0.72 CME

Ischemic Stroke in young patients

Speaker: Dr. Bhupesh Kumar Mansukhani

Director and Founder of NeuroMet Wellness Care, Gurugram, Haryana

Description

Ischemic Stroke in Young Patients is a growing clinical concern, marked by the sudden loss of blood supply to the brain in individuals typically under 50 years of age. Unlike older adults, young stroke patients often present with atypical risk factors such as genetic predispositions, autoimmune disorders, cardiac abnormalities, or lifestyle-related factors like smoking and drug use. Early diagnosis and targeted investigations—such as imaging, coagulation studies, and cardiac evaluations—are essential for identifying the underlying cause. Management includes acute reperfusion therapy, secondary prevention, and long-term rehabilitation to address functional and psychosocial impacts. A multidisciplinary approach is key to improving outcomes and minimizing long-term disability in this age group.

Summary

A 36-year-old male presented to the ER with left-sided weakness, slurred speech, and facial deviation, registering an NIHSS score of 6 or 7. He received IV tPA (alteplase) at the recommended dose, achieving a door-to-needle time of 45 minutes. Post-tPA, a CT head was performed after 12 hours to rule out hemorrhage.
Initial imaging showed a moderate infarct in the right globus pallidus and putamen. CT angiography ruled out large vessel occlusion (LVO), but a digital subtraction angiogram (DSA) was performed as a precaution and was also negative.
Extensive blood work, including a lipid profile, HbA1c, autoimmune markers, and cardiac investigations like transesophageal echocardiogram (TEE), Holter monitoring, and stress echo, all returned negative, ruling out cardioembolic causes. A second DSA was also performed to rule out any active thrombus formation, and that, too, was negative.
Further questioning revealed the patient was an active smoker of cigarettes and admitted to smoking marijuana, hash, and weed for 17 years. Research suggests marijuana use is linked to elevated carboxyhemoglobin levels, postural hypertension, tachycardia, and early stroke signs.
The patient was advised to stop substance use, referred to an addiction center, and started on dual antiplatelet therapy (DAPT) plus a statin. DAPT was discontinued after 21 days due to the risk-benefit ratio. The patient has since recovered well, with no recurrence of stroke episodes, following neurorehabilitation and lifestyle changes.