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From the Department of Neurology (Drs. Kittner, Macko, Price, Sloan, and Wozniak, and B.R. Feeser) and the Department of Epidemiology and Preventive Medicine (Drs. Kittner, Price, Sloan, and R.J. McCarter), University of Maryland at Baltimore, MD; the Department of Neurology (Drs. Buccholz, Earley, Johnson, and Wityk), Johns Hopkins University, Baltimore, MD; and the Department of Neurology (Dr. Stern), Emory University, Atlanta, GA.
Address correspondence and reprint requests to Dr Kittner, Bressler Bldg., Room 12-013, U.M.A.B., 655 W. Baltimore St., Baltimore, MD 21201.
Background: Few reports on stroke in young adults have included cases from all community and referral hospitals in a defined geographic region.
Methods: At 46 hospitals in Baltimore City, 5 central Maryland counties, and Washington, DC, the chart of every patient 15 to 44 years of age with a primary or secondary diagnosis of possible cerebral arterial infarction during 1988 and 1991 was abstracted. Probable and possible etiologies were assigned following written guidelines.
Results: Of 428 first strokes, 212 (49.5%) were assigned at least one probable cause, 80 (18.7%) had no probable cause but at least one possible cause, and 136 (31.8%) had no identified probable or possible cause. Of the 212 with at least one probable cause, the distribution of etiologies was cardiac embolism(31.1%), hematologic and other (19.8%), small vessel (lacunar) disease(19.8%), nonatherosclerotic vasculopathy (11.3%), illicit drug use (9.4%), oral contraceptive use (5.2%), large artery atherosclerotic disease (3.8%), and migraine (1.4%). There were an additional 69 recurrent stroke patients.
Conclusions: In this hospital-based registry within a region characterized by racial/ethnic diversity, cardiac embolism, hematologic and other causes, and lacunar stroke were the most common etiologies of cerebral infarction in young adults. Nearly a third of both first and recurrent strokes had no identified cause.
Supported by a Grant-in-Aid from the American Heart Association and with funds contributed in part by the American Heart Association, Maryland Affiliates, Inc. Drs. Kittner, Price, Sloan, and Ms. Feeser were supported by a Clinical Stroke Research Center Award (NS16332-11) and Dr. Wozniak by a Clinical Investigator Development Award (K08-NS01764-07A1) from the National Institute of Neurological Disorders and Stroke.
Received May 2, 1997. Accepted in final form November 6, 1997.
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