What are the causes of stroke in young adults?

From the Guidelines

Strokes in young people (under 45) are primarily caused by a combination of traditional and unique risk factors, with arterial dissection being a relatively common cause, particularly among young patients, as noted in studies such as 1 and 1. Traditional risk factors include hypertension, diabetes, smoking, high cholesterol, and obesity, which are increasingly affecting younger populations due to lifestyle changes. Unique causes more common in young adults include:

• Arterial dissection (tears in blood vessel walls)
• Patent foramen ovale (a hole in the heart that didn't close after birth)
• Blood clotting disorders
• Migraine with aura
• Recreational drug use (particularly cocaine and amphetamines)
• Oral contraceptive use in women, especially those who smoke Inflammatory conditions like lupus and vasculitis can also damage blood vessels and increase stroke risk. Genetic disorders such as CADASIL, Fabry disease, and sickle cell anemia contribute to a smaller percentage of cases. Young adults experiencing symptoms like sudden weakness, numbness, speech difficulties, vision problems, or severe headache should seek immediate medical attention, as prompt treatment significantly improves outcomes, as emphasized in guidelines like 1. Prevention focuses on lifestyle modifications including regular exercise, healthy diet, avoiding smoking and excessive alcohol, and managing underlying conditions like hypertension or diabetes, in line with recommendations from 1 and 1.

From the Research

Causes of Stroke in Young Adults

The causes of stroke in young adults are diverse and can be attributed to various factors. Some of the key causes include:

• Traditional risk factors such as hypertension, diabetes, and use of tobacco 2
• Use of illicit substances 2
• Intracerebral and subarachnoid hemorrhage, which are more common in young adults compared to older adults 2
• Rare monogenic disorders, which can cause early-onset ischemic stroke 3
• Pregnancy/puerperium and oral contraceptive use, which are age-specific factors 3
• Behavioral risk factors such as low physical activity, excess alcohol consumption, and smoking 3

Risk Factors for Stroke in Young Adults

Several risk factors have been identified for stroke in young adults, including:

• HIV infection, which increases the risk of stroke by 3.57 times 4
• Elevated waist to hip ratio, which increases the risk of stroke by 11.59 times 4
• Sickle cell disease, which increases the risk of stroke by 4.68 times 4
• Hypertension, diabetes, and hyperlipidemia, although no association was found in one study 4
• Inflammatory disorders, infection, pollution, and cardiac atrial disorders, which are more recently described risk factors 5

Prevention of Stroke in Young Adults

Prevention of stroke in young adults is crucial to reduce the burden of the disease. Some of the strategies for prevention include:

• Early recognition and aggressive risk profile modification 2
• Primary and secondary prevention therapy optimization 2
• Lifestyle and behavioral modification, such as dietary changes or smoking cessation 5
• Identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk 5
• Using angiotensin receptor blockers (ARB) instead of angiotensin-converting enzyme (ACE) inhibitors for stroke prevention in patients with hypertension and diabetes 6