Abstract
Approximately 15% of acute ischemic strokes (AIS) occur in young adults. Of all strokes among persons age 15 to 44, approximately 50% are AIS, 20% are intracerebral haemorrhage (ICH), and 30% are subarachnoid haemorrhage. Among young adults, the major contributors to stroke are cardiovascular risk factors. However, recent data suggest that despite possessing fewer cardiovascular risk factors, young women experience more strokes than men. A 30-year-old female with no medical history arrived via Emergency Medical Services with left-sided weakness that started suddenly thirty minutes prior to arrival. A neurologic exam demonstrated left facial palsy, left upper and lower extremity weakness, partial right gaze palsy, and slurred speech. The patient’s National Institute of Health Stroke Scale (NIHSS) was 14 with profound disability. Advanced neuroimaging demonstrated a large vessel occlusion of the right middle cerebral artery branches. The patient received an intravenous alteplase with a dramatic improvement of her symptoms. Upon discharge from the hospital, her NIHSS was zero and her ninety-day Modified Rankin Score was also zero. Despite comprehensive evaluations, the cause of AIS remains undetermined in approximately one-third of young patients. With more young women than men having strokes, understanding sex-mediated etiologies is critical to stroke treatment and prevention efforts in young adults.

Key words: Acute ischemic stroke, stroke in young adults, stroke in women, large vessel occlusion