Sex differences in characteristics of ischaemic strokes in a prospective series of 334 young patients

Background and purpose: to analyze trends in risk factors, aetiologies and clinical outcome of ischaemic stroke (IS) related in men versus women. Methods: We have prospectively included 334 young adults (<45 years) between 2005 and 2014 with an acute IS confirmed by MRI. We have obtained patients approval, as necessary. The patients were investigated by standardized protocol including biological and toxicological screenings and cardio-vascular check-up. Results: In the whole series of 334 patients, mean age was 36.8 ± 0.36 and sex ratio 1.1. Lifestyle risk factors were significantly more common in men: smoking in 54.8% vs 44% (p = 0.03), active cannabis use 23.4% vs 10.6% (p = 0.02), alcohol 22.8% vs 6.2% (p < 0.001). Also potentially modifiable risk factors as hypercholesterolemia, hypertension and diabetes were more common in men respectively (49.7 vs 32%, p = 0.01; 30.2% vs 16.3%, p = 0.02; 7.4 vs 1.8%, p = 0,01). History of migraine was more prevalent in women 37.1% vs 12.5%, p < 0.001. The following aetiologies had similar prevalence in both sexes: cardioembolism, intracranial arterial stenosis, isolated patent foramen ovale, haematological diseases, atherosclerosis. Small vessel disease and aneurysm were present only in men 1.7% and 1.1% respectively. Cervical dissection was more frequent in women 15% vs 8%. Aetiology of IS was unknown in 26% for both. The mRS at 3-6 months was ≤ 2 in about 90% for both. Conclusion: Non-modifiable and modifiable lifestyle risk factors are highly prevalent in men. IS are more frequently associated with migraine and cervical dissection in women. The clinical outcome is similar despite differences in aetiologies and risk factors.