5 ISCHAEMIC STROKE IN THE YOUNG – MANAGEMENT 1 Andreea Ördög, 1 Mădălina Şteţca, 1,2 Nicoleta Tohănean 1,2 Lăcrămioara Perju-Dumbrava 1 SCJU Cluj-Napoca, Department of Neurology, Cluj-Napoca, Romania 2 Faculty of Medicine, “Iuliu Hațieganu“ University of Medicine and Pharmacy, Department of Neurology, Cluj-Napoca, Romania Abstract The incidence of ischaemic stroke in young adults (18-50 years) has increased substantially in the last 3 decades, mainly because of the rising incidence of vascular risk factors in this age group (hyperten- sion, hypercholesterolemia, diabetes mellitus, smok- ing, obesity) and increased illicit drugs and alcohol consumption. Although progress has been made in early diagnosis of stroke, specific guidelines for the management and secondary prevention of ischaemic stroke in the young are lacking. Ischaemic stroke in young adults has a con- siderable socio-economic impact and is responsible for an important decrease in the labor force. While subarachnoid and intracerebral hemorrhage are more frequent in the young population, hemorrhagic stroke still remains less common than ischaemic stroke. The etiology of ischaemic stroke can be rep- resented by non-atherosclerotic vasculopathy (arte- rial dissection, inherited or acquired thrombophilia) or cardioembolism in the context of patent foramen ovale and atrial septal aneurysm. In this age group, specific investigations for less common causes of stroke are needed (genetic diseases, autoimmune dis- eases, vasculitis). Secondary prevention is of major importance because young patients have a long life expectancy af- ter stroke, including mainly changes in lifestyle, diet and long-term antiplatelet or anticoagulant therapy. The aim of this presentation is to illustrate re- cent findings on the heterogeneity of stroke etiology in the young, the adequate case management consid- ering its severe long-term disability and mortality risk and the need for guidelines specifically devoted to is- chaemic stroke in this population. Epidemiology and risk factors Stroke is the second leading cause of death and third leading cause of disability worldwide [1]. The incidence of ischaemic stroke in young adults (18-50 years) has increased substantially by up to 40% in the last 3 decades, with more than two million young adults having an ischaemic stroke yearly. This rising incidence of cerebrovascular events in this age group can be explained by more advanced neuroimaging techniques (diffusion-weighted MRI), increased in- cidence of modifiable traditional risk factors and in- creased illicit and recreational drug use. Women have a higher incidence of stroke considering gender-spe- cific factors such as pregnancy, puerperium, use of oral contraceptives and autoimmune disorders (an- tiphospholipid syndrome) [2]. Ischaemic stroke in young adults has a consid- erable socio-economic impact and is responsible for an important decrease in the labor force [3]. Although progress has been made in identifying the etiology of stroke, a large proportion of ischaemic strokes in the young remain cryptogenic. In this age group, specific investigations for less common causes of stroke are needed (non-atherosclerotic arteriopathy, patent fora- men ovale, atrial septal aneurysm, genetic diseases) [2]. Journal of School and University Medicine, Vol. X, Issue 2, April-June 2023 * Corresponding author: Mădălina Şteţca, SCJU Cluj-Napoca, Department of Neurology, Cluj-Napoca, Roma- nia, Email: stetca_madalina@yahoo.com Article received: 30.06.2023, accepted: 10.07.2023, published: 01.08.2023 Cite: Ördög A, Ștețca M, Tohănean N, Perju-Dumbrava L. Ischaemic stroke in the young – management. The Journal of School and University Medicine 2023;10(2):5-11