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September 17, 2013; 81 (12) Views & Reviews

Recognition and management of stroke in young adults and adolescents

Aneesh B. Singhal, José Biller, Mitchell S. Elkind, Heather J. Fullerton, Edward C. Jauch, Steven J. Kittner, Deborah A. Levine, Steven R. Levine
First published August 14, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a4a451
Aneesh B. Singhal
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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José Biller
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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Mitchell S. Elkind
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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Heather J. Fullerton
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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Edward C. Jauch
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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Steven J. Kittner
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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Deborah A. Levine
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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Steven R. Levine
From the Department of Neurology (A.B.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (M.S.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York; Departments of Neurology and Pediatrics (H.J.F.), University of California San Francisco; Division of Emergency Medicine and Department of Neurosciences (E.C.J.), Medical University of South Carolina, Charleston; Department of Neurology (S.J.K.), Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD; Departments of Internal Medicine and Neurology (D.A.L.), University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI; and Departments of Neurology and Emergency Medicine (S.R.L.), SUNY Downstate College of Medicine and Medical Center, and Kings County Hospital Center, Brooklyn, NY.
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Citation
Recognition and management of stroke in young adults and adolescents
Aneesh B. Singhal, José Biller, Mitchell S. Elkind, Heather J. Fullerton, Edward C. Jauch, Steven J. Kittner, Deborah A. Levine, Steven R. Levine
Neurology Sep 2013, 81 (12) 1089-1097; DOI: 10.1212/WNL.0b013e3182a4a451

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Abstract

Approximately 15% of all ischemic strokes (IS) occur in young adults and adolescents. To date, only limited prior public health and research efforts have specifically addressed stroke in the young. Early diagnosis remains challenging because of the lack of awareness and the relative infrequency of stroke compared with stroke mimics. Moreover, the causes of IS in the young are heterogeneous and can be relatively uncommon, resulting in uncertainties about diagnostic evaluation and cause-specific management. Emerging data have raised public health concerns about the increasing prevalence of traditional vascular risk factors in young individuals, and their potential role in increasing the risk of IS, stroke recurrence, and poststroke mortality. These issues make it important to formulate and enact strategies to increase both awareness and access to resources for young stroke patients, their caregivers and families, and health care professionals. The American Academy of Neurology recently convened an expert panel to develop a consensus document concerning the recognition, evaluation, and management of IS in young adults and adolescents. The report of the consensus panel is presented herein.

GLOSSARY

CI=
confidence interval;
ICH=
intracerebral hemorrhage;
IS=
ischemic stroke;
PFO=
patent foramen ovale

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received January 28, 2013.
  • Accepted in final form June 17, 2013.
  • © 2013 American Academy of Neurology
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  • Article
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