Stroke in Children and Younger Adults.

Stroke incidence is rising among younger adults, with an increased burden of vascular risk factors playing a role, particularly in adults older than 35 years.

• The rise in stroke among younger adults may be attributable to a confluence of underlying predisposing nonatherosclerotic risks and inciting triggers.
• Conventional vascular risk factors play a larger role in stroke risk in patients older than 35 years.
• The paper identifies this trend as a key distinguishing feature separating younger adult stroke from pediatric stroke.

Stroke in young patients more commonly results from nonatherosclerotic mechanisms rather than conventional atherosclerotic disease.

• Nonatherosclerotic mechanisms include dissection, arteriopathies, cardiac shunts, and systemic disease.
• The paper reviews distinct acquired and congenital etiologies specific to children and younger adults.
• These mechanisms differ substantially from the predominantly atherosclerotic mechanisms seen in older adult stroke populations.

New data and American Heart Association/American Stroke Association scientific statements are informing antithrombotic management in cervical artery dissection and cerebral venous thrombosis in younger patients.

• Updated AHA/ASA scientific statements were identified as key sources guiding current management recommendations.
• Both cervical artery dissection and cerebral venous thrombosis are highlighted as conditions with evolving antithrombotic guidance.
• These updates are noted as particularly relevant to the younger patient population reviewed in this article.

Chronic conditions including moyamoya arteriopathy, sickle cell disease, and congenital heart disease create accumulating and modulating cerebrovascular risks as affected individuals age.

• Young people with these chronic conditions may face lifelong and evolving stroke risk.
• The paper calls for lifelong cerebrovascular surveillance and individualized risk reduction strategies for these populations.
• Facilitating access to follow-up with specialized multidisciplinary care is described as important in optimally managing these complex diseases.

Sex-specific factors including menstruation, contraception, and pregnancy can complicate management and amplify stroke risks in younger patients.

• These sex-specific factors are identified as distinct considerations not typically present in older adult stroke populations.
• The paper underscores the need to promote awareness of these factors among neurologists who treat cerebrovascular disease in younger individuals.
• These risks are noted as requiring individualized management approaches.

Specialized multidisciplinary care and follow-up access are identified as important components of managing cerebrovascular conditions in children and young adults.

• The complexity of diseases such as sickle cell disease, congenital heart disease, and moyamoya arteriopathy is cited as justification for multidisciplinary care models.
• The paper specifically highlights facilitating access to follow-up as an important management goal.
• Age-specific and sex-specific risks are noted as requiring tailored clinical approaches distinct from those used in older adult populations.