Stroke in young adults: Risk factors, subtypes, and outcome an experience from the St. Lukes Medical Center.

INTRODUCTION. The features of cerebrovascular disease in younger patients may not be the same as those in the later decades of life. Accurate diagnosis and effective management of these patients often pose a challenge. This study may provide insights on stroke pathologic types and mechanisms in a series of young adults admitted to a tertiary hospital. This study aims to determine the risk factors, subtypes, etiology, and outcome of stroke among young adults.

OBJECTIVE. To determine the risk factors, subtypes, etiology, and outcome of stroke among young adult patients

METHODS. The Stroke Data Bank of St. Lukes Medical Center is an ongoing prospective registry of patients age 18 years and above admitted for stroke. We selectively reviewed patients /- 49 years old admitted from January 1999 to June 2000. Demographics, risk factors, neurological and mini-mental status examinations, and results of diagnostic investigations were analyzed. Classification of stroke subtype and underlying mechanism were made following the National Institute for Neurologic Disorders and Stroke Stroke Data Bank (NINDS SDB) Scheme.

RESULTS. Of 897 patients enrolled in the SDB from January 1999 to June 2000, 159 patients (17.7 percent) belonged to the 18-49 year age group (mean age = 41.8 years). Cerebral Infarction occurred in 109 cases (68.5 percent), intracerebral hemorrhage in 37 (23.2 percent), and subarachnoid hemorrhage in 13 cases (8.2 percent). The proportion of hemorrhagic strokes in younger patients is higher than in older adults (31.4 percent vs. 21.7 percent). In 42.2 percent of all infarctions, no clear etiology was established. Lacunar infarctions, atherosclerosis, and cardiac embolism accounted for the remaining 50 percent. Hypertensive ICH (76 percent) was the most common subtype of intracerebral hemorrhage. All cases of subarachnoid hemorrhage were due to aneurysm. Risk factor profile was similar to the general stroke population. On discharge, 62.3 percent of patients had a Rankin of /- 3. Overall mortality rate was 9.4 percent, highest in ICH (21.6 percent).

CONCLUSION. One out of 6 strokes occurs in young adults. The proportion of hemorrhagic strokes is higher compared to older patients. More than half of survivors are moderately to severely disabled on discharge. Fatality rate is high in ICH. In one-third of cases, the cause is undetermined. (Author)