Background: Stroke is the 5th leading cause of death in the United States .Every year, more than 795,000 people in the United States have a stroke. Ischemic Stroke in young adults age ≤50 years old has a prevalence of 3-5%. Many young patients with Ischemic Stroke don’t have common stroke risk factors such as high blood pressure, diabetes or hyperlipidemia and in general 33% of infarcts in this age group are cryptogenous.
Methods: Retrospective review of prospectively collected data from the Temple University Hospital stroke database. Patients were selected based on age ≤50, clinical presentation and primary diagnosis of Ischemic Stroke. Characteristics including hypercoagulability work up, vessel imaging, heart studies and risk factors were reviewed. IRB approval was obtained.
Results: From January 2011 through December 2014, we enrolled 1924 registered patients with Ischemic Stroke. 198 patients were ≤50 years old (10.2%). Baseline characteristics are Male (54%), NIHSS 0-16 (Median 6), Hypertension (48%), Diabetes (30%), Smoking (60%), Hyperlipidemia (20%), Positive drug screen (22%), Abnormal cardiac studies (42%). Despite 42% abnormal cardiac echocardiograms, there were no cardiac arrhythmias diagnosed. Abnormal brain or vessel imaging including brain MRI/MRA, CTH or CTA (36%). Hypercoagulability tests were checked in 68% of patients. Abnormalities showed factor-V Leiden (100% Normal), Prothrombin Mutation (100% Normal), Protein-C (80% Normal), Protein-S (84% Normal), Antithrombin-III (89% Normal), Antiphospholipid antibody (80% Normal), Lupus Anticoagulant (79% Normal), ANA (80% Normal)
Conclusions: The incidence of Ischemic Stroke in this cohort is much higher than that reported in other observational studies. Despite an extensive work up, a cause was not found in the majority of patients. These data support the need for a more in depth investigation of the causes of stroke in the young in urban, underserved communities. Standard of care diagnostic tests fail to explain the unusually high incidence of Ischemic Stroke in the young in this cohort.