Ischaemic Stroke in the Young – Management

The incidence of ischaemic stroke in young adults (18-50 years) has increased substantially in the last 3 decades, mainly because of the rising incidence of vascular risk factors in this age group (hypertension, hypercholesterolemia, diabetes mellitus, smoking, obesity) and increased illicit drugs and alcohol consumption.Although progress has been made in early diagnosis of stroke, specifi c guidelines for the management and secondary prevention of ischaemic stroke in the young are lacking.Ischaemic stroke in young adults has a considerable socio-economic impact and is responsible for an important decrease in the labor force.While subarachnoid and intracerebral hemorrhage are more frequent in the young population, hemorrhagic stroke still remains less common than ischaemic stroke.The etiology of ischaemic stroke can be represented by non-atherosclerotic vasculopathy (arterial dissection, inherited or acquired thrombophilia) or cardioembolism in the context of patent foramen ovale and atrial septal aneurysm.In this age group, specifi c investigations for less common causes of stroke are needed (genetic diseases, autoimmune diseases, vasculitis).Secondary prevention is of major importance because young patients have a long life expectancy after stroke, including mainly changes in lifestyle, diet and long-term antiplatelet or anticoagulant therapy.The aim of this presentation is to illustrate recent fi ndings on the heterogeneity of stroke etiology in the young, the adequate case management considering its severe long-term disability and mortality risk and the need for guidelines specifi cally devoted to ischaemic stroke in this population.