Ischemic Stroke in Young Adults: Experience in 329 Patients Enrolled in the Iowa Registry of Stroke in Young Adults

doi:10.1001/archneur.1995.00540290081021

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Vol. 52 No. 5, May 1995

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Ischemic Stroke in Young Adults

Experience in 329 Patients Enrolled in the Iowa Registry of Stroke in Young Adults

Harold P. Adams, Jr, MD; L. Jaap Kappelle, MD; José Biller, MD; David Lee Gordon, MD; Betsy B. Love, MD; Francisco Gomez, MD; Marta Heffner, RN, MA

Arch Neurol. 1995;52(5):491-495.

Abstract

Objectives
To describe the likely causes of ischemic stroke in a populationof young adults and to report the influence of strict algorithmson the diagnosis of the likely cause of stroke in this cohort.

Design
Between July 1, 1977, and January 1, 1993, we registered 329young adults with ischemic stroke in our registry. Diagnosticstudies were selected on a case-by-case basis. Presumed causesof stroke were determined using clinical information and theresults of diagnostic tests. In each case, a second causativediagnosis was made using the criteria developed for a largeclinical trial.

Setting
Patients referred to the Division of Cerebrovascular Diseasesin the Department of Neurology at the University of Iowa Hospitalsand Clinics, Iowa City, by physicians in Iowa and adjacent states.

Patients
Three hundred twenty-nine young adults (182 men and 147 women)aged 15 to 45 years with ischemic stroke; 102 persons, 48 menand 54 women, were aged 30 years or younger.

Results
Cerebral arteriography was performed in 227 cases, and the findingswere abnormal in 146. Transthoracic echocardiography revealedabnormalities in 82 of 221 patients examined. We identifiedapproximately 60 different disorders that were presumed to bethe cause of stroke. There were no major changes in the frequencyof subtype diagnoses between the first 144 patients and thesubsequent 185. Use of strict diagnostic criteria increasedthe number of cases of stroke of undetermined etiology (from45 to 113), and the number attributed to large artery atherosclerosisdeclined from 71 to 32.

Conclusions
The causes of ischemic stroke in young adults are numerous.Because treatment options in this group are influenced by apresumed cause, an evaluation on a case-by-case basis is warranted.Our experience suggests that a likely cause will be detectedin most cases and that a regimented battery of tests may notbe required. If strict diagnostic criteria are used, the diagnosisof stroke of undetermined etiology considerably increases. Whilesuch strict criteria are important in clinical trials that testnew interventions, the value of the application of such methodologiesto an unusual population, such as stroke in young adults, needsclarification. In particular, the usefulness of categorizinga stroke as undetermined when two or more possible causes areidentified needs to be explored.

Author Affiliations

From the Division of Cerebrovascular Diseases, Department of Neurology, The University of Iowa College of Medicine (Drs Adams, Kappelle, Biller, Gordon, Love, and Gomez and Ms Heffner), and the Department of Neurology, Iowa City Veterans Administration Medical Center (Drs Adams, Biller, Gordon, Love, and Gomez and Ms Heffner), Iowa City. Dr Kappelle is now with the Department of Neurology, University Hospital, Utrecht, the Netherlands; Dr Biller is with the Department of Neurology, Indiana University, Indianapolis; Dr Gordon is with the Department of Neurology, University of Mississippi, Jackson; and Dr Gomez is in private practice, Decatur, Ill.

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