Background/aims:
The diagnostic workup of young adult stroke (aged 18-55) requires careful aetiological evaluation often requiring specialised investigations. In comparison to stroke in the elderly, young adults have strokes due to a broader range of conditions, from common vascular risk factors to rare causes. Accurate and prompt diagnosis affects patient outcome by providing timely intervention, reducing the risk of stroke recurrence, morbidity and mortality. Non-targeted investigations risk detecting non-causative abnormalities which may confound result interpretation and lead to delays in management. Furthermore, it may cause unnecessary exposure to procedural risk, adverse medication effects and additional costs associated with investigations. This study aimed to develop a practical, mechanism-based framework to guide young adult stroke workup.
Methods:
We developed a mechanism-based approach utilising consensus opinion from nine leading experts, to guide young adult stroke work-up for non-stroke trained clinicians in the outpatient setting.
Results:
Stepwise decision pathways were developed for work up of ischaemic and haemorrhagic stroke following identification on standard neuroimaging. Recommendations for subsequent workup were then illustrated in a stepwise fashion, with prioritisation of aetiologies associated with high risk of neurological deterioration and/or recurrence if not adequately treated. Guidance on when to seek specialist input is provided, in addition to a summary of investigations for rarer causes and recommendations on follow up testing in cases of diagnostic uncertainty.
Conclusion:
Our framework supports safe, timely and economical work-up of young adult stroke and is readily applicable to non-specialist clinicians the outpatient setting. Prospective evaluation of its clinical impact is needed.