Risk factors and subtypes of ischemic strokes in young adults: A tertiary care hospital study from southern part of India

Background: In the last few decades ischemic stroke in young adults (15-45 years) has been increasingly reported. This study was aimed to evaluate the epidemiological features, risk factors and mechanisms of ischemic stroke in young adults. Methods: From June 2018 to February 2020, patients diagnosed with ischemic stroke in the age group of 15-45 years from a tertiary care referral hospital in Hyderabad, India, were consecutively enrolled to study their risk factors, mechanisms and outcome. Results: Out of 971 patients of ischemic strokes 164 (16.8%) were young adults, among whom 113 (69%) were in the age group 36-45 years. Males constituted 71.3% of cohort. Risk factors were alcohol abuse (39.63%), dyslipidemia (39.02%), hypertension (32.32%), smoking (27.44%), diabetes (25.61%), family history of stroke (23.78%) and past history of stroke (12.20%). As regards subtypes, large artery atherosclerosis constituted 26.22%, lacunar stroke 15.24%, cardio- embolic strokes 15.85%, stroke of other etiology 18.9% and stroke of unknown etiology 23.78%. At the time of discharge, death and dependency in younger adults was 8.53% and 45.12% respectively. Conclusion: About 90% of young adults with ischemic stroke had at least 1 established modifiable vascular risk factor. Large artery atherosclerosis both intra and extra-cranial was the most frequent mechanism. Stroke due to other etiologies unique to young adults constituted about one fifth of all ischemic strokes.