title: Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS).
abstract: Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16-55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60% men), median age was 46 (IQR 39-51) years and median NIHSS on admission 3 (IQR 1-8). Modifiable vascular risk factors were found in 73%. Stroke aetiology was mostly cardioembolism (32%) and of other defined origin (24%), including cervicocerebral artery dissection (17%). Fabry disease was diagnosed in 2 patients (0.3%). Aetiology remained unknown in 20%. Outcome at 3 months was favourable (mRS 0-1) in 61% and fatal in 2.9%. Stroke severity (p < 0.001) and diabetes mellitus (p = 0.023) predicted unfavourable outcome. Stroke recurrence rate at 3 months was 2.7%. Previous stroke or TIA predicted recurrent cerebrovascular events (p = 0.012). In conclusion, most young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones.
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland. barbara.goeggelsimonetti@insel.ch.
authors.forename: Barbara
authors.initials: B
authors.lastname: Goeggel Simonetti
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Mono
authors.affiliation: Department of Nephrology, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Uyen
authors.initials: U
authors.lastname: Huynh-Do
authors.affiliation: Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.affiliation: Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland.
authors.forename: Celine
authors.initials: C
authors.lastname: Odier
authors.affiliation: Department of Neurology, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Sztajzel
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lyrer
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Leo
authors.initials: L
authors.lastname: Bonati
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Henrik
authors.initials: H
authors.lastname: Gensicke
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Traenka
authors.affiliation: Department of Neurology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tettenborn
authors.affiliation: Department of Neurology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
authors.forename: Bruno
authors.initials: B
authors.lastname: Weder
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Aekaterini
authors.initials: A
authors.lastname: Galimanis
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Luedi
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: De Marchis
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Weck
authors.affiliation: Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Ospedale Civico, Lugano, Switzerland.
authors.forename: Carlo W
authors.initials: CW
authors.lastname: Cereda
authors.affiliation: NeuroCenter, Hirslanden Klinik, Zurich, Switzerland.
authors.forename: Ralf
authors.initials: R
authors.lastname: Baumgartner
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Bassetti
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.|Department of Neurology, Cantonal Hospital Aargau, Aarau, Switzerland.
authors.forename: Krassen
authors.initials: K
authors.lastname: Nedeltchev
authors.affiliation: Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland. marcel.arnold@insel.ch.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000628:therapy*; D013557:Switzerland; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aetiology; Ischaemic stroke; Outcome; Risk factors; Stroke in young adults; Stroke recurrence