A diagnostic approach to ischemic stroke in young and middle-aged adults

We prospectively studied 160 patients (18-47 years of age) with TIA (18) or ischemic stroke (142). Eighty-five subjects were under the age of 40. All patients underwent noninvasive ultrasound studies (transcranial doppler and echocardiography), plus a battery of laboratory studies including coagulation and antibodies tests and blood lactate-pyruvate. Angiographic studies were performed in 42% of patients (33% with DSA and 9% with MRA). The most common etiologies mere found to be cardioembolic (more common in the 18-39 age group) and atherothromboticic (more common in the 40-47 age group). Autoimmune conditions affect-ed 12.5% of patients, while arterial dissections affected 11%. In 10% of patients the etiology of the cerebral ischemic event could not be determined, in spite of an extensive and expensive workout. Hence, a set of guidelines aimed at optimizing, in terms of cost-benefit, a protocol of investigations in young adults,vith ischemic stroke is tentatively proposed.