ISCHEMIC STROKE IN YOUNG ADULTS: A MODERN OVERVIEW
Abstract
The incidence of ischemic stroke in young adults (typically defined as population under 50 years of age) is rising measurably in recent years, an estimated 10-14% of strokes worldwide. It brings severe implications for global public health and economic productivity. This review provides a comprehensive analysis of evidence regarding the changing epidemiology, heterogeneous etiology and long-term outcomes of stroke in the young age. In opposition to older people, where atherosclerosis is one of the most common causes, among young adults there’s a wider variety of risk factors including cervical artery dissection, diverse heart defects, genetic blood clotting disorders and autoimmune diseases. However in a significant number of cases, the cause is difficult to diagnose and often requires advanced diagnosis beyond standard protocols. Modern lifestyle habits, such as obesity, hypertension and substance abuse are responsible for escalating stroke rates. The findings might prove themselves useful in establishing specialized care models for young adults' stroke.
References
Campbell, B. C. V., & Khatri, P. (2020). Ischaemic stroke. Lancet, 396(10244), 129–142. https://pubmed.ncbi.nlm.nih.gov/31601801/
Putaala, J. (2018). Ischemic stroke in young adults. Continuum (Minneap Minn), 24(1), 126–144. https://pubmed.ncbi.nlm.nih.gov/30303851/
George, M. G. (2020). Risk factors for ischemic stroke in younger adults: A review. Neuroepidemiology. https://pubmed.ncbi.nlm.nih.gov/32015089/
GBD 2019 Stroke Collaborators. (2021). Global, regional, and national burden of stroke and its risk factors 1990–2019. Lancet Neurology, 20, 795–820. https://pubmed.ncbi.nlm.nih.gov/34906974/
Ekker, M. S., Boot, E. M., Singhal, A. B., et al. (2018). Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurology, 17(9), 790–801. https://pubmed.ncbi.nlm.nih.gov/30129475/
Aho, K., Harmsen, P., Hatano, S., et al. (n.d.). Young adult stroke etiologies and risk factors. Review. https://pubmed.ncbi.nlm.nih.gov/32078487/
Rajsic, S., et al. (2022). Stroke in young adults: Current perspectives. Frontiers in Neurology. https://pmc.ncbi.nlm.nih.gov/articles/PMC9272308/
Zerna, C., et al. (2022). Cryptogenic stroke in the young: Emerging mechanisms. Stroke. https://pubmed.ncbi.nlm.nih.gov/36511150/
Malhotra, K., et al. (2023). Cervical artery dissection: Epidemiology, diagnosis and management. Journal of Stroke and Cerebrovascular Diseases. https://pubmed.ncbi.nlm.nih.gov/37039409/
Ma, Z., et al. (2024). Global burden of stroke in adolescents and young adults 1990–2019. Stroke. https://pubmed.ncbi.nlm.nih.gov/39080669/
Fonseca, A. C., et al. (2024). Long-term outcomes of young adult ischemic stroke survivors. Neurology. https://pubmed.ncbi.nlm.nih.gov/40292815/
Leung, L. Y., et al. (2024). Building centers of excellence for young adult stroke care. Journal of the American Heart Association. https://pubmed.ncbi.nlm.nih.gov/39474734/
Henninger, N., & Pathak, S. (2019). Stroke in young adults: Current trends, opportunities for prevention and pathways forward. Frontiers in Neurology, 10, 1471.
Aarnio, K., Haapaniemi, E., Melkas, S., Kaste, M., et al. (2019). Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology, 93(5), e487–e494.
Saadatnia, M., Putaala, J., Vojinović, J., et al. (2021). Global differences in risk factors, etiology, and outcome of ischemic stroke in young adults: A worldwide meta-analysis. Neurology, 98(6), e573–e585.
Harbison, J. W., Templeton, J. E., Tinker, A., et al. (2020). First ischemic stroke in young adults: Sex- and age-related differences in stroke rates, risk factors, and etiologies. Neurology, 95(11), e1539–e1546.
Tang, S., Li, M., Zhao, X., et al. (2020). Sex differences of ischemic stroke in young adults: A single-center Chinese cohort study. Journal of Stroke and Cerebrovascular Diseases, 29(5), 104830.
