Challenges in Diagnosis and Treatment of Cardioembolic Stroke in Young Adults

Abstract

Cardioembolic ischemic stroke in young adults is an increasingly recognized clinical and public health challenge, differing in etiology and management from strokes in older populations. This retrospective study, conducted at the University Hospital of Annaba between 2020 and 2023, analyzed 48 cases of young adults aged 26 to 55 years diagnosed with cardioembolic stroke (TOAST type II). The most common underlying cause was patent foramen ovale (PFO), found in 62.5% of patients, followed by rheumatic mitral valve disease, acute myocardial infarction, atrial fibrillation, and infective endocarditis. Clinical presentations were typically characterized by hemiparesis and carotid territory infarctions. Management strategies were tailored to each etiology: PFO closure with antiplatelet therapy, anticoagulation for atrial fibrillation and valvulopathies, and guideline-based treatment for myocardial infarction and endocarditis. The in-hospital mortality rate was low (4.2%), but complications such as post-stroke depression, hemorrhagic transformation, epilepsy, and recurrence were observed. The findings underscore the need for early diagnostic workup, etiological classification, and personalized treatment strategies to optimize outcomes and prevent recurrence in young adults with cardioembolic stroke.