What are the causes of stroke in young individuals?

From the Guidelines

Strokes in young individuals are primarily caused by arteriopathy, with moyamoya disease, arterial dissection, and vasculitis being common underlying conditions, as well as sickle cell disease and congenital or acquired heart disease. The causes of stroke in young individuals can be attributed to various factors, including:

• Arteriopathy, which accounts for a significant proportion of pediatric ischemic stroke cases, with moyamoya disease being a notable example 1
• Sickle cell disease, which can lead to cerebral arteriopathy and increase the risk of stroke 1
• Congenital or acquired heart disease, which can also increase the risk of stroke in young individuals 1
• Infections, such as varicella, meningitis, and otitis media, which can trigger arterial stroke or venous stroke 1
• Head trauma, which can trigger arterial stroke, and dehydration, which can trigger venous stroke 1
• Blood clotting disorders, such as antiphospholipid syndrome, Factor V Leiden, or protein C and S deficiencies, which can increase stroke risk by promoting abnormal clot formation 1
• Genetic disorders, such as homocystinuria, which can cause both arterial and venous occlusion 1
• Pregnancy-related complications, which can alter blood clotting mechanisms and increase the risk of stroke 1

It is essential to note that many children have multiple risk factors that together determine the risk of stroke or stroke recurrence 1. Early identification of these risk factors is crucial for prevention and treatment in young stroke patients. The most recent and highest quality study 1 highlights the importance of arteriopathy as a cause of stroke in young individuals, and moyamoya disease is a significant contributor to this condition.

From the Research

Causes of Stroke in Young Individuals

The causes of stroke in young individuals are multifactorial and can be categorized into modifiable and non-modifiable risk factors.

• Modifiable risk factors include:
  • Sedentary lifestyle 2
  • Smoking 2, 3
  • Abnormal alcohol consumption 2
  • Drug abuse 2, 4
  • Overweight 2, 3
  • Hypertension 2, 3, 5, 4
  • Abnormal sleep patterns 2
  • Usage of hormonal contraceptives 2, 4
• Non-modifiable risk factors include:
  • Age 3
  • Sex 3
  • Race/ethnicity 3
  • Genetic predisposition 2, 3, 6
  • Family history of stroke 6

Less Explored Risks

Less explored risks that may contribute to stroke in young individuals include:

• Primary vascular dysregulation and associated symptoms characteristic for Flammer syndrome (FS) 2
• Inflammatory disorders 3
• Infection 3
• Pollution 3
• Cardiac atrial disorders independent of atrial fibrillation 3
• Cervical dissection 6, 4
• Cardioembolic phenomenon 4
• Vasculitis and vasculopathy 4
• Connective tissue disease 4
• Patent foramen ovale 4
• Cerebral venous thrombosis 4

Mechanisms of Stroke in Young Adults

The mechanisms of stroke in young adults can be different from those in older adults, with a higher proportion of strokes caused by:

• Extracranial dissection 5
• Cardioembolism 5
• Large artery athero-thromboembolism 5
• Cerebral venous thrombosis 5, 4
• Vasculitis and vasculopathy 4