared with stroke in the elderly. Defining the diagnosis and cause of stroke in the young is often a challenging task. The causes of stroke among young adults are more diverse than in the elderly and require an extensive diagnostic workup. Bogousslaysky and Pierre [1] listed up to 120 causes of stroke in the young and some authors [2, 3] also provided guidelines for clinical management of both commonly and rarely encountered cerebrovascular disorders in young adults. Hower, it is difficult to give an accurate hierarchy of causes of stroke based on their frequency because most studies come from secondary or tertiary care centers so that the results are invariably biased toward uncommon causes. Yet, the etiology or the underlying disorder of approximately one third of ischemic stroke remains undetermined. Table 1 shows the potential causes of ischemic stroke in young adults.


Ischemic Stroke Infective Endocarditis Arterial Dissection Paradoxical Embolism Atrial Septal Aneurysm 
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  1. 1.
    Bogousslaysky J, Pierre P (1992) Ischemic stroke in patients under 45. Neurol Clin 10: 113–124Google Scholar
  2. 2.
    Kristensen B, Malm J, Carlberg B et al (1997) Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years In northern Sweden. Stroke 28: 1702–1709PubMedCrossRefGoogle Scholar
  3. 3.
    Caplan LR (1993) Stroke in children and young adults. In: Stroke. A clinical approach. 2nd edn. Butterworth-Heinemann, Boston, MA, pp 469–485Google Scholar
  4. 4.
    Carolei A, Marini C, Ferranti E et al (1993) A prospective study of cerebral ischemia in the young: analysis of pathogenic determinants. Stroke 24: 362–367PubMedCrossRefGoogle Scholar
  5. 5.
    Biller J (1994) Atherosclerotic cerebral infarction in young adults. In: Stroke in children and young adults. Butterworth-Heinemann, Boston, MA, pp 45–56Google Scholar
  6. 6.
    Cardiogenic brain embolism (1989) The second report of the Cerebral Embolism Task Force. Arch Neurol 46: 727–743CrossRefGoogle Scholar
  7. 7.
    Labovitz AJ, Pearson AC (1993) Cardiac masses and cardiac source of emboli. In: Trans-esophageal echocardiography: basic principle and clinical applications. Lea & Febiger, Philadelphia, London, pp 106–116Google Scholar
  8. 8.
    Lechat PH, Mas JL, Lascault G et al (1988) Prevalence of patent foramen ovale in young stroke patients. N Engl J Med 318: 1148–1152PubMedCrossRefGoogle Scholar
  9. 9.
    Ranoux D, Cohen A, Cabanes L et al (1993) Patent foramen ovale: is stroke due to paradoxical embolism? Stroke 24: 31–34PubMedCrossRefGoogle Scholar
  10. 10.
    Cabanes L, Mas JL, Cohen A et al (1993) Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using trans-esophageal echocardiography. Stroke 24: 1865–1873Google Scholar
  11. 11.
    Lucas C, Moulin T, Deplanque D et al (1998) Stroke patterns of internal carotid artery dissection in 40 patients. Stroke 29: 2646–268PubMedCrossRefGoogle Scholar
  12. 12.
    Bozzao L, Fantozzi LM, Bastianello S et al (1989) Occlusion of the extracranial internal carotid artery in the acute stroke; angiographic findings within six hours. Acta Neurochir (Wien) 100: 39–42CrossRefGoogle Scholar
  13. 13.
    Cook PJ, Honeybourne D, Lip GYH et al (1998) Chlamydia pneumoniae antibody titers are significantly associated with acute stroke and transient cerebral ischemia. The West Birmingham Stroke Project. Stroke 29: 404–410Google Scholar
  14. 14.
    Hart RG, Kanter MC (1990) Hematological disorders and ischemic stroke. A selective review. Stroke 21: 1111–1121Google Scholar
  15. 15.
    De Stefano V, Chiusolo P, Paciaroni K et al (1998) Prothrombin G20210A mutant genotype is a risk factor for cerebrovascular ischemic disease in young patients. Blood 91: 3562–3565PubMedGoogle Scholar
  16. 16.
    Chaturvedi S, Dzieczkowski J (1998) Multiple hemostatic abnormalities in young adults with activated protein C resistance and cerebral ischemia. J Neurol Sci 159: 209–212PubMedCrossRefGoogle Scholar
  17. 17.
    Levine SR, Brey RL, Sawaya KL et al (1995) Recurrent stroke and thrombo-occlusive events in the antiphospholipid syndrome. Ann Neurol 38: 119–124PubMedCrossRefGoogle Scholar
  18. 18.
    Henderson GV, Kittner SJ, Johns DR (1997) An incidence study of stroke secondary to Melas in the young. Neurology 49: A439Google Scholar
  19. 19.
    Sabbadini G, Francia A, Calandriello L et al (1995) Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (Cadasil): clinical, neuroimaging, pathological and genetic study of a large Italian family. Brain 118: 207–215PubMedCrossRefGoogle Scholar
  20. 20.
    Becker WJ (1997) Migraine and oral contraceptives. Can J Neurol Sci 24: 16–21PubMedGoogle Scholar
  21. 21.
    Carolei A, Marini C, De Matteis G (1996) History of migraine and risk of cerebral ischaemia in young adults. Lancet 347: 1503–1506PubMedGoogle Scholar
  22. 22.
    Headache Classification Committee of the International Headache Society (1998) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalgia 8 [Suppl 7]: 13Google Scholar
  23. 23.
    Grosset DG, Ebrahim S, Bone I et al (1995) Stroke in pregnancy and puerperium: what magnitude of risk? J Neurol Neurosurg Psychiatry 58: 129–131PubMedCrossRefGoogle Scholar
  24. 24.
    Knepper LE, Giuliani MJ (1995) Cerebrovascular disease in women. Cardiology 86: 339–348PubMedCrossRefGoogle Scholar
  25. 25.
    Lindgren A, Brattstrom L, Norrving B et al (1995) Plasma homocysteine in the acute and convalescent phases after stroke. Stroke 6: 795–800CrossRefGoogle Scholar
  26. 26.
    Fieschi C, Rasura M, Anzini A et al (1996) A diagnostic approach to ischemic stroke in young and middle-aged adults. Eur J Neurol 3: 324–330CrossRefGoogle Scholar

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© Springer-Verlag Italia 2000

Authors and Affiliations

  • A. Anzini
  • M. Rasura
  • C. Fieschi

There are no affiliations available

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