Ischemic stroke in young people

The article was written by Doctor Vu Duy Dung - Department of General Internal Medicine - Vinmec Times City International General Hospital.

Epidemiology reports that the incidence of ischemic stroke in young adults (18-50 years old) has increased significantly. These young patients often have a desire to live a long life after a stroke. The long-term health care costs are very expensive, which poses a major challenge for health care systems.

Part 1: General
Although current recommendations for stroke treatment in young and old patients (>50 years of age) are similar, the issue of optimal management for young patients with stroke is stroke is not widely known. Young people are often not recruited to participate in clinical trials and subgroup analyses.
Specifically, young patients with stroke are often not recruited because of the low incidence of stroke and the low prevalence of vascular risk factors in young adults. However, progress has been made in identifying significant risk factors for stroke events in patients, such as those with foramen ovale. Future prevention studies may help reduce the incidence of stroke and its consequences in young adults. Developing specific and detailed guidelines for stroke management in young people will be an important step in helping to reduce stroke rates.

Worldwide, more than two million young people have an ischemic stroke every year. Stroke in young people has a huge socioeconomic impact because of high health care costs and lost productivity. In contrast to the declining incidence of stroke in the elderly, epidemiological studies have consistently reported an increasing incidence and proportion of young adults with stroke in the total population. stroke cases in the community (one in ten stroke cases are young people). This incidence underscores the need to rapidly identify new risk factors and elucidate the modes of action of traditional vascular risk factors such as hypertension, smoking, and obesity. to find the best way to reverse this trend.
The study of the cause of ischemic stroke at a young age is often difficult. In contrast to stroke in the elderly, stroke in young age has a variety of causes and risk factors, which are rare, including drug use, pregnancy, arterial dissection and foramen ovale (PFO). , which needs more research and specific treatment. In addition, the prognosis after stroke varies among patients with a follow-up survival of several decades, compared with elderly patients. Recommendations on the approach and clinical management of stroke in young people are scarce in guidelines published by the American Heart and Stroke Association and the Royal Society of Physicians.
Although, there is no formal identification of young patients, most studies place the age of this group of people between 18 and 50 years old. However, the studies did not disaggregate age in detail, often the lower limit varied between 15 and 18 years of age, and the upper limit between 45 and 65 years of age.
In this review, we will cover the epidemiological evidence and provide insights into traditional risk factors and increased prevalence in young adults for stroke. We also discuss the diagnosis and management of specific causes of stroke in young adults according to TOAST criteria, long-term prognosis, and future perspectives on stroke diagnosis and management in humans.

The incidence of ischemic stroke in young adults varies considerably between countries, from 7 to 8 per 100,000 person-years in Europe to more than 100 per 100,000 person-years in sub-Saharan Africa. . This difference may be due to differences in research methods, diversity in stroke definitions in young people, in terms of age and under stroke type, and geographical differences in climate and air pollution. , genetics, race, comorbidities, cardiovascular risk data, and socioeconomic status.
Worldwide, the incidence of stroke in young people has increased by 40% over the past decades. Reasons to account for this increased incidence may include better stroke detection by advanced neuroimaging techniques, especially diffuse pulse MRI, the increased prevalence of traditional modifiable risk factors, and the growing problem of illicit and recreational drug use. Female-specific risk factors such as pregnancy and lactation, use of oral contraceptives, and higher incidence of autoimmune diseases (eg, antiphosphoslipid syndrome), are may explain a higher incidence rate seen in women than in men (especially in young people under 30 years of age). However, other studies found no difference, possibly because patients aged between 50 and 65 were also enrolled in the study.
Other unspecified risk factors may be present, as the rate of idiopathic stroke is higher in the young than in the elderly. This has remained unchanged over the past decade. The call for global collaboration has been heeded, with the recently launched Total Long-term Outcomes After Stroke in Young People (GOAL) initiative and the SECRETO study, which will help to describe it in detail. characteristics of these unidentified risk factors and their global distribution.
>>> Stroke in young people: Causes and risk factors - P1
>>> Stroke in young people: Causes and risk factors - P2

References source:
Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, de Leeuw FE. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol 2018; 17: 790-801.