Stroke in Young

Evidence-based approach to work-up for ischemic stroke in young patients, based on the latest guide lines from the American Academy of Neurology

1. Stroke in Young by Yasser Alzainy

2. < 45 years 55

3. What is the most common cause of stroke in young patient? Cardioembolic

4. Work up

5. Lab Homocysteine TSH (hyperthyrodism = risk afib) ESR & CRP (vasculitis or endocarditis) Hypercoagulable panel → before or >2wk after anticoagulation course) Antiphospholipid antibodies: LA, ACL, β-2 glycoprotein Prothrombin G20210A gene mutation Factor V Leiden Protein C/protein S/antithrombin III deficiencies.

6. Imaging CTA / MRA Carotid duplex (if CTA/MRA not done) 24-h Holter looking for atrial fibrillation in pts w/ high suspicion of afib: 7–14 days. Echocardiogram Looking for PFO or atrial septal aneurysm, CHF, thrombus, left atrial dilatation (↑ risk for afib), LV hypokinesis, valvular abnormality. TEE: better for looking at valves . CT venogram of lower extremities : For + PFO to rule out DVTs. (LE U/S do not evaluate for DVT in iliac veins.)

7. Diagnosis of APLS ? 2 +ve blood test 12 weeks apart

8. Cause-based Workup

9. In a nutshell Lab Homocystine TSH LA, ACL, β-2 glycoprotein Prc, Prs, AT III ESR & CRP +ve: ANA, Anti ds-DNA ANCA (P&C) RF C3 and C4 Imaging 24h Holter CTA / MRA PFO +ve: CT venography of LL

10. Thank You