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Stroke in young adults: etiopathogenesis, clinical issues, advanced diagnosing and treatment methods

[Reviews]
Anastasia Igorevna Raevskaya; Dzutsev Akhsarbek Irbekovich; Shakhramanyan Lilit Vadimovna; Pohilko Valeria Alexandrovna; Sergei Karpov; Irina Vishlova; Dmitry Anatolyevich Iskra;

Strokes in young adults stand out as an urgent issue faced by modern medicine because they feature significant differences in terms of their causes, course, and consequences compared to those in elderly patients. This literature review summarizes the currently available knowledge related to strokes in younger adults, including the clinical and epidemiological specifics, etiology, and pathogenesis, as well as a discussion of the relevant diagnostic and treatment methods.

This review provides details on the prevalence of stroke, risk factors, clinical manifestations, and forecasts for younger patients. There is a special focus on various etiological aspects, along with the consideration of the advanced diagnostic methods.

Special discussion is offered about the treatment strategies that are aimed at recovering the functioning and relapse prevention, including thrombolysis, anticoagulant therapy, and treatment of specific causes of stroke in young adults.

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References:
1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795-820. https://doi.org/10.1016/S1474-4422(21)00252-0
2. Jacob M. A., Ekker M. S., Allach Y., Cai M., Aarnio K. [et al.] Global differences in risk factors, etio- logy, and outcome of ischemic stroke in young adults – A worldwide meta-analysis: The GOAL Initiative. Neurology. 2022;98(6):e573-e588. https://doi.org/10.1212/WNL.0000000000013195
3. Potter T. B. H., Tannous J., Vahidy F. S. A Contempo rary review of epidemiology, risk factors, etiology, and outcomes of premature stroke. Curr. Atheroscler. Rep. 2022;24(12):939-948. https://doi.org/10.1007/s11883-022-01067-x
4. Chen C. Y., Lin P. T., Wang Y. H., Syu R. Y., Hsu S. L. [et al.] Etiology and risk factors of intracranial hemorrhage and ischemic stroke in young adults. J. Chin. Med. Assoc. 2021;84(10):930-936. https://doi.org/10.1097/JCMA.0000000000000598
5. Boot E., Ekker M. S., Putaala J., Kittner S., De Leeuw F. K. [et al.] Ischaemic stroke in young adults: a global perspec tive. J. Neurol. Neurosurg. Psychiatry. 2020;91(4):411-417. https://doi.org/10.1136/jnnp-2019-322424
6. Yahya T., Jilani M. H., Khan S. U., Maszar R., Hassan S. Z. [et al.] Stroke in young adults: Current trends, opportunities for prevention and pathways forward. Am. J. Prev. Cardiol. 2020;3:100085. https://doi.org/10.1016/j.ajpc.2020.100085
7. Ekker M. S., Jacob M. A., van Dongen M. M. E., Aarnio K., Annamalai A. K. [et al.] Global outcome assessment life-long after stroke in young adults initiative-the GOAL in itiative: study protocol and rationale of a multicentre retro spective individual patient data meta-analysis. BMJ Open. 2019;9(11):e031144. https://doi.org/10.1136/bmjopen-2019-031144
8. Siriratnam P., Godfrey A., O’Connor E., Pearce D., Hu S. S. [et al.] Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective. Intern. Med. J. 2020;50(6):698-704. https://doi.org/10.1111/imj.14407
9. Pizov N. A., Baranova I. S., Pizova N. V., Bakucheva M. V. Lacunar stroke in young men. RMJ. Medical Review. 2023;7(10):614-619. https://doi.org/10.32364/2587-6821-2023-7-10-1
10. Gurková E., Štureková L., Mandysová P., Šaňák D. [et al.] Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health Qual. Life Outcomes. 2023;21(1):4. https://doi.org/10.1186/s12955-023-02090-5
11. Madsen T. E., Khoury J. C., Leppert M., Alwel K., Moo- maw C. [et al.] Temporal trends in stroke incidence over time by sex and age in the GCNKSS. stroke. 2020;51(4):1070-1076. https://doi.org/10.1161/STROKEAHA.120.028910
12. Leppert M. H., Ho P. M., Burke J., Madsen T. E., Kleindor- fer D. [et al.] Young women had more strokes than young men in a large, United States claims Sample. stroke. 2020;51(11):3352-3355. https://doi.org/10.1161/STROKEAHA.120.030803
13. Leppert M. H., Burke J. F., Lisabeth L. D., Madsen T. E., Kleindorfer D. O. [et al.] Systematic review of sex differences in ischemic strokes among young adults: are young women disproportionately at risk? stroke. 2022;53(2):319-327. https://doi.org/10.1161/STROKEAHA.121.037117
