How would stroke workup differ for a young person or someone without the usual stroke risk factors?
Stroke workup in the young patient begins with a detailed history including personal or family history of clotting, autoimmune disease, trauma, and cardiac disease.
Careful examination of eyes and skin may provide clues to neurofibromatosis, Fabry’s disease, connective tissue diseases, or endocarditis.
As young stroke patients are more likely to have cardiac abnormalities, a detailed cardiac evaluation including transesophageal echo should be performed.
MRI brain, vessel imaging, and hypercoagulable workup are standard, as are toxicology, autoimmune, and vasculitis labs (erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, antineutrophil cytoplasmic antibody, rheumatoid factor, complement).
Rapid plasma reagin and human immunodeficiency virus testing are vital.
Lumbar puncture may reveal additional infectious or inflammatory conditions.
