Particular care should be exercised when evaluating the young adult (ages 15 to 50) with acute stroke. In this group, arterial dissection accounts for 20 percent of all ischemic strokes and may often be preceded by only minor trauma. The young adult with a cardioembolic event may have mitral valve prolapse, rheumatic heart disease, or paradoxical embolism as the originating cause. Migrainous stroke in this age group is a potential, with a female predominance. Air embolism should be considered in patients with a history of recent scuba diving or an invasive medical procedure. Such patients should be placed in a left lateral decubitus position and also placed on 100% oxygen. Emergent recompression in a hyperbaric chamber should be arranged. Finally, this population is at risk for ischemic stroke from substance abuse, with heroin, cocaine, and amphetamines often implicated. Any drug with sympathomimetic effects increases the risk of hemorrhagic stroke.
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