14. Ali M., van Os H. J. A., van der Weerd N., Schoones J. W., Heymans M. W. [et al.] Sex differences in presentation of stroke: A systematic review and meta-analysis. stroke. 2022;53(2):345-354. https://doi.org/10.1161/STROKEAHA.120.034040
15. Tang M., Yao M., Zhu Y., Peng B., Zhou L. [et al.] Sex differences of ischemic stroke in young adults – A single-center Chinese cohort study. J. stroke Cerebrovasc. Dis. 2020;29(9):105087. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105087
16. Bako A. T., Pan A., Potter T., Tannous J., Johnson C. [et al.] Contemporary trends in the nationwide incidence of primary intracerebral hemorrhage. stroke. 2022;53(3):e70-e74. https://doi.org/10.1161/STROKEAHA.121.037332
17. Tatlisumak T., Cucchiara B., Kuroda S., Kasner S. K., Putaala J. Nontraumatic intracerebral haemorrhage in young adults. Nat. Rev. Neurol. 2018;14(4):237-250. https://doi.org/10.1038/nrneurol.2018.17
18. George M. G. Risk factors for ischemic stroke in younger adults: A focused update. stroke. 2020;51(3):729-735. https://doi.org/10.1161/STROKEAHA.119.024156
19. Pourasgari M., Mohamadkhani A. Heritability for stroke: Essential for taking family history. Caspian J. Intern. Med. 2020;11(3):237-243. https://doi.org/10.22088/cjim.11.3.237
20. Divišová P., Šaňák D., Král M., Polidar P., Veverka T. [et al.] Young cryptogenic ischemic stroke: A descriptive analysis of clinical and laboratory characteristics, outcomes and stroke recurrence. J. stroke Cerebrovasc. Dis. 2020;29(9):105046. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105046
21. Martinez-Majander N., Artto V., Ylikotila P., Sarnowski B. V., Waje-Andreassen U. [et al.] SECRETO Study Group. Association between Migraine and Cryptogenic Ischemic Stroke in Young Adults. Ann. Neurol. 2021;89(2):242-253. https://doi.org/10.1002/ana.25937
22. André C. Endovascular closure of patent foramen ovale: a critical appraisal of published trials. Arq. Neuropsiquiatr. 2019;77(10):731-740. https://doi.org/10.1590/0004-282X20190120
23. Man H., Xu Y., Zhao Z. The coexistence of a patent foramen ovale and obstructive sleep apnea may increase the risk of wake-up stroke in young adults. Technol. Health Care. 2019;27(S1):23-30. https://doi.org/10.3233/THC-199004
24. Li Z., Liu J., Wang X., Xiaohui L., Qinjian S. [et al.] Bilateral vertebral artery dissection complicated by posterior circulation stroke in a young man: A case report. Medicine (Baltimore). 2020;99(44):e22822. https://doi.org/10.1097/MD.0000000000022822
25. Berkman S. A., Song S. S. Ischemic stroke in the young. Clin. Appl. Thromb Hemost. 2021;27:10760296211002274. https://doi.org/10.1177/10760296211002274
26. Yen P. S., Lin Y. H., Chang T. W., Yang C. P. Endovascular treatment for spontaneous bilateral carotid artery dissection with acute ischemic stroke: A case report with automated postprocessing CT perfusion findings and Review of the Literature. Acta Neurol. Taiwan. 2023;32(2):48-56.
27. Ohya Y., Matsuo R., Sato N., Irie F., Nakamura K. [et al.] Investigators for Fukuoka stroke registry. Causes of ischemic stroke in young adults versus non-young adults: A multicenter hospital-based observational study. PLos One. 2022;17(7):e0268481. https://doi.org/10.1371/journal.pone.0268481
28. Petri M. A., Conklin J., O’Malley T., Dervieux T. Platelet-bound C4d, low C3 and lupus anticoagulant associate with thrombosis in SLE. Lupus sci. Med. 2019;6(1):e000318. https://doi.org/10.1136/lupus-2019-000318
29. Yelnik C. M., Kozora E., Appenzeller S. Non-stroke Central Neurologic Manifestations in Antiphospholipid Syndrome. Curr. Rheumatol. Rep. 2016;18(2):11. https://doi.org/10.1007/s11926-016-0568-x
30. Swartz R. H., Cayley M. L., Foley N., Ladhani N. N., Leffert L. [et al.] The incidence of pregnancy-related stroke: A systematic review and meta-analysis. Int. J. stroke. 2017;12(7):687-697. https://doi.org/10.1177/1747493017723271
31. Katsafanas C., Bushnell C. Pregnancy and stroke risk in women. Neurobiol. Dis. 2022;169:105735. https://doi.org/10.1016/j.nbd.2022.105735
32. Elgendy I. Y., Gad M. M., Mahmoud A. N., Keeley E. S., Pepine C. J. Acute Stroke During Pregnancy and Puerperium. J. Am. Coll. Cardiol. 2020;75(2):180-190. https://doi.org/10.1016/j.jacc.2019.10.056