Jones, E. M., Okpala, M., Zhang, X., et al. (2020). Racial disparities in post-stroke functional outcomes in young patients with ischemic stroke. Journal of Stroke and Cerebrovascular Diseases, 29(8), 104987.
Jones, E. M., Kittner, S. J., Aradine, M. E., et al. (2019). Ethnic differences in ischemic stroke subtypes in young-onset stroke: Stroke Prevention in Young Adults Study. BMC Neurology, 15, 120.
POINT Trial Investigators. (2021). Association of Black race with early recurrence after minor ischemic stroke or TIA. JAMA Neurology, 78(5), 447–454.
Goyal, M., Alshafei, M., et al. (2025). Racial and ethnic disparities in endovascular treatment outcomes in acute ischemic stroke: A systematic review and meta-analysis. Stroke (in press).
Jo, Y. J., Kim, D. H., Sohn, M. K., Lee, J., Shin, Y. I., Oh, G. J., Lee, Y. S., Joo, M. C., Lee, S. Y., Song, M. K., et al. (2022). Clinical characteristics and risk factors of first-ever stroke in young adults: A multicenter, prospective cohort study. Journal of Personalized Medicine, 12, 1505. https://doi.org/10.3390/jpm12091505
Jermakow, N., Maluchnik, M., Sienkiewicz-Jarosz, H., Karaszewski, B., Wierzchowska-Cioch, E., & Ryglewicz, D. (2022). Trends of stroke hospitalisation and fatality rates in young vs elderly people in Poland during 2010–2019. Neurologia i Neurochirurgia Polska, 56(5), 417–427. https://doi.org/10.5603/PJNNS.a2022.0055
Tang, M., Han, G., Yao, M., Peng, B., Zhu, Y., Zhou, L., & Ni, J. (2022). Risk factors of ischemic stroke in young adults: A Chinese single-center study. Frontiers in Neurology, 13, 874770. https://doi.org/10.3389/fneur.2022.874770
Kafle, D. R., & Jha, S. (2021). Hypertension among young adults with ischemic stroke at a tertiary care centre in Nepal: A descriptive cross-sectional study. JNMA Journal of the Nepal Medical Association, 59(240), 775–778.
Silver, A. E., et al. (2007). Overweight and obese humans demonstrate increased vascular endothelial NAD(P)H oxidase-p47phox expression and evidence of endothelial oxidative stress. Circulation, 115(5), 627–637.
Strazzullo, P., et al. (2010). Excess body weight and incidence of stroke. Stroke, 41(5), e418–e426.
Mitchell, A. B., et al. (2015). Obesity increases risk of ischemic stroke in young adults. Stroke, 46(6), 1690–1692.
Maida, C. D., et al. (2022). Diabetes and ischemic stroke: An old and new relationship. International Journal of Molecular Sciences, 23(4).
Tsatsakis, A., et al. (2019). A mechanistic and pathophysiological approach for stroke associated with drugs of abuse. Toxicology Reports, 8(9), 1295.
[31] MISSING AUTHOR — cannot format correctly: please provide author names.
Uchino, K. (2025). Ischaemic stroke in the young — is it time to consider alcohol reduction for stroke prevention? Stroke, 96(2), 104.
Martinez-Majander, N., et al. (2025). Association between heavy alcohol consumption and cryptogenic ischaemic stroke in young adults: A case-control study. Journal of Neurology, 96(2), 114–121.
Gąsiorek, P. E., et al. (2018). Udar jako wynik zatoru kardiogennego — charakterystyczne cechy w diagnostyce i prewencji. Neurologia i Neurochirurgia Polska, 13(1), 21–28.
Ohya, Y., et al. (2022). Causes of ischemic stroke in young adults versus non-young adults: A multicenter observational study. PLoS One, 17(7), e0268481.
