A stroke in an adult under 55 needs the same vascular risk factor work-up as in an older patient, because hypertension, diabetes and smoking now account for much of it. It also needs a search for causes that are relatively more common in the young: cervical artery dissection, cardioembolism including through a patent foramen ovale, and drugs such as cocaine, amphetamines and cannabis.
The drug history is the part most often skipped or asked badly. A direct, non-judgemental question, and a urine toxicology screen where appropriate, changes both secondary prevention and the conversation about relapse.
- Ask directly about cannabis, stimulants and other recreational drugs in every young stroke patient.
- Image the neck vessels to look for dissection, particularly after neck pain or minor trauma.
- Look for a cardioembolic source, including patent foramen ovale where no other cause is found.
- Screen for hypertension, diabetes, lipids and smoking as thoroughly as in older patients.
Why it matters
Young stroke patients have decades of secondary prevention ahead, so finding the cause matters more.
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