From the Guidelines
Stroke in young women requires prompt evaluation and management, with a focus on identifying and addressing underlying causes such as oral contraceptive use, pregnancy/postpartum state, migraine with aura, patent foramen ovale, autoimmune disorders, and genetic conditions. Young women experiencing stroke symptoms should seek immediate medical attention by calling emergency services. Initial assessment includes neurological examination, brain imaging (CT or MRI), and vascular studies to determine stroke type and cause.
Common Causes and Risk Factors
- Oral contraceptive use
- Pregnancy/postpartum state
- Migraine with aura
- Patent foramen ovale
- Autoimmune disorders
- Genetic conditions Treatment depends on stroke type - for ischemic stroke, tissue plasminogen activator (tPA) may be administered within 4.5 hours of symptom onset, while endovascular thrombectomy might be considered within 24 hours for large vessel occlusions.
Secondary Prevention
Secondary prevention typically includes:
- Antiplatelet therapy (aspirin 81-325mg daily, clopidogrel 75mg daily, or combination therapy) 1
- Statins
- Blood pressure control Hormonal contraceptives should be discontinued, particularly in women with additional risk factors. Lifestyle modifications including smoking cessation, regular exercise, healthy diet, and limited alcohol consumption are essential. Young women with stroke require comprehensive follow-up care including rehabilitation services and screening for underlying conditions that may have contributed to the stroke 1.
From the Research
Incidence and Risk Factors of Stroke in Young Women
- The incidence of ischemic stroke in premenopausal women ranges from 3.65 to 8.9 per 100,000 in the United States 2.
- Several risk factors for ischemic stroke exist for young women, including oral contraceptive (OCP) use and migraine with aura 2.
- Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35 2.
Evaluation and Management of Ischemic Stroke in Young Women
- The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials 2.
- Current evidence regarding the management of acute ischemic stroke in young women is summarized, including the use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals 2.
- Dual antiplatelet therapy (DAPT) has been shown to be effective in preventing recurrent stroke in patients with acute stroke or transient ischemic attack, but it increases the risk of major bleeding events 3.
Diagnosis and Treatment of Ischemic Stroke in Young Adults
- The incidence of ischemic stroke in young adults has been increasing since the 1980s, which has occurred in parallel with increasing prevalence of vascular risk factors and substance abuse among the younger population 4.
- Young adults have a considerably wider range of risk factors than older patients, including age-specific factors such as pregnancy/puerperium and oral contraceptive use 4.
- Several recent advances have been made in diagnosis and management of stroke in young adults, including molecular characterization of monogenic vasculitis due to deficiency of adenosine deaminase 2 and transcatheter closure of patent foramen ovale for secondary prevention 4.
Antiplatelet Therapy in Acute Ischemic Stroke
- Antiplatelet therapy is key for preventing thrombotic events after transient ischemic attack or ischemic stroke 3.
- Early (<24 hours) post-tPA antiplatelet use has been explored in select mechanical thrombectomy (MT) patients with luminal irregularities or underlying intracranial atherosclerotic disease, and it may be safe and effective in preventing recurrent stroke 5.