Ekker, M. S., Verhoeven, J. I., Schellekens, M. M. I., Boot, E. M., van Alebeek, M. E., Brouwers, P. J. A. M., Arntz, R. M., van Dijk, G. W., Gons, R. A. R., van Uden, I. W. M., den Heijer, T., de Kort, P. L. M., de Laat, K. F., van Norden, A. G. W., Vermeer, S. E., van Zagten, M. S. G., van Oostenbrugge, R. J., Wermer, M. J. H., Nederkoorn, P. J., ... de Leeuw, F. E. (2023). Risk factors and causes of ischemic stroke in 1322 young adults. Stroke, 54(2), 439–447. https://doi.org/10.1161/STROKEAHA.122.040524
Hart, R. G., Catanese, L., Perera, K. S., Ntaios, G., & Connolly, S. J. (2017). Embolic stroke of undetermined source: A systematic review and clinical update. Stroke, 48(4), 867–872. https://doi.org/10.1161/STROKEAHA.116.016414
Perera, K. S., Vanassche, T., Bosch, J., et al.; ESUS Global Registry Investigators. (2016). Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry. International Journal of Stroke, 11(5), 526–533. https://doi.org/10.1177/1747493016641967
Kent, D. M., & Wang, A. Y. (2025). Patent foramen ovale and stroke: A review. JAMA, 334(16), 1463–1473. https://doi.org/10.1001/jama.2025.10946
Wu, L. A., Malouf, J. F., Dearani, J. A., et al. (2004). Patent foramen ovale in cryptogenic stroke: Current understanding and management options. Archives of Internal Medicine, 164(9), 950–956. https://doi.org/10.1001/archinte.164.9.950
Alsheikh-Ali, A. A., Thaler, D. E., & Kent, D. M. (2009). Patent foramen ovale in cryptogenic stroke: Incidental or pathogenic? Stroke, 40(7).
Miranda, B., Fonseca, A. C., & Ferro, J. M. (2018). Patent foramen ovale and stroke. Journal of Neurology, 265(8), 1943–1949.
Dardick, J. M., Flomenbaum, D., Labovitz, D. L., Cheng, N., Liberman, A. L., Esenwa, C. (2021). Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes. Scientific Reports, 11, 275. https://doi.org/10.1038/s41598-020-79499-1
Israels, S. J., & Seshia, S. S. (1987). Childhood stroke associated with protein C and S deficiency. Journal of Pediatrics, 111(4), 562–564.
Green, D., Otoya, J., Oriba, H., & Rovner, R. (1992). Protein S deficiency in middle-aged women with stroke. Neurology, 42(5), 1029–1033.
Mayer, S., Sacco, R., Hurlet-Jensen, A., Shi, T., & Mohr, J. P. (1993). Free protein S deficiency in acute ischemic stroke: A case-control study. Stroke, 24(2), 224–227.
Fields, M. C., & Levine, S. R. (2005). Thrombophilia and stroke: Diagnosis, treatment and prognosis. Journal of Thrombosis and Thrombolysis, 20(2), 113–126.
Gatti, J. R., Torriente, A. G., & Sun, L. R. (2021). Clinical presentation and stroke incidence differ by Moyamoya etiology. Journal of Child Neurology, 36(4), 272–280. https://doi.org/10.1177/0883073820967160
Kumar, M., Larson, A., Jabal, M. S., Rinaldo, L., Savastano, L., Lanzino, G., Meyer, F., Lehman, V., & Klaas, J. (2022). Comparison of stroke risk factors between symptomatic and asymptomatic patients in a North American Moyamoya disease cohort. Cerebrovascular Diseases Extra, 12(2), 72–75. https://doi.org/10.1159/000525098
Unda, S. R., Antoniazzi, A. M., Miller, R., et al. (2021). Moyamoya disease and syndrome: A national inpatient study of ischemic stroke predictors. Journal of Stroke and Cerebrovascular Diseases, 30(9), 105965. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105965
Blum, C. A., & Yaghi, S. (2015). Cervical artery dissection: A review of the epidemiology, pathophysiology, treatment, and outcome. Archives of Neuroscience, 2(4), e26670. https://doi.org/10.5812/archneurosci.26670
Jazbec, L., Menih, M., & Arh, R. (2021). Ischemic stroke in young adults caused by cervical artery dissection. International Journal of Angiology, 31(2), 126–130. https://doi.org/10.1055/s-0041-1740318
Micheli, S., Paciaroni, M., Corea, F., Agnelli, G., Zampolini, M., & Caso, V. (2010). Cervical artery dissection: Emerging risk factors. Open Neurology Journal, 4, 50–55. https://doi.org/10.2174/1874205X01004010050
Jillella, D. V., & Wisco, D. R. (2019). Infectious causes of stroke. Current Opinion in Infectious Diseases, 32(3), 285–292.
