The cause and prognosis of strokes in people under 50 years

Abstract

A study of 192 personal cases of completed stroke, reversible ischaemic neurological deficit (RIND) or transient ischaemic attack (TIA) in patients aged 10–49 years seen between 1961 and 1979 inclusive is reported. Three died acutely; 189 were followed for up to 15 years. The main cause of the initial event was atheromatous or hypertensive vascular disease. Of the 90 patients whose initial event was a completed stroke 19 (21%) developed a second stroke, whereas only 4 of the 78 patients with TIA suffered a stroke later. In the entire series there were 6 cardiac deaths and one from mesenteric thrombosis during the follow-up period. The risk of stroke following TIA is less in persons under 50 years than in the older age group. The risk of a second stroke following an initial stroke depends on whether or not there is evidence of vascular disease. In the absence of such evidence the risk is small; in the presence of evidence it is high, being of the order of 20%.