POSTERIOR REVERSIBL ENSEFALOPATİ SENDROMU? | 24.01.2024

YOUNG STROKE

Updated on 05/01/2024

We refer to strokes that occur before the age of fifty as young strokes. The causes of stroke in young patients differ from those in older individuals. Therefore, research protocols should also be different.

Young Stroke Treatment - Prof. Dr. Dilek Necioğlu Örken | Turkey

Epidemiology

The annual incidence is 5-20/100,000 individuals worldwide. However, in Africa, this rate can reach up to 100/100,000. Low-income countries have a higher 3-month mortality rate. While strokes are more common in women under the age of thirty-five, the female-to-male ratio becomes equal between the ages of 35-55.

Causes of Stroke

1. Vascular malformations

Arteriovenous malformations are the leading cause of brain hemorrhages in individuals aged 16-30, while hypertension is more common between the ages of 31-45. Surgical, embolization, or radiation therapy, or various combinations of these, can be used to treat arteriovenous malformations.

2. Vasculopathies

The most common vasculopathy in young individuals is dissection, which involves tearing of the blood vessel wall. Vasculopathies such as CADASIL, Fabry's disease, fibromuscular dysplasia, and moyamoya disease, which affect large, medium, or small-sized vessels, should be carefully considered in the differential diagnosis of young adults under the age of forty-five. Rotational arteriopathy, which occurs when the vertebral artery is compressed due to head rotation, should also be considered as a treatable cause of stroke in young adults.

3. Cardiac causes

Emboli of cardiac origin are an important cause of stroke in young individuals. Patent foramen ovale (PFO), a small opening between the right and left atria within the heart, is one of the most common causes. A blood clot formed in the leg veins can travel to the heart, pass through the PFO from the right atrium to the left atrium, and then reach the brain, causing a blockage in the brain's blood vessels and resulting in a stroke. There are certain characteristics that suggest the responsibility of PFO in causing a stroke. Some of these characteristics are related to the patient, some to PFO itself, and some to the nature of the disease. If a stroke is caused by PFO, closing this passage can prevent future strokes. Other congenital heart diseases can also cause strokes in young adults. Congenital heart diseases increase the risk of stroke in young adults by at least 6 times.

4. Inflammatory and autoimmune diseases

Infections increase the risk of stroke in both children and young adults. Another inflammatory disease is primary angiitis of the central nervous system, which leads to stroke by the entry of inflammatory cells into the brain's blood vessels. Autoimmune diseases such as systemic lupus erythematosus, sarcoidosis, rheumatoid arthritis, or inflammatory bowel diseases can increase the risk of stroke in young adults.

5. Hematological causes

Sickle cell anemia is the most important cause of stroke in young adults. Arteriopathy and increased stroke risk can be detected using transcranial Doppler, and patients can be treated accordingly. Hematological disorders that cause coagulation abnormalities, both inherited and acquired, are another significant cause of stroke in young adults. Additionally, cancer diseases can also lead to coagulation disorders.

6. Genetic causes

Genetic vasculopathies such as COL4A1 and COL3A1, Marfan syndrome, homocystinuria, sickle cell anemia, CADASIL, and cerebral cavernous malformations are causes of stroke. Fabry's disease and X-linked lysosomal storage disorders can also cause both large and small vessel diseases. Mitochondrial diseases such as MELAS, which result from mutations in the MT-TL1 gene, can also lead to stroke.

7. Other causes

Migrainous infarctions are a rare cause of stroke in young adults.

REFERENCE:
S. Fraser, L. Pabst , F. Smith. Stroke in the young.
Curr Opin Neurol 2023, 36:131–139 DOI:10.1097/WCO.0000000000001145

Photo: Rupa Panda via flickr
Attribution 2.0 Generic (CC BY 2.0)

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