Aetiologia

Aetiological diagnosis of ischaemic stroke in young adults
José M Ferro, Ayrton R Massaro, Jean-Louis Mas
Despite improvements in diagnosis and treatment, ischaemic stroke in young adults remains a catastrophic event from the patients’ perspective. Stroke can cause death, disability, and hamper quality of life. For the neurologist treating a young adult with suspected ischaemic stroke, the diagnostic challenge is to identify its cause.
Contemporary neuroimaging of the brain and its vessels, and a comprehensive cardiac assessment, will enable identifi cation of the most frequent causes of stroke in this age group: cardioembolism and arterial dissection.
Specifi c diagnostic tests for the many other rare causes of ischaemic stroke in young adults (angiography, CSF examination, screening for vasculitis and thrombophilia, genetic testing, and ophthalmological examination) should be guided by suspected clinical fi ndings or by the high prevalence of diseases associated with stroke in some countries.
Introduction
The incidence of stroke rises exponentially with age and is therefore low in young adults.
Nevertheless, ischaemic stroke in young adults is a common cause of admission to stroke units and referral to neurology departments or tertiary hospitals.
Traditional risk factors for stroke such as hypertension and diabetes are not very frequent in young adults; 2,3 however, some other permanent or transient risk factors such as smoking, use of oral contraceptives, migraine, trauma, use of illicit drugs, and pregnancy or puerperium have a more important role in this age group than in older adults. The main clinical challenge in management of a young adult with acute stroke is the identifi cation of its cause. Although large extracranial and intracranial atheroma, small-vessel disease, and atrial fi brillation4,5 have a major role in cases of stroke in older adults, these disorders are much less frequent in young adults. Our ability to establish a defi