Ambler, W. G., & Kaplan, M. J. (2024). Vascular damage in systemic lupus erythematosus. Nature Reviews Nephrology, 20(4), 251–265. https://doi.org/10.1038/s41581-023-00797-8
Arsovska, A. (2022). Vasculitis secondary to systemic disease. In D. Uluduz (Ed.), Rare Causes of Stroke: A Handbook (pp. 66–71). Cambridge University Press.
Miyakis, S., Lockshin, M. D., Atsumi, T., et al. (2006). International consensus update of the classification criteria for definite antiphospholipid syndrome (APS). Journal of Thrombosis and Haemostasis, 4(2), 295–306.
Akhter, E., Shums, Z., Norman, G. L., Binder, W., Fang, H., & Petri, M. (2013). Utility of antiphosphatidylserine/prothrombin and IgA antiphospholipid assays in SLE. Journal of Rheumatology, 40(3), 282–286. https://doi.org/10.3899/jrheum.120084
Panichpisal, K., Rozner, E., & Levine, S. R. (2012). Management of stroke in antiphospholipid syndrome. Current Rheumatology Reports, 14(1), 99–106.
Vargas-Hitos, J. A., Ateka-Barrutia, O., Sangle, S., & Khamashta, M. A. (2011). Efficacy and safety of long-term low molecular weight heparin in APS. Annals of the Rheumatic Diseases, 70(9), 1652–1654.
Ruffatti, A., Tonello, M., Del Ross, T., et al. (2006). Antibody profile and clinical course in primary APS with pregnancy morbidity. Thrombosis and Haemostasis, 96(3), 337–341. https://doi.org/10.1160/TH06-05-0287
Ginsberg, J. S., Wells, P. S., Brill-Edwards, P., et al. (1995). Antiphospholipid antibodies and venous thromboembolism. Blood, 86(10), 3685–3691.
Lim, W. (2009). Antiphospholipid antibody syndrome. Hematology: American Society of Hematology Education Program, 2009, 233–239.
Crowther, M. A., Ginsberg, J. S., Julian, J., et al. (2003). Comparison of two intensities of warfarin for prevention of recurrent thrombosis in APS. New England Journal of Medicine, 349(12), 1133–1138.
Kono, Y., Terasawa, Y., Sakai, K., Iguchi, Y., Nishiyama, Y., Nito, C., et al. (2020). Risk factors, etiology, and outcome of ischemic stroke in young adults: A Japanese multicenter study. Journal of the Neurological Sciences, 417, 117068. https://doi.org/10.1016/j.jns.2020.117068
Renna, R., Pilato, F., Profice, P., et al. (2014). Risk factor and etiology analysis of ischemic stroke in young adults. Journal of Stroke and Cerebrovascular Diseases, 23(3), e221–e227.
Putaala, J., Metso, A. J., Metso, T. M., et al. (2009). Analysis of 1008 first-ever ischemic stroke patients aged 15–49: Helsinki young stroke registry. Stroke, 40(4), 1195–1203.
Rasura, M., Spalloni, A., Ferrari, M., et al. (2006). A case series of young stroke in Rome. European Journal of Neurology, 13(2), 146–152.
Varona, J. F., Guerra, J. M., Bermejo, F., Molina, J. A., & Gomez de la Camara, A. (2007). Causes of ischemic stroke in young adults and evolution of etiological diagnosis. European Neurology, 57(4), 212–218.
Stack, C. A., & Cole, J. W. (2021). The clinical approach to stroke in young adults. In S. Dehkharghani (Ed.), Stroke (Chap. 3). Exon Publications.
Martin, P. J., Enevoldson, T. P., & Humphrey, P. R. (1997). Causes of ischaemic stroke in the young. Postgraduate Medical Journal, 73(855), 8–16.
Stack, C. A., & Cole, J. W. (2017). A diagnostic approach to stroke in young adults. Current Treatment Options in Cardiovascular Medicine, 19(11), 84.
Poisson, S. N., Schardt, T. Q., Dingman, A., & Bernard, T. J. (2014). Etiology and treatment of arterial ischemic stroke in children and young adults. Current Treatment Options in Neurology, 16(10), 315.
Bukhari, S., Yaghi, S., & Bashir, Z. (2023). Stroke in young adults. Journal of Clinical Medicine, 12(15), 4999.
Smajlović, D. (2015). Strokes in young adults: Epidemiology and prevention. Vascular Health and Risk Management, 11, 157–164.
