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Young Stroke – Extended Workup — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseYoung Stroke – Extended WorkupSCE Neurology

A 38-year-old woman presents with a recent ischaemic stroke. Standard investigations (ECG, echocardiography, carotid Doppler, CT angiography) are unremarkable. She has no conventional vascular risk factors. Her neurologist initiates a 'young stroke' workup. Which additional investigations should be performed?

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Correct answer: A — Thrombophilia screen, autoimmune screen (ANA, ANCA, lupus anticoagulant, antiphospholipid antibodies), homocysteine, HIV, syphilis, urine drug screen, extended cardiac monitoring, and consideration of genetic causes (Fabry, CADASIL)

Stroke in a young adult (<50 years) without conventional risk factors requires an extended workup including: thrombophilia screen, antiphospholipid antibodies, autoimmune screen (ANA, ANCA, complement), homocysteine, HIV, syphilis serology, urine toxicology (cocaine, amphetamines), extended cardiac monitoring (for paroxysmal AF), bubble echocardiography (for PFO), and consideration of rare genetic causes (Fabry disease — alpha-galactosidase A; CADASIL — NOTCH3; mitochondrial disease). A: Standard workup is insufficient for young stroke. C: Huntington disease does not cause stroke. D: CT chest alone is insufficient. E: Prolactin is for seizure differentiation.

Reference: RCP National Clinical Guideline for Stroke (2023); EAN Young Stroke Guidelines