Background: A few studies have comprehensively assessed the epidemiology, aetiology, prognosis, and secondary prevention of ischaemic stroke in young adults. To gain further information on this field, we have prospectively studied a hospital-based series of young adults with a first-ever episode of cerebral ischaemia (CI). Methods: Sixty consecutive patients aged 17–45 with ischaemic stroke (55 patients) or transient ischaemic attack within 24 h before hospital admission were recruited and investigated by a standardized rigorous protocol. The patients were followed up for ≧1 year after hospital discharge. Arbitrary doses of aspirin 100 mg/d or ticlopidine 250 mg b.i.d. in case of intolerance to aspirin were given for the secondary prevention. Adjusted-dose oral anticoagulation (INR target 2.5) was used in the presence of cardioembolism or hypercoagulable states. Endpoints included the residual disability, rated by modified Rankin Scale (RS) and Barthel Index (BI), and poststroke recurrence. Results: CI was associated with two or more risk factors in 61.6% of patients. Cigarette smoking was more frequently associated with male gender (p < 0.05) and migraine history with female sex (p < 0.05). The atherothrombotic diagnostic subtype and the subtype from ‘other cause’ predominated significantly among patients ≧35 years old (p < 0.05) and <35 years (p < 0.025), respectively. The ‘other cause’ subset was more frequent in female gender (p < 0.05). Transoesophageal echocardiography (TEE) detected potential cardiac sources of emboli (PCSE) at an extent 3 times higher (p < 0.0001) than transthoracic echocardiography. Congenital heart defects were nearly threefold more frequent than acquired ones, with a prevalence of patent foramen ovale. At a mean of 6.1 ± 2.6 years (confidence interval 5.4 to 6.8), follow-up data were available for only 54 patients, since five patients were lost and one died in the acute phase. Poststroke recurrence rate was low (7.4%) and no event was fatal. General handicap was severe to moderately severe (RS>3) in 11% of the patients, slight to moderate (1≧RS≤3) in 59% and absent in 30% (RS = 0). Functional disability was relatively low with 50% of the patients independent (BI ≧95), 38.9% partially dependent (BI 60 to 86), and 11.1% fully dependent (BI <60). Thirty-seven (68.5%) patients returned to work, although adjustments (other job or part-time employment) were necessary for 10 out of them (27%). Conclusions: The present study, though limited by the relatively small number of subjects, suggests that the overall prognosis of ischaemic stroke in young adults is good. We strongly recommend TEE in all patients with ischaemic stroke as an essential tool to increase the detection of PCSE and make the therapeutic approach more efficient.

Hart RG, Miller VT: Cerebral infarction in young adults: A practical approach. Stroke 1983;14:110–114.
Nencini P, Inzitari D, Baruffi MG, Fratiglioni L, Gagliardi R, Benvenuti L, Buccheri AM, Cecchi L, Passigli A, Rosselli A: Incidence of stroke in young adults in Florence, Italy. Stroke 1988;19:977–981.
Carolei A, Marini C, Ferranti E, Frantoni M, Prencipe M, Fieschi C: A prospective study of cerebral ischemia in the young. Analysis of pathogenic determinants. Stroke 1993;24:362–367.
Rasura M, Cao M: Stroke in the young: A diagnostic protocol. Ann Ital Med Int 1996;11:8–11.
Bogousslavsky J, Regli F: Ischemic stroke in adults younger than 30 years of age. Cause and prognosis. Arch Neurol 1987;44:479–482.
Adams HP, Kappelle LJ, Biller J, Gordon DL, Love BB, Gomez F, Heffner M: Ischemic stroke in young adults. Experience in 329 patient enrolled in the Iowa Registry of Stroke in Young Adults. Arch Neurol 1995;52:491–495.
Biller J, Adams HP, Bruno A, Love BB, Marsh EE: Mortality in acute cerebral infarction in young adults. A ten-year experience. Angiology 1991;42:224–230.
