Emergency Department Diagnosis and Management of Stroke In Young Adults - Stroke EXTRA Supplement (Stroke CME)

Publication Date: December 2025 (Volume 27, Supplement 12)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 12/20/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Stroke CME credits, subject to your state and institutional approval.

Authors

Karissa C. Arthur, MD

Assistant Professor of Clinical Neurology and Associate Program Director, Neurology Residency; Lewis Katz School of Medicine at Temple University, Philadelphia, PA

Taylor N. Haight, MD

Assistant Professor, Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA

Rohan Arora, MD, FAHA

Director, Stroke Clinical Trials, Northwell Health; Program Director, Vascular Neurology Fellowship; Director, Stroke Program, Long Island Jewish Forest Hills, Forest Hills, NY; Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY

Shraddha Mainali, MD

Associate Professor of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA

Peer Reviewers

William A. Knight IV, MD, FNCS, FACEP

Professor, Emergency Medicine, Neurosurgery and Neurology, University of Cincinnati, Cincinnati, OH

Camelia Valhuerdi Porto, MD

Neurology Chief Resident, Department of Neuroscience, Tufts Medical Center, Boston, MA

Abstract

Early recognition of stroke in young adults is crucial for effective treatment and mitigation of long-term impact on quality of life. This issue of Emergency Medicine Practice: Stroke EXTRA! offers a comprehensive, evidence-based review of stroke in young adults, including its distinct etiologies, diagnostic complexities, and tailored management approaches. Select case presentations highlight key considerations in evaluating and managing stroke in young adults, emphasizing the importance of timely recognition, rapid intervention, and long-term management.

Case Presentations

CASE 1

A 28-year-old woman arrives in the ED via EMS with new-onset severe headache, dysarthria, and left arm weakness...

A stroke code is called on her arrival to the ED. She was last known to be at her baseline about 5 hours prior to arrival. Her initial blood pressure is 176/94 mm Hg, and her serum glucose level is 102 mg/dL. On examination, she is in distress due to headache; on neurologic examination, she has mild weakness of the left lower face and weakness of the left arm. Her NIHSS score is 2. She has a history of polysubstance use. What are the most appropriate studies needed for this patient? Is she a candidate for any acute stroke intervention?

CASE 2

A 32-year-old man presents to the ED via EMS after acute onset of vertigo, nausea, and vomiting 1 hour ago while at work...

The patient reports that he awoke in the morning with pain in the left side of his neck and has had a progressive headache throughout the day. He recalls that he was lifting weights the night prior and had some mild left-sided neck pain during his workout, but it had resolved. He has no past medical history. On arrival to the ED, his blood pressure is 136/82 mm Hg. On neurologic examination, he has reduced sensation and weakness in the right arm and leg, and mild gait unsteadiness. Does this patient need emergent neuroimaging? If so, what studies should be ordered? Is he a candidate for any acute stroke intervention?

CASE 3

A 41-year-old woman presents to the ED viah EMS after her husband found her confused and disoriented…

He said she was unable to locate the telephone, which was sitting on the table next to her, and when he noticed a left facial droop, he called 911. He reports that she seemed fine about 5 hours earlier. On arrival to the ED her blood pressure is 186/102 mm Hg. Her serum glucose level is 205 mg/dL. She has a history of hypertension, diabetes, and active smoking. On examination, she denies any deficits but is looking toward her right side and will not look to her left. She has a left-sided visual field deficit, lower facial droop, and is not moving her left arm. Her NIHSS score is 13. What imaging studies are needed emergently? Is this patient a candidate for any acute stroke intervention?

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