{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T03:02:32Z","timestamp":1767927752231,"version":"3.49.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background and objectives<\/jats:title>\n<jats:p>Ischemic strokes in young adults have been a significant concern due to various potential etiologies and had substantial clinical and public health impacts. We aimed to study the diagnostic tests, etiologies, and functional outcomes of acute ischemic stroke (AIS) and transient ischemic attack (TIA) in young adult patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The data were retrieved from the Chiang Mai University Hospital Stroke Registry between January 2018 and December 2021. Consecutive AIS or TIA patients were included if they were 18\u201350 years and had no stroke mimics. Study outcomes were proportions of positive diagnostic tests, and 90-day modified Rankin Scale (mRS).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 244 enrolled patients, 59.0% (n = 144) were male, and 38.1% (n = 93) were aged 18\u201340, classified as the younger age group. There was a high incidence of diabetes (24.5%) and dyslipidemia (54.3%) among patients aged 41\u201350, associated with small-vessel occlusion and large-artery atherosclerosis stroke classification in this age group. Patients aged 18\u201340 years had more other determined etiologies (39.8%), with hypercoagulability (8.2%), arterial dissection (7.8%), and cardiac sources (6.6%) being the first three causes, which were associated with higher anticoagulant treatment. The cerebrovascular study, cardiac evaluation using echocardiography, and antiphospholipid syndrome testing were commonly performed, of which computed tomography angiography provided a high proportion of positive results (80.3%). 76.3% of young adult patients had excellent functional outcomes (mRS 0\u20131) with a median mRS of 0 (interquartile range 0\u20131) at 90-day follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Stroke of other determined etiology remained the common cause of stroke in young adults, and most affected individuals had excellent clinical outcomes. Blood tests for arterial hypercoagulability and noninvasive vascular and cardiac evaluations are encouraged in selected patients to determine the stroke etiology and guide for appropriate preventive strategies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292274","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T17:34:26Z","timestamp":1696440866000},"page":"e0292274","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["The diagnostic tests and functional outcomes of acute ischemic stroke or transient ischemic attack in young adults: A 4-year hospital-based observational study"],"prefix":"10.1371","volume":"18","author":[{"given":"Jakraphat","family":"Sakseranee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peerapong","family":"Sethabouppha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanapat","family":"Pattarasakulchai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theerawee","family":"Klaewkla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0556-541X","authenticated-orcid":true,"given":"Kitti","family":"Thiankhaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"issue":"12","key":"pone.0292274.ref001","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1212\/WNL.0b013e3182a4a451","article-title":"Recognition and management of stroke in young adults and adolescents","volume":"81","author":"AB Singhal","year":"2013","journal-title":"Neurology"},{"key":"pone.0292274.ref002","doi-asserted-by":"crossref","first-page":"157","DOI":"10.2147\/VHRM.S53203","article-title":"Strokes in young adults: epidemiology and prevention.","volume":"11","author":"D. 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Cryptogenic Stroke","volume":"374","author":"JL Saver","year":"2016","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0292274.ref005","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/jnnp.2004.040543","article-title":"Ischaemic stroke in young adults: predictors of outcome and recurrence","volume":"76","author":"K Nedeltchev","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"7","key":"pone.0292274.ref006","doi-asserted-by":"crossref","first-page":"e0268481","DOI":"10.1371\/journal.pone.0268481","article-title":"Causes of ischemic stroke in young adults versus non-young adults: A multicenter hospital-based observational study","volume":"17","author":"Y Ohya","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"pone.0292274.ref007","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jstrokecerebrovasdis.2008.09.004","article-title":"The use of diagnostic tests in patients with acute ischemic stroke","volume":"18","author":"EH Yu","year":"2009","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"1","key":"pone.0292274.ref008","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment","volume":"24","author":"HP Adams","year":"1993","journal-title":"Stroke"},{"issue":"7","key":"pone.0292274.ref009","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association\/American Stroke Association","volume":"52","author":"DO Kleindorfer","year":"2021","journal-title":"Stroke"},{"issue":"2","key":"pone.0292274.ref010","first-page":"386","article-title":"Ischemic Stroke in Young Adults","volume":"26","author":"J. Putaala","year":"2020","journal-title":"Continuum (Minneap Minn)."},{"issue":"1","key":"pone.0292274.ref011","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1161\/01.STR.0000048162.16852.88","article-title":"Yield of screening for CADASIL mutations in lacunar stroke and leukoaraiosis","volume":"34","author":"Y Dong","year":"2003","journal-title":"Stroke"},{"issue":"12","key":"pone.0292274.ref012","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1056\/NEJMcp1214999","article-title":"Carotid Stenosis","volume":"369","author":"JC Grotta","year":"2013","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"pone.0292274.ref013","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1161\/STROKEAHA.119.027356","article-title":"CTA-for-All.","volume":"51","author":"SA Mayer","year":"2020","journal-title":"Stroke"},{"issue":"1","key":"pone.0292274.ref014","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1161\/STROKEAHA.115.009171","article-title":"Comparing vessel imaging: noncontrast computed tomography\/computed tomographic angiography should be the new minimum standard in acute disabling stroke","volume":"47","author":"AM Demchuk","year":"2016","journal-title":"Stroke"},{"issue":"1","key":"pone.0292274.ref015","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1001\/jamaneurol.2013.575","article-title":"Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis.","volume":"70","author":"R Ji","year":"2013","journal-title":"JAMA Neurol."},{"issue":"2","key":"pone.0292274.ref016","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4103\/bc.bc_68_20","article-title":"Transesophageal echocardiogram in the evaluation of acute ischemic stroke of young adults","volume":"7","author":"MK Ahmed","year":"2021","journal-title":"Brain Circ"},{"issue":"3","key":"pone.0292274.ref017","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jstrokecerebrovasdis.2010.01.004","article-title":"Causes of ischemic stroke in young adults in Thailand: a pilot study","volume":"20","author":"PA Dharmasaroja","year":"2011","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"1","key":"pone.0292274.ref018","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1161\/STROKEAHA.112.665190","article-title":"Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study","volume":"44","author":"B von Sarnowski","year":"2013","journal-title":"Stroke"},{"issue":"4","key":"pone.0292274.ref019","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1136\/svn-2018-000169","article-title":"Utility of current thrombophilia screening in young patients with stroke and TIA","volume":"3","author":"V Alakbarzade","year":"2018","journal-title":"Stroke Vasc Neurol"},{"issue":"9","key":"pone.0292274.ref020","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/S1474-4422(18)30233-3","article-title":"Epidemiology, aetiology, and management of ischaemic stroke in young adults","volume":"17","author":"MS Ekker","year":"2018","journal-title":"Lancet Neurol"},{"key":"pone.0292274.ref021","first-page":"104647","article-title":"Etiology and risk factors of stroke in young adults: A multicentric study","volume":"82","author":"A Aslam","year":"2022","journal-title":"Ann Med Surg (Lond)."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292274","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T17:34:43Z","timestamp":1696440883000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292274"}},"subtitle":[],"editor":[{"given":"Redoy","family":"Ranjan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,4]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292274","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,4]]}}}