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Background: Stroke in young patients results in disproportionately high societal cost given the productive life-years lost. Little is known about stroke in young Egyptian patients. We aimed to analyze clinicodemographic characteristics, functional outcome and socioeconomic impact of ischemic stroke among young Egyptian adults. Methods: Prospective, observational cohort study of consecutively recruited patients with acute ischemic stroke (AIS), 18- 50 years, between September 2022-Septemeber 2023 at a tertiary stroke center in the south of Egypt. We recorded baseline demographic and cardiovascular risk factors, stroke severity, stroke subtype according to the TOAST classification, intravenous thrombolysis, employment and ambulation status pre and post stroke, post stroke complications and 90-day functional outcome measured by the modified Rankin Scale (mRS). Results: Our cohort comprised 210 patients, 38.0 (±7.8) years; 89 (42%) females. Mean NIHSS score was 11.2(±4.8); in-hospital case fatality was 9% (19 patients). Dyslipidemia (n=105, 50%), smoking (n=105, 50%), and hypertension (n=67, 32%) were the most prevalent cardiovascular risk factors. At 90 days 58 (29%) patients had a 90-mRS 0-1 and 53 (26%) met criteria for depression diagnosis. Sixty-nine of the 116 employed individuals (59%) remained out of work after 90 days of stroke, 61 of whom were single earners in their household. . 36/60 (60%) thrombolysis-eligible patients received it; an additional 98 otherwise thrombolysis-eligible patients presented >4.5 hours from symptom onset. Patients receiving IV thrombolysis were significantly more likely to have resumed full time work at 90 days (32% vs 11%, p=0.006) but with no significant difference in 90-day mRS. Conclusions: Young adult AIS patients in Egypt experience high rates of post-stroke depression and face challenges in their ability to work and provide for their families. Since most patients have treatable cardiovascular risk factors and only about two-thirds of eligible patients receive thrombolysis, reinforcing primary prevention, education about early stroke signs and benefits of acute can improve outcomes and have significant potential societal benefit.

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