الفهرس 
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Abstract
We studied 70 patients with acute ischemic stroke or transient ischemic attack who were admitted in the stroke unit –Neurology department, Kasr-Alainy hospital within the first week of acute event during the period between December 2018 and December 2019.
Their age ranged from 18 to 40 years with a mean age of 35.6 ± 5.8 years. We found that most patients (84.3%) were in the age group (>30 to 40 years), while 15.7% were in the age group (18 to 30 years).
We found 37 Females (52.9%) and 33 males (47.15%). The majority of patients (64.3%) were from rural areas. Most patients had mild (45.7%) to moderate (35.7%) strokes as measured by NIHSS at time of presentation.
We found three patients with coagulopathy and vasculitis screening was negative in all patients who were screened inspite of two patients were diagnosed clinically as vasculitis.
About half of the patients (45.7%) were cigarette smokers, more than one third (36%) of the patients had cardiac risk factors and nearly about one quarter of the patients (27.5%) was dyslipidemics. The other most prevalent risk factors were drug abuse, hypertension, obesity and diabetes.
Smoking and drug abuse were significantly higher among males, while RHD and AF were more common in females. More females were found migraineures.
We found only about 5 % of patients with no risk factors while about 95 % of them had at least one risk factor; 17% of patients had one risk factor, about 25% of the patients had two risk factors. Moreover, nearly half of the patients had three or more risk factors.
There was no statistically significant difference between younger (18-30years) and older age (>30-40 years) groups regarding risk factors except in hyperlipidemia (P=0.029) with nearly all cases were present in the older age group. Also we found that in the younger age group, smoking was the commonest risk factor (27.3%), followed by drug abuse (18.8%), RHD and cardiomyopathy (9.1% each).
There was a statistically significant positive correlation between age and number of risk factors.
Most of the studied patients (82.9%) had territorial infarction and anterior circulation strokes represented 74.3% of total sample.
As regards vascular imaging, most patients (71%) had normal vascular imaging while 10 patients had atherosclerotic vasculopathy and similar number had non atherosclerotic vasculoathy.
Nearly, one quarter of the patients had valvular heart disease and 6 patients had PFO.
We used the classic Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification to describe the stroke etiology. Cardio-embolism was the commonest etiology for stroke representing (37.1%) of the sample. It was followed by other determined etiology representing about (21%) of the studied patients. Drug abuse was the most common among other determined etiology followed by dissection and finally other rare causes.
Furthermore, Undetermined etiology comes third by about (14.3%), followed by LVD (12.9%), While ESUS represented the etiology for the stroke among (8.6%) of the patients, finally SVD comes by (5.7%) of the sample.
In Males, cardio-embolic, drug-induced and undetermined causes were the most common etiologies for stroke representing together 63.3% (21 patients). While among females, about half of the cases (48.6%) were due to cardio-embolic etiology.
ESUS was the commonest etiology (27.3%) in the younger age group (18-30 years), while in the older age group; the majority of cases (61.5%) were due to cardio-embolic etiology followed by LVD.
Non-smokers, normoglycemics, normotensives and patients with normal lipid profile showed cardio-embolic etiology as the most frequent cause of stroke, while diabetics and hyperlipidemics showed LVD, SVD, and cardio-embolism as an etiology of stroke.
Moreover, we found that large vessel disease was the most common etiology in obese patients.