Sič, A., Andrejić, N., Ivanović, J., Karadžić Ristanović, V., Gajić, S., Bjelić, D., Baralić, M., & Stojanović, N. (2025). Stroke in young adults: Non-pharmacological prevention strategies. Brain Sciences, 15(4), 375.
Dopler, B. (2023). Stroke prevention. Dela Journal of Public Health, 9(3), 6–10.
Hankey, G. J. (2013). Stroke in young adults: Implications of the long-term prognosis. JAMA, 310(17), [incomplete pagination].
Varona, J. F. (2011). Long-term prognosis of ischemic stroke in young adults. Stroke Research and Treatment, 2011, 879817.
Marini, C., Totaro, R., & Carolei, A. (1999). Long-term prognosis of cerebral ischemia in young adults. Stroke, 30(11), 2320–2325.
Goeggel Simonetti, B., Cavelti, A., Arnold, M., Bigi, S., Regényi, M., Mattle, H. P., et al. (2015). Long-term outcome after arterial ischemic stroke in children and young adults. Neurology, 84(19), 1941–1947.
Kappelle, L. J., Adams, H. P. Jr., Heffner, M. L., Torner, J. C., Gomez, F., & Biller, J. (1994). Prognosis of young adults with ischemic stroke: Iowa Registry long-term follow-up. Stroke, 25(7), 1360–1365.
Schaapsmeerders, P., Maaijwee, N. A. M., van Dijk, E. J., Rutten-Jacobs, L. C. A., Arntz, R. M., Schoonderwaldt, H. C., et al. (2013). Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke, 44(6), 1621–1628.
Naess, H., Waje-Andreassen, U., Thomassen, L., Nyland, H., & Myhr, K.-M. (2006). Health-related quality of life among young adults with ischemic stroke. Stroke, 37(5), 1232–1236.
Bartholomé, L., & Winter, Y. (2020). Quality of life and resilience of patients with juvenile stroke: A systematic review. Journal of Stroke and Cerebrovascular Diseases, 29(9), 105129.
Schneider, S., Taba, N., Saapar, M., Vibo, R., & Kõrv, J. (2021). Determinants of long-term health-related quality of life in young ischemic stroke patients. Journal of Stroke and Cerebrovascular Diseases, 30(2), 105499.
Gurková, E., Štureková, L., Mandysová, P., & Šaňák, D. (2023). Factors affecting the quality of life after ischemic stroke in young adults: A scoping review. Health and Quality of Life Outcomes, 21, 4.
Yoon, S., Kim, H. Y., & Kim, S. R. (2021). A prediction model of health-related quality of life in young stroke patients. Journal of Clinical Nursing, 30(13–14), 2023–2035.
Muli, G., & Rhoda, A. (2013). Quality of life among young adults with stroke living in Kenya. African Health Sciences, 13(3), 632–638.
Kim, J. S., Choi-Kwon, S., Kwon, S. U., Lee, H., Park, K. A., & Seo, Y. S. (2005). Factors affecting quality of life after ischemic stroke: Young versus old. Journal of Clinical Neurology, 1(1), 59–68.
Béjot, Y., Daubail, B., & Giroud, M. (2021). Epidemiology of stroke in young adults. Stroke. PMID: 34487721
Li, L., Yiin, G. S., Geraghty, O. C., Schulz, U. G., Kuker, W., Mehta, Z., Rothwell, P. M.; Oxford Vascular Study. (2015). Incidence, outcome, risk factors, and long-term prognosis of cryptogenic TIA and ischemic stroke. Lancet Neurology, 14(9), 903–913.
Sacco, R. L., Kasner, S. E., Broderick, J. P., et al. (2013). An updated definition of stroke for the 21st century. Stroke. PMID: 31601801
Putaala, J. (2024). Long-term outcomes of young adult ischemic stroke. Stroke. PMID: 40292815
Singhal, A. B., Biller, J., Elkind, M. S., Fullerton, H. J., Jauch, E. C., Kittner, S. J., Levine, D. A., & Levine, S. R. (2013). Recognition and management of stroke in young adults and adolescents. Neurology, 81(12), 1089–1097.
Ekker, M. S., Boot, E. M., Singhal, A. B., et al. (2022). Epidemiology, diagnosis, and management of young stroke. Nature Reviews Neurology. PMID: 39474734
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