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SUBTYPES AND PRECISE RISK FACTORS OF ISCHEMIC STROKE FOR YOUNG ADULTS IN SINGAPORE
SUBTYPES AND PRECISE RISK FACTORS OF ISCHEMIC STROKE FOR YOUNG ADULTS IN SINGAPORE
Abstract
Background and Aims
Risk factors and causes of acute ischemic stroke (AIS) are more varied in young adults, with around one-third having unknown etiologies. Precise stroke characterisation is important, influencing management and prognostication. We aim to describe stroke subtypes and risk factors in a young adult population in Singapore.
Methods
Consecutive young AIS patients aged 18-50 years admitted to a comprehensive stroke centre from 2020-2021 were included. Stroke workup including neuroimaging and vascular imaging, thrombophilia screening, echocardiogram, transcranial Doppler with bubble study and ambulatory electrocardiogram monitoring were performed at discretion of the treating neurologist. Stroke subtype and risk factors were adjudicated using Trial of Org 10172 in Acute Stroke Treatment (TOAST) and adapted International Pediatric Stroke Study (IPSS) classifications after at least 3-months follow-up, and compared between younger (18-39 years) and older (40-50 years) age groups.
Results
A total of 226 AIS patients were included; mean age 43±5.5 years and 69.9% male (n=158). The most common stroke subtypes were small-vessel disease and undetermined etiology (Figure 1A). A myriad of IPSS risk factors were identified in 93.8% study population (Table 1), and 75.9% patients with TOAST subtype undetermined etiology (Figure 1B). Cardiac disorders, prothrombotic states and arteriopathy were more common in the younger age group (Figures 1B; 28.1% vs. 14.9%, p=0.017; 22.8% vs. 9.2%, p=0.005; 15.8% vs. 5.7%; p=0.021, respectively), while atherosclerosis more prevalent in older age group (67.8% vs. 33.3%; p<0.001).
Conclusions
Young adults have diverse etiologies for AIS, and should be evaluated systematically. Further categorisation into IPSS risk factors may help direct long-term, individualised management.