33. Elgendy I. Y., Bukhari S., Barakat A. F., Pepine C. J., Lindley K. J. [et al.] American College of Cardiology Cardiovascular Disease in Women Committee. Maternal Stroke: A Call for Action. Circulation. 2021;143(7):727-738. https://doi.org/10.1161/CIRCULATIONAHA.120.051460
34. Dawood M. H., Mahmood K., Roshan M., Sherani L. R., Perveen H. Evaluation of stroke in pregnant and non-pregnant women of reproductive years: A multicenter ambispective cohort study in a low- to middle-income country. sAGE Open Med. 2024;12:20503121241242610. https://doi.org/10.1177/20503121241242610
35. Canonico M., Carcaillon L., Plu-Bureau G., Oger E., Singh-Manoux A. [et al.] Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen. stroke. 2016;47(7):1734-41. https://doi.org/10.1161/STROKEAHA.116.013052
36. Bukhari S., Yaghi S., Bashir Z. Stroke in Young Adults. J. Clin. Med. 2023;12(15):4999. https://doi.org/10.3390/jcm12154999
37. León Cejas L., Mazziotti J., Zinnerman A., Nofal P., Pardal M. F. [et al.] Misdiagnosis of acute ischemic stroke in young patients. Medicina (B Aires). 2019;79(2):90-94.
38. Chang B. P., Wira C., Miller J., Akhter M., Barth B. E. [et al.] Neurology Concepts: Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department. Acad. Emerg. Med. 2018;25(1):54-64. https://doi.org/10.1111/acem.13243
39. Hurford R., Sekhar A., Hughes T. A. T., Muir K. W. Diagnosis and management of acute ischaemic stroke. Pract. Neurol. 2020;20(4):304-316. https://doi.org/10.1136/practneurol-2020-002557
40. Balami J. S., White P. M., McMeekin P. J., Ford G. A., Buchan A. M. Complications of endovascular treatment for acute ischemic stroke: Prevention and management. Int. J. stroke. 2018;13(4):348-361. https://doi.org/10.1177/1747493017743051
41. Powers W. J., Rabinstein A. A., Ackerson T., Adeoye O. M., Bambakidis N. C. [et al.] Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. stroke. 2019;50(12):e344-e418. https://doi.org/10.1161/STR.0000000000000211
42. Khybyrtova M. R., Dolgova I. N., Baturin V. A., Karpov S. M., Simkhes Yu. V. New pathogenetic aspects in chronic brain ischemia. Medical Nеws of North Caucasus. 2022;17(1):14-16. https://doi.org/10.14300/mnnc.2022.17004
43. Steinberg A., Moreira T. P. Neuroendocrinal, Neurodevelopmental, and Embryotoxic Effects of Recombinant Tissue Plasminogen Activator Treatment for Pregnant Women with Acute Ischemic Stroke. Front. Neurosci. 2016;10:51. https://doi.org/10.3389/fnins.2016.00051
44. Miller E. C., Leffert L. Stroke in Pregnancy: A Focused Update. Anesth Analg. 2020:130(4):1085-1096. https://doi.org/10.1213/ANE.0000000000004203
45. Karjalainen L., Tikkanen M., Rantanen K., Aarnio K., Korhonen A. [et al.] Stroke in Pregnancy and Puerperium: Validated Incidence Trends With Risk Factor Analysis in Finland 1987–2016. Neurology. 2021;96(21):e2564-e2575. https://doi.org/10.1212/WNL.0000000000011990
46. Farouk M., Sato K., Matsumoto Y., Tominaga T. Endovascular Treatment of Internal Carotid Artery Dissection Presenting with Acute Ischemic Stroke. J. stroke Cerebrovasc. Dis. 2020;29(3):104592. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104592
47. Ognerubov D. V., Tereshchenko A. S., Samko A. N., Arutyunyan G. K., Sivakova O. A. [et al.] Safety and efficacy of endovascular patent foramen ovale closure: the firstresults of a Russian multicenter study. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):26-32. https://doi.org/10.14412/2074-2711-2020-6-26-32
48. Sposato L. A., Albin C. S. W., Elkind M. S. V., Kamel H., Saver J. L. Patent Foramen Ovale Management for Secondary Stroke Prevention: State-of-the-Art Appraisal of Current Evidence. stroke. 2024;55(1):236-247. https://doi.org/10.1161/STROKEAHA.123.040546
49. Ekker M. S., Boot E. M., Singhal A. B., Tan K. S., Debette S. [et al.] Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17(9):790-801. https://doi.org/10.1016/S1474-4422(18)30233-3
50. Feigin V. L., Norrving B., Mensah G. A. Global Burden of Stroke. Circ Res. 2017;120(3):439-448. https://doi.org/10.1161/CIRCRESAHA.116.308413

Keywords: acute cerebrovascular accident, stroke, young age, diagnostics, therapy


Founders:
Stavropol State Medical Academy
Pyatigorsk State Research Institute of Balneotherapeutics
Pyatigorsk State Pharmaceutical Academy