Resident Physician Johnson Rehabilitation Institute at JFK Medical Center New Brunswick, New Jersey, United States
Case Diagnosis: Acute left caudate, right midbrain, and right cerebellar cryptogenic ischemic strokes
Case Description: A 41 year old male with a past medical history of ischemic strokes (right occipital, right frontal, and left thalamic), hypertension, and alcohol abuse presented to an Emergency Department with new onset left gaze preference, right hemiparesis, and ataxia. He was found to have new left caudate, right midbrain, and right cerebellar ischemic infarcts, and he subsequently underwent embolectomy. Patient was not on anticoagulation due to a history of frequent falls related to alcohol abuse. Of note, transesophageal echocardiogram in 2021 showed no patent foramen ovale or thrombus, patient had no known history of atrial fibrillation, and recent hypercoagulable workup was negative. Patient was stabilized and discharged to acute inpatient rehabilitation for targeted therapy of activities of daily living, functional mobility, and dysphagia.
Discussions: Although still more predominant among elderly individuals, recent literature has demonstrated a rising incidence of strokes among individuals aged less than 45 years. Modifiable risk factors such as hypertension, high cholesterol, and tobacco use play a contributing role across all demographics. Coagulation disorders, hereditary and genetic diseases, and cardioembolic events account for a portion of these cases among young people, but recent studies suggest that the majority remain of unknown etiology. In this patient case, his risk of stroke was likely elevated due to underlying hypertension and alcohol use, but this doesn’t suffice to explain his significant stroke frequency and extent.
Conclusions: Strokes are one of the leading causes of morbidity and mortality worldwide, and the incidence among young individuals is on the rise. Due to the significant burden on independence, functionality, and quality of life, primary and secondary prevention of stroke are of the utmost importance. Further research should be considered to better understand this rising incidence of strokes among younger individuals.
