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Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS)

Journal of Neurology volume 262, pages 2025–2032 (2015)Cite this article

An Erratum to this article was published on 14 December 2015

Abstract

Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16–55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60 % men), median age was 46 (IQR 39–51) years and median NIHSS on admission 3 (IQR 1–8). Modifiable vascular risk factors were found in 73 %. Stroke aetiology was mostly cardioembolism (32 %) and of other defined origin (24 %), including cervicocerebral artery dissection (17 %). Fabry disease was diagnosed in 2 patients (0.3 %). Aetiology remained unknown in 20 %. Outcome at 3 months was favourable (mRS 0–1) in 61 % and fatal in 2.9 %. Stroke severity (p < 0.001) and diabetes mellitus (p = 0.023) predicted unfavourable outcome. Stroke recurrence rate at 3 months was 2.7 %. Previous stroke or TIA predicted recurrent cerebrovascular events (p = 0.012). In conclusion, most young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones.

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Acknowledgments

We thank the staff and participants of all SYSS-centres for their important contribution, particularly Marianne Kormann, Andrea Surtmann Huguenin, Niklaus Meier, Mirjam R. Heldner, Oliver Findling, Fabienne Aregger, Ashraf Eskandari and Fabienne Kormann for their help in collecting the data, and Pietro Ballinari for his statistical advice. This study was supported by an unrestricted grant of Shire Human Genetic Therapies®, Grand-Rue, 92/CP 1526, 1820 Montreux VD, Switzerland. The Swiss National Science Foundation supported B.G.S., S.J., and U.F. (SNSF SPUM Grants 140340, 33CM30).

Conflicts of interest

The authors declare no financial or other conflicts of interest.

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    Affiliations

    1. Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland

      Barbara Goeggel Simonetti, Marie-Luise Mono, Urs Fischer, Aekaterini Galimanis, Simon Jung, Rudolf Luedi, Gian Marco De Marchis, Anja Weck, Claudio L. Bassetti, Heinrich P. Mattle, Krassen Nedeltchev & Marcel Arnold

    2. Department of Nephrology, Inselspital, University Hospital, University of Bern, Bern, Switzerland

      Uyen Huynh-Do

    3. Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland

      Patrik Michel & Celine Odier

    4. Department of Neurology, University Hospital Geneva, Geneva, Switzerland

      Roman Sztajzel

    5. Department of Neurology, University Hospital Basel, Basel, Switzerland

      Philippe Lyrer, Stefan T. Engelter, Leo Bonati, Henrik Gensicke & Christopher Traenka

    6. Department of Neurology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland

      Barbara Tettenborn & Bruno Weder

    7. Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Ospedale Civico, Lugano, Switzerland

      Carlo W. Cereda

    8. NeuroCenter, Hirslanden Klinik, Zurich, Switzerland

      Ralf Baumgartner

    9. Department of Neurology, Cantonal Hospital Aargau, Aarau, Switzerland

      Krassen Nedeltchev

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    1. Barbara Goeggel Simonetti
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    Correspondence to Marcel Arnold.

    Additional information

    B. Goeggel Simonetti and M.-L. Mono contributed equally.

    K. Nedeltchev and M. Arnold jointly directed this work.

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    Supplementary material 1 Electronic supplementary material may be found in the online version of this article: Supplementary Fig. 1: Stroke aetiology in SYSS compared with the literature. (TIFF 2703 kb)

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    Goeggel Simonetti, B., Mono, ML., Huynh-Do, U. et al. Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS). J Neurol 262, 2025–2032 (2015). https://doi.org/10.1007/s00415-015-7805-5

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    • DOI: https://doi.org/10.1007/s00415-015-7805-5

    Keywords

    • Ischaemic stroke
    • Stroke in young adults
    • Risk factors
    • Aetiology
    • Stroke recurrence
    • Outcome