Contemporary Management of Cardioembolic Stroke in Young Adults

Cardioembolic stroke is a major cause of ischaemic stroke, arising from emboli of cardiac origin and carrying a substantial risk of recurrent events. In young adults, ischaemic stroke is less common than in older populations but is associated with a disproportionate lifetime burden of disability and mortality. The aetiological profile of this group is relatively different from older patients, with a higher contribution by cardioembolic and non-atherosclerotic factors, including structural cardiac abnormalities, occult atrial fibrillation (AF), and patent foramen ovale (PFO)(Ohya et al. 2022). This narrative review examines the major aetiologies of cardioembolic stroke in young adults, with a focus on cardiovascular pathophysiology and management. Clinical recognition challenges are identified as presenting characteristics are frequently nonspecific and insufficient to adequately differentiate cardioembolic stroke from other ischaemic subtypes. (Marcoff and Homma 2014). This review will discuss diagnostic strategies such as electrocardiography, cardiac imaging, and prolonged rhythm monitoring (Stack and Cole 2017). Management and secondary prevention strategies are discussed, however much of the available evidence relies on extrapolation from older populations. While advances in diagnosis and risk stratification have increased detection of cardioembolic causes, age-based findings are still lacking to assist in determining the best management strategies (Bukhari et al. 2023). This review discusses the importance of mechanism-driven individualised approaches to reduce recurrent stroke risk for cardioembolic ischaemic stroke in young adults.