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Stroke in younger adults is less common than in older adults, with approximately 10-15% of all strokes occurring in adults aged 18 to 50 years of age. The pathogenesis of stroke in younger adults requires additional considerations for several less common risk factors and etiologies. As with any stroke patient, a thorough workup including evaluations of the brain, the blood vessels of the head and neck, the heart, and basic bloodwork must be performed. On the basis of these results, as well as case-specific clinical findings, family history, and other considerations, additional testing for genetic or hypercoagulable causes and specialized vascular and echocardiography can be performed. Overall, it is critical to identify the likely pathogeneses to prevent stroke recurrence. Regardless of pathogenesis, young stroke survivors with high rates of traditional risk factors must have these risk factors aggressively managed for long-term risk reduction. In this chapter, we focus on ischemic stroke in the young emphasizing a clinical evaluation framework, describing key considerations regarding etiology, treatment, and prevention that providers should contemplate in course of individualized patient care.
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