Stroke in Children and Younger Adults

Oct 11, 2026

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This article reviews acquired and congenital etiologies of stroke in children and younger adults, detailing how risks and long-term implications vary by age and sex. It highlights rising stroke incidence among younger adults and the growing vascular-risk-factor burden after age 35, alongside predisposing nonatherosclerotic risks and triggers. Evidence updates and AHA/ASA statements inform antithrombotic management for cervical artery dissection and cerebral venous thrombosis, with emphasis on moyamoya arteriopathy, sickle cell disease, and congenital heart disease. The article underscores the need for lifelong surveillance, individualized risk reduction, and specialized multidisciplinary follow-up to address complex, sex-specific care issues.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages28

Reading Time1 h 11 min

AccessFree to download

Abstract

Introduction

Epidemiology

Stroke in Young Adults

Stroke in Children and Younger Adults By Thalia S. Field, MD, FRCPC, MHSc; Thiviya Selvanathan, MD, PhD, FRCPC ABSTRACT OBJECTIVE: This article reviews distinct acquired and congenital etiologies, age-speciﬁc and sex-speciﬁc risks, and lifelong implications of cerebrovascular conditions in children and young adults. LATEST DEVELOPMENTS: Stroke incidence is rising among younger adults. An increased burden of vascular risk factors, particularly in adults older than 35 years, may play a role, as well as a conﬂuence of underlying predisposing nonatherosclerotic risks and inciting triggers. New data and American Heart Association/American Stroke Association scientiﬁc statements are informing antithrombotic management in the setting of cervical artery dissection and cerebral venous thrombosis. Young people with chronic conditions affecting cerebrovascular health, including moyamoya arteriopathy, sickle cell disease, and congenital heart disease, may face accumulating and modulating risks for stroke as they age. Facilitating access to follow-up with specialized multidisciplinary care is important in optimally managing these complex diseases. ESSENTIAL POINTS: Stroke in young patients can result from nonatherosclerotic mechanisms such as dissection, arteriopathies, cardiac shunts, or systemic disease. Conventional vascular risk factors play a larger role in stroke risk in patients older than 35 years. Chronic conditions such as sickle cell disease, congenital heart disease, and moyamoya arteriopathy require lifelong cerebrovascular surveillance and individualized risk reduction strategies. Sex-speciﬁc factors, including menstruation, contraception, and pregnancy, can complicate management and amplify risks in younger patients, underscoring the need to promote awareness among neurologists who treat cerebrovascular disease in these individuals. INTRODUCTION A lthough stroke incidence increases with age, certain etiologies are more common in childhood and younger adulthood, and stroke rates among younger adults are rising globally. Chronic cerebrovascular diseases with childhood onset, including moyamoya arteriopathy, and systemic diseases with cerebrovascular involvement, such as sickle cell disease and complex congenital heart disease, confer an elevated risk of stroke across the life REVIEW ARTICLE CONTINUUM AUDIO INT ERVIEW AVAI LABLEON LINE CONTINUUM ALOUD RECORDING AVAILABLE ON LINE C ITE AS : CONTINUUM ( MIN NEA P M INN) 2026;32(3, CEREBROVASCULAR DISEASE):791–818. Address correspondence to Dr Thalia S. Field, 2775 Laurel St, Room 8275B, Vancouver, BC V5Z 1M9, Canada, Thalia. [Field@ubc.ca](Field@ubc.ca). RELATIONSHIP DISCLOSURE: Dr Field has received personal compensation in the range of $500 to $4999 for serving on ascientiﬁc advisory or data safety monitoring board for AstraZeneca, Bayer AG, Boston Scientiﬁc Corporation, and Novartis AG and for serving on a speakers bureau for AstraZeneca. Continued on page 818 UNLABELED USE OF PRODUCTS/ INVESTIGATIONAL USE DISCLOSURE: Drs Field and Selvanathan report no disclosures. All cases in this article are hypothetical or composite. © 2026 American Academy of Neurology. CONTINUUM . AAN . COM 791 Copyright © 2026 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. STROKE IN CHILDREN AND YOUNGER ADULTS course. This risk may stem from disease progression (eg, worsening arteriopathy), iatrogenic events (eg, reoperations in congenital heart disease), acquired vascular risk, and sex-speciﬁc risks, including heavy menstrual bleeding, hormonal contraception, pregnancy, and menopause. Acute events provide a key opportunity to reconnect patients with specialist multidisciplinary care. Strong communication and education for patients, families, and providers, alongside advocacy for care access, are essential. Children and younger adults with stroke are at increased risk of delayed diagnosis.1 Pediatric stroke o

FAQs

What causes stroke in children and younger adults beyond traditional atherosclerotic mechanisms?

Stroke in young patients can result from nonatherosclerotic mechanisms such as dissection, arteriopathies, cardiac shunts, or systemic disease.

Why is stroke incidence increasing among younger adults?

The article links the rise to increased burdens of vascular risk factors, especially in adults older than 35 years, plus the combined effect of predisposing nonatherosclerotic risks and inciting triggers.

Which young patients require lifelong cerebrovascular surveillance?

Chronic conditions such as sickle cell disease, congenital heart disease, and moyamoya arteriopathy call for lifelong cerebrovascular surveillance and individualized risk-reduction strategies.

Oct 11, 2026

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