Ischaemic stroke in young adults: predictors of outcome and recurrence

Background: There is limited information about predictors of outcome and recurrence of ischaemic stroke affecting young adults. Objective: To assess the predictive value of the presenting characteristics for both outcome and recurrence in young stroke victims. Methods: Clinical and radiological data for 203 patients aged 16 to 45 years were collected prospectively; they comprised 11% of 1809 consecutive patients with ischaemic stroke. The National Institutes of Health stroke scale ( NIHSS), the Bamford criteria, and the trial of ORG 10172 in acute stroke treatment ( TOAST) classification were used to define stroke severity, subtype, and aetiology. The clinical outcome of 198 patients ( 98%) was assessed using the modified Rankin scale ( mRS) and categorised as favourable ( score 0 - 1) or unfavourable ( score 2 - 6). Results: Stroke was caused by atherosclerotic large artery disease in 4%, cardioembolism in 24%, small vessel disease in 9%, another determined aetiology in 30%, and undetermined aetiology in 33%. Clinical outcome at three months was favourable in 68%, unfavourable in 29%, and lethal in 3%. Thirteen non- fatal stroke, two fatal strokes, and six transient ischaemic attacks ( TIA) occurred during a mean ( SD) follow up of 26 ( 17) months. High NIHSS score, total anterior circulation stroke, and diabetes mellitus were independent predictors of unfavourable outcome or death ( p, 0.0001, p = 0.011, and p = 0.023). History of TIA predicted stroke recurrence ( p = 0.02). Conclusions: Severe neurological deficits at presentation, total anterior circulation stroke, and diabetes mellitus predict unfavourable outcome. Previous TIA are associated with increased risk of recurrence.