Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term.
BACKGROUND
Causes of ischemic stroke in young adults (15-45 years) are diverse, but undetermined etiology is common in a majority of studies.


OBJECTIVE
The present series study aims to evaluate causes and changes in the etiological diagnosis of ischemic stroke in young adult patients admitted to a tertiary medical center over a period of 27 years.


METHODS
We retrospectively reviewed the records of patients with a first-ever stroke in the age range of 15-45 years who were admitted to the '12 de Octubre' University Hospital between 1974 and 2002.


RESULTS
272 young adults with ischemic stroke were identified. The etiological diagnoses were: undetermined in 36% of patients, large-artery atherosclerosis in 21%, cardioembolism in 17%, non-atherosclerotic vasculopathy in 17%, and other specific etiologies in 9%. While in the first study period (1974-1988) 45% of patients were diagnosed with uncertain etiology, in the last period (1989-2002) only 26% were diagnosed with cryptogenic stroke (45% with two or more potential etiologies identified; 45% with no identified cause despite complete evaluation, and 10% with incomplete evaluation).


CONCLUSIONS
The etiological diagnosis of stroke in young adults has changed over time as a result of improvements in diagnostic workup. While cryptogenic stroke was the most frequent diagnosis in the past, today specific causes (non-atherosclerotic vasculopathy, large-artery atherosclerosis, cardioembolism and hematological disorder) are identified in the majority of patients.
Varona
J F
JF
Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain. jfva_varona@yahoo.com
Guerra
J M
JM
Bermejo
F
F
Molina
J A
JA
Gomez de la Cámara
A
A
D000293:Adolescent; D000328:Adult; D001161:Arteriosclerosis / Q000150:complications / Q000175:diagnosis; D002545:Brain Ischemia / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis; D004617:Embolism / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis