Abstract / Summary
Background: Stroke in young adults is increasing worldwide and is associated with substantial long-term disability. Unlike stroke in older populations, young patients frequently present with uncommon etiologies that require specific diagnostic approaches and targeted secondary prevention strategies. Early recognition of these causes remains a major clinical challenge. Objective: This study aimed to provide a comprehensive review of the principal uncommon causes of stroke in young adults, emphasizing their clinical characteristics and neuroimaging findings relevant to etiological diagnosis. Methods: A narrative review was conducted focusing on cerebrovascular disorders that disproportionately affect young adults, including arterial dissections, patent foramen ovale, moyamoya disease, reversible cerebral vasoconstriction syndrome, cerebral venous thrombosis, thrombophilias, autoimmune diseases, infections, genetic disorders, malignancy, and cardiac conditions. Particular attention was given to neuroradiological patterns and imaging modalities useful for diagnosis. Results: Numerous uncommon etiologies contribute significantly to stroke in young adults and often occur in the absence of traditional vascular risk factors. Neuroimaging plays a pivotal role in diagnosis, helping identify characteristic findings such as double-lumen signs in arterial dissections, collateral vessel networks in moyamoya disease, reversible multifocal vasoconstriction in RCVS, venous filling defects in cerebral venous thrombosis, and distinctive imaging signatures associated with genetic, infectious, inflammatory, and neoplastic disorders. Recognition of these patterns can substantially improve diagnostic accuracy and guide appropriate secondary prevention. Conclusions: Stroke in young adults encompasses a broad spectrum of etiologies that differ considerably from those observed in older populations. Awareness of characteristic clinical and neuroimaging features is essential for accurate etiological investigation and implementation of effective preventive strategies.