Ischemic Stroke in the Young: Influence of Diagnostic Criteria

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Abstract
In 4–66% of young stroke patients in reported series no cause is found. To study the influence of diagnostic criteria on the eventual diagnosis of the ischemic stroke we reviewed retrospectively the results of 71 patients with an ischemic stroke, all aged 20–45 years. In 23 of the 71 patients a certain cause was found: atherosclerosis (11 patients), cardiac embolism (6), arterial dissection (3) trauma (2) and vasculitis (1). Subsequently, we used the diagnostic criteria of other investigators and applied these to our patient group. The found percentages of explained ischemic stroke varied substantially from 14 to 56%, depending on the criteria used. Atherosclerosis ranged from 16 to 27%, cardiac causes from 14 to 20%, different vasculopathies from 14 to 17% and metabolic/hematologic causes from 0 to 22%. The discrepancies about causes of stroke in the young as found in the literature may to a large extent be the consequence of varying criteria sets. It is possible that more rigorous criteria lead to a larger proportion of unexplained strokes.

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