[Juvenile ischemic brain infarction. Clinical aspects, etiology spectrum, diagnosis and therapy].

Ischemic stroke in the young (age: 18-45 years) constitutes a diagnostic and therapeutic challenge. A broad spectrum of potential causes of juvenile strokes exists. Above all, nonatherosclerotic arteriopathies with dissections as their main proponent, paradoxical embolism, and thrombophilias have to be considered. Transient brief episodes with neurological deficits are difficult to discriminate from migrainous aura, epileptic seizure, psychogenic disorder. Therefore, the diagnostic work-up of juvenile stroke patients usually exceeds the amount of compulsory tests recommended in official guidelines. Various therapeutic modalities are not based on randomized large-scale studies and have to be selected on an individual basis. Despite good compliance, the annual risk of stroke recurrence is 2-3% and 1% for myocardial infarction.