Abstract

 Cerebrovascular accidents (CVA) remain a leading cause of death as well as a major burden from both a quality of life and disability standpoint.1,2 This is particularly problematic for younger CVA patients who may be disabled during their most productive years of life.2,3 Although CVAs in younger patients are rare, incidence of CVAs among young adults continues to remain stable and these patients often present atypically, such as with headache and dizziness, highlighting a persistent concern for care providers.4-7 Furthermore, CVAs may be misdiagnosed as seizures and the sequelae of CVAs may themselves precipitate traumatic accidents, further obscuring assessment. These difficulties complicate differential diagnoses and result in the potential for misdiagnosis and delayed time-sensitive CVA treatment.5,8 We describe a case of a healthy young patient presenting to the ED initially as a trauma resuscitation and subsequently converting to a stroke resuscitation outside the window for tPA treatment. 
Highlights
Emergency department (ED) management of cerebrovascular accidents (CVA) in younger patients is complicated by atypical presentations, rarer etiologies, and greater disability costs
CVAs in this patient group are relatively rare, making up only 16% of all CVAs in 2013, incidence of this disease among ED visits continues to remain stable [2]. This is reflected in national trend data revealing that the ED visit rate for ischemic stroke or TIA for patients aged 55 and older has decreased, whereas no change was observed for patients aged 18 to 54, highlighting a persistent concern for care providers [1, 2, 4]
We report a case of a successful emergent endovascular intervention for bilateral middle cerebral artery (MCA) CVAs in a previously healthy 27-yearold patient
Summary
Maisa Alafyouni a , 1 Derrick Huang b , 1 Scott Kleiman c and Shanna Jones b aDepartment of Emergency Medicine, Royal Oak, MI, USA,bOakland University, William Beaumont School of Medicine, Rochester, MI, USA, and cDepartment of Emergency Medicine, Troy Beaumont Hospital, Troy, MI, USA. CVAs in this patient group are relatively rare, making up only 16% of all CVAs in 2013, incidence of this disease among ED visits continues to remain stable [2] This is reflected in national trend data revealing that the ED visit rate for ischemic stroke or TIA for patients aged 55 and older has decreased, whereas no change was observed for patients aged 18 to 54, highlighting a persistent concern for care providers [1, 2, 4]. Time-sensitive decision making and the undifferentiated nature of patients in the ED are inherent in the assessment and treatment of CVA patients In younger patients, this difficulty is exacerbated by atypical presentations, such as headache and dizziness, as well as potentially rarer etiologies, such as antiphospholipid antibody syndrome and hyperhomocysteinemia [5,6,7]. We present a case that showcases the persistent complexities of CVA care in a young patient and involves new imaging modalities in the ED that are essential in diagnosis and subsequent treatment
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