Young-onset stroke, defined here as stroke occurring before age 50, is an expanding public health concern with substantial socioeconomic consequences. The study frame notes rising global and regional stroke burden and emphasizes that the UAE has shown a particularly high age-standardized stroke prevalence in the MENA region. The authors aimed to characterize epidemiology, risk factors, stroke subtypes, management patterns, and outcomes among young adults with stroke admitted to a major tertiary hospital in the UAE.
This was a retrospective chart review conducted at Al Qassimi Hospital (AQH), a large governmental tertiary care facility in Sharjah, UAE. The study included all patients aged under 50 years admitted with a stroke diagnosis between January 1, 2016, and December 31, 2022. An initial electronic case list was generated using ICD-10-CM stroke codes, and five trained reviewers performed manual chart extraction to capture variables not consistently recorded in the electronic medical record.
The centre’s standard acute stroke imaging protocol includes non-contrast CT brain, CT perfusion, and CT angiography of the head and neck to assess for large-vessel occlusion, stenosis, or dissection. Cardiac evaluation consisted of minimum 24-hour telemetry monitoring and transthoracic echocardiography prior to discharge. Advanced cardiac tests such as transoesophageal echocardiography or prolonged ambulatory Holter monitoring (>24 hours) were performed selectively. Implantable loop recorders were not used at the