Ischemic stroke in young adults is an uncommon but clinically significant condition that frequently occurs in the absence of traditional cardiovascular risk factors. In this population, identification of nontraditional and potentially iatrogenic contributors is essential for accurate diagnosis and effective secondary prevention. We report the case of a 28-year-old woman with normal body mass index who presented with acute-onset expressive aphasia accompanied by right-sided motor and sensory deficits. Her medical history was notable for chronic migraine treated with daily sumatriptan use over three years and intermittent administration of diclofenac (Fastenal), a non-selective NSAID, used as needed for pain control. A prior transient neurological episode three years earlier was associated with unremarkable neuroimaging. Current diagnostic evaluation with 1.5-Tesla brain magnetic resonance imaging (MRI), GE Brivo MR355 1.5T (GE Healthcare, Chicago, IL, USA), revealed two punctate acute ischemic lesions localized to the M4 cortical territory of the left middle cerebral artery. Laboratory investigations obtained on admission as part of the emergency department acute stroke protocol were largely unremarkable, except for subclinical hypothyroidism and borderline dyslipidemia. This case underscores the diagnostic value of magnetic resonance imaging in identifying small cortical ischemic infarcts that may be undetectable on computed tomography. It also highlights the potential contributory role of chronic vasoconstrictive migraine therapies in conjunction with non-steroidal anti-inflammatory drug (NSAID) use and minor metabolic abnormalities in precipitating ischemic stroke in young adults. Increased clinical vigilance is warranted when evaluating young migraine patients presenting with acute focal neurological deficits.
Babukhadia et al. (2026) studied this question.