Hindfelt B, Nilsson O: Long-term prognosis of ischemic stroke in young adults. Acta Neurol Scand 1992;86:440–445.
Ferro JM, Crespo M: Prognosis after transient ischemic attack and ischemic stroke in young adults. Stroke 1994;25:1611–1616.
Kappelle LJ, Adams HP, Heffner ML, Torner JC, Gomez F, Biller J: Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke 1994;25:1360–1365.
Report of the WHO Task Force on Stroke and Other Cerebrovascular Disorders: Recommendations on stroke preventions, diagnosis, and therapy. Stroke 1989;20:1407–1431.
National Diabetes Data Group: Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039–1057.
Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: 1. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 1979;242:2562–2571.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Summary of the Second Report of the National Cholesterol Education Program (NCEP). JAMA 1993;269:3015–3023.
Burke BS: The dietary history as a tool in research. J Am Diet Assoc 1947;23:1041–1046.
Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8(suppl 7):1–96.
SALT Collaborative Group: Swedish Aspirin Low-Dose Trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischemic events. Lancet 1991;338:1345–1349.
Hass WK, Easton JD, Adams HP Jr, Pryse-Phillips W, Molony BA, Anderson S, Kamm B: A randomized trial comparing ticlopidine hydro-chloride with aspirin for the prevention of stroke in high risk patient: Ticlopidine Aspirin Stroke Study. N Engl J Med 1989;321:501–507.
Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force. Arch Neurol 1989;46:727–743.
van Swieten JC, Koudstaal PJ, Visser MC, Shouten HJ, van Gijn J: Interobserver Agreement for the Assessment of Handicap in Stroke patient. Stroke 1988;19:604–607.
Mahoney FD, Barthel DW: Functional evaluation: The Barthel Index. Md State Med J 1965;14:61–65.
Bogousslavsky J, Van Melle G, Regli F: The Lausanne Stroke Registry: Analysis of 1000 consecutive patient with first stroke. Stroke 1988;19:1083–1092.
Bogousslavsky J, Cachin C, Regli F, Despland PA, Van Melle G, Kappenberger L: Cardiac sources of embolism and cerebral infarction – Clinical consequences and vascular concomitants: The Lausanne Stroke Registry. Neurology 1991;41:855–859.
Werner GD, Mügge A: Transesophageal echocardiography. N Engl J Med 1995;332:1268–1279.
A report of the American College of Cardiology/American Heart Association Task Force on Practise Guidelines (Committee on Clinical Application of Echocardiography). J Am Coll Cardiol 1997;29:862–879.
Neau JP, Ingrand P, Mouille-Brachet C, Rosier MP, Couderq C, Alvarez A, Gil R: Functional recovery and social outcome after cerebral infarction in young adults. Cerebrovasc Dis 1998;8:296–302.
Bogousslavsky J, Pierre P: Ischemic stroke in patient under age 45. Neurol Clin 1992;10:113–124.
American Heart Association Prevention Conference. IV. Prevention and Rehabilitation of Stroke: Risk Factors. Stroke 1997;28:1507–1517.
Hannaford PC, Croft PR, Kay CR: Oral contraception and stroke: Evidence from the Royal College of General Practitioners’ Oral Contraception Study. Stroke 1994;25:935–942.
Petitti DB, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel HK: Stroke in users of low-dose oral contraceptives. N Engl J Med 1996;335:8–15.
Carolei A, Marini G, de Matteis G: History of migraine and risk of cerebral ischaemia in young adults. The Italian National Research Council Study Group on Stroke in the Young. Lancet 1996;347:1503–1506.
Rothrock J, North J, Madden K, Lyden P, Fleck P, Dottrich H: Migraine and migrainous stroke: Risk factors and prognosis. Neurology 1993;43:2473–2476.
Black-Shaffer RM, Osberg JS: Return to work after stroke: Development of a predictive model. Arch Phys Med Rehabil 1990;71:285–290.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.