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 were found to be cardioembolic (more common in the 18–39 age group) and atherothromboticic (more common in the 40–47 age group). Autoimmune conditions affected 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 with ischemic stroke is tentatively proposed.