Unusual Causes of Stroke in a Young Adult

Cerebral infarction in the young adult is uncommon. Nonatheromatous causes for stroke preponderate in young adults, in contrast to cerebral infarction in the older population. When a cause can be identified, cardiac emboli are most frequently responsible, with rheumatic valvular disease, atrial arrhythmias, and bacterial endocarditis the most common underlying conditions; congenital heart disease is a rare association. REPORT OF A CASE A 33-year-old man was admitted because of the sudden onset of nonfluent aphasia, right hemiparesis, and transient loss of vision in the left eye. Cardiac findings included a grade 2/6 systolic murmur heard best at the lower left sternal border, a grade 1/6 pansystolic murmur heard in the left axilla, and a diastolic sound at the lower left sternal border, thought to be a tricuspid flow murmur. Neurologic examination disclosed nonfluent aphasia and mild right hemiparesis. A VDRL serologic test was positive in the 1:65 dilution. The FTA-ABS