This question (and the answer below) appeared in today’s Resident e-Bulletin / Teaching Topics from the New England Journal of Medicine
Patent foramen ovale (PFO) is the most frequent cardioembolic risk factor for stroke in young adults. Others include congenital heart disease, infectious nonbacterial thrombotic endocarditis, rheumatic valvular heart disease, cardiac surgery or catheter intervention, arrhythmia (e.g., atrial fibrillation or sick sinus syndrome), cardiac tumors (e.g., atrial myxoma or papillary fibroelastoma), recent myocardial infarction, and dilated cardiomyopathy.
Up to 14% of all strokes occur in children and young adults. The incidence rates are 10 to 23 ischemic strokes per 100,000 young adults (18 to 50 years of age) and 3 to 9 hemorrhagic strokes per 100,000 young adults. Unfortunately, stroke remains under recognized and often misdiagnosed in young adults, particularly those less than 35 years of age and those with abnormalities in the posterior circulation.
To read more and to review a case study of an 18 year old patient at MGH that NEJM is featuring in their current issue click here
David Dansereau for Know-Stroke.org