Nonatherosclerotic Causes of Stroke

SUMMARY

Twenty-one cases of completed ischemic strokes of unusual causes occurring in patients aged 15 to 45 years are reported. In 17 cases a specific cause was determined. Cases related to hypertension, diabetes, hyperlipidemias, or hypotension were not considered. In young patients a variety of diseases other than those related to atherosclerosis can present as stroke. These diseases can be classified under the headings of migraine (4 cases), embolic processes (8 cases), vasculitides (4 cases), hematological disorders (1 case), and idiopathic processes (4 cases). In general, they present with sufficient extraneurological signs and symptoms so that attention is directed to the underlying systemic illness. Occasionally, the neurological problem can completely dominate the clinical picture and thereby pose considerable diagnostic difficulties. The differential diagnosis of these conditions is discussed, and selected case reports of stroke related to migraine, atrial myxoma, and idiopathic thrombocytosis are presented. These conditions are often amenable to specific therapy. The need for establishing a specific cause in all cases of stroke is emphasized.