Diagnostic Work-Up and Etiology in Ischemic Stroke in Young Adults: Before and Now

Abstract

Unlike in the elderly, causes of ischemic stroke in young adults (15-45 years) are diverse. Non-atherosclerotic arteriopathy -dissection of the extra cranial arteries, migraine, drugs, vasculitis, premature atherosclerosis, cardioembolism, hypercoagulable states and cerebral venous thrombosis are the most relevant. Over time, the etiological diagnosis of ischemic stroke in young patients has changed significantly as a result of the improvement in diagnostic workup and the emergence of new risk factors, particularly drug abuse. Current diagnostic investigations allow the identification of specific cardiac, vascular and coagulation abnormalities previously undetectable. Thus, while 3 or 4 decades ago more than half of patients were diagnosed with uncertain etiology, currently less than 20% are diagnosed with cryptogenic stroke, and half of those with two or more identified potential causes. Specific etiologies, such as non-atherosclerotic vasculopathy, large-artery atherosclerosis, cardioembolism and haematological disorder, are demonstrated in the majority of patients. The scope of the present manuscript is to review the current state of the art, underlying the improvements with respect to the past.