Today we discussed stroke in a young patient. Most references use under 45 as the cutoff for invoking some of the possibilities discussed below.
Differential diagnosis to consider for any patient presenting with "stroke", particularly a young patient:
Structural disease (tumor, bleed), seizure (Todd's paresis), dissection, migraine (esp. migraine sensory aura), demyelination, hypoglycemia. Anything that can cause delirium can cause focal findings when superimposed on a structurally abnormal brain.
In pts 45 and younger, common causes of ischemic stroke include
-Cardioembolic is #1 etiology (structural heart disease, endocarditis, others)
-Always consider dissection, even in the absence of trauma (esp if pain with onset). Dissections are usually extracranial, assoc with trauma or neck manipulation.
-Vasculitis
-Hypercoagulable state
-Cocaine, amphetamines
-Sickle cell disease
-Migranous stroke
More exotic causes: CADASIL, MELAS, Moya-moya
In many patients, an underlying cause is never found.
Workup:
CT/MRI/MRA/MRV
TEE
carotid doppler
thrombophilia screen
skin bx if suspect CADASIL
Antiphospholipid antibodies
Link:
Click here for NEJM review of PFO and stroke in young patients
Link:
Click here for NEJM review of PFO and stroke in young patients
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