title: Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis.
abstract: BACKGROUND
  Approximately 10% to 14% of ischemic strokes occur in young adults.
  
  
  OBJECTIVE
  To investigate the yield of diagnostic tests, neuroimaging findings, and treatment of ischemic strokes in young adults.
  
  
  METHODS
  We retrospectively reviewed data from our Get with the Guidelines-Stroke database from 2005 through 2010.
  
  
  METHODS
  University hospital tertiary stroke center.
  
  
  METHODS
  A total of 215 consecutive inpatients aged 18 to 45 years with ischemic stroke/transient ischemic attack. The mean (SD) age was 37.5 (7) years; 51% were male.
  
  
  RESULTS
  There were high incidence rates of hypertension (20%), diabetes mellitus (11%), dyslipidemia (38%), and smoking (34%). Relevant abnormalities were shown on cerebral angiography in 136 of 203 patients, on cardiac ultrasonography in 100 of 195, on Holter monitoring in 2 of 192; and on hypercoagulable panel in 30 of 189 patients. Multiple infarcts were observed in 31% and were more prevalent in individuals younger than age 35 years. Relevant arterial lesions were frequently detected in the middle cerebral artery (23%), internal carotid artery (13%), and vertebrobasilar arteries (13%). Cardioembolic stroke occurred in 47% (including 17% with isolated patent foramen ovale), and 11% had undetermined stroke etiology. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 0-9) and 81% had good outcome at hospital discharge. Of the 29 patients receiving thrombolysis (median National Institutes of Health Stroke Scale score, 14; interquartile range, 9-17), 55% had good outcome at hospital discharge and none developed symptomatic brain hemorrhage.
  
  
  CONCLUSIONS
  This study shows the contemporary profile of ischemic stroke in young adults admitted to a tertiary stroke center. Stroke etiology can be determined in nearly 90% of patients with modern diagnostic tests. The causes are heterogeneous; however, young adults have a high rate of traditional vascular risk factors. Thrombolysis appears safe and short-term outcomes are favorable.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Ruijun
authors.initials: R
authors.lastname: Ji
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Pervez
authors.forename: Aneesh B
authors.initials: AB
authors.lastname: Singhal
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D002533:Cerebral Angiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult