Routine imaging justified in young patients with stroke symptoms

Vascular imaging delivered a high yield among adults aged 18 to 45 years with ischemic stroke or transient ischemic attack, according to a study published Oct. 29 in Archives of Neurology.

Approximately 10 to 14 percent of ischemic strokes in the U.S. occur among adults aged 18 to 45 years, and recent research has suggested the incidence of strokes among young adults is increasing. However, data about this population are sparse and dated. Ruijun Ji, MD, PhD, of the department of neurology at Massachusetts General Hospital (MGH) in Boston, and colleagues sought to determine the yield of diagnostic tests and characterize brain and vascular findings.

The researchers retrospectively reviewed data from the MGH database for 215 consecutive patients aged 18 to 45 years admitted with ischemic stroke or transient ischemic attack. Extensive blood tests, Holter monitoring and echocardiography were ordered for most patients.

“The diagnostic yield was relatively low for Holter monitoring (1 percent), toxicology screening (5 percent), and vasculitis panel (<5 percent), as well as relatively high for echocardiography (51 percent) and angiography (64 percent),” wrote Ji and colleagues.

Among the 203 patients with ischemic lesions, CT was performed in 97 percent and MRI was performed in 98 percent. Transfemoral CT or MRI cerebral angiography was performed in 99 percent of patients, and 20 percent also underwent vascular ultrasound, reported Ji et al.

Although the researchers reported positive cardiac ultrasound results in 51 percent of patients, they noted the true diagnostic yield is likely lower, as the majority of these patients had a patent foramen ovale deemed incidental in cases with alternate etiologies.

In contrast, they referred to the high yield of vascular imaging, and wrote, “These data justify routine cerebrovascular imaging in young adults with stroke-like symptoms.” Ji and colleagues suggested the data may help develop cost-effective diagnostic strategies for ischemic stroke in young adults.