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Stroke in Young Adults

Under the direction of Robert Wityk, M.D.

Stroke in young adults (under the age of 45 to 50 years old) is often completely unexpected by the patient and frequently unexplained by the physician. In this patient population, strokes tend to be due to unusual disorders and in fully a third of patients, no clear cause is found despite extensive testing. As a tertiary referral center, we make use of extensive resources and expertise in allied fields of neuroradiology, neurosurgery, cardiology, hematology, rheumatology (Vasculitis Center) and rehabilitation medicine to bring the most advanced diagnostic and treatment options to patients with this uncommon problem.

Over the years, Johns Hopkins has developed clinical research registries to try and learn more about possible causes for some of these conditions, and to offer the best multidisciplinary treatment options. Examples include the following:

Arterial dissection of cerebral vessels is perhaps the most common cause of stroke in otherwise healthy persons. There are many misperceptions about the outcome and long-term risk of dissection.

Fibromuscular dysplasia may be associated with dissection, but generally is a rather benign condition when it involves the cerebral arteries.

Moyamoya disease -- in collaboration with pediatric neurology and neurosurgery, we also see a number of patients with this strange condition in which the arteries in the brain gradually narrow down and occlude. Considerable controversy surrounds the appropriate treatment of this condition. I have treated some patients with minimal intervention, and we have had success in selected patients with bypass surgery or even intracranial angioplasty. Our investigations using perfusion MRI techniques to follow this condition may give us tools to predict how patients will do long-term.

Patent Foramen Ovale (PFO) -- the appropriate management of the common cardiac condition in a young stroke patient is poorly understood, and we strongly support the use of clinical trials to gather scientific evidence for medical or interventional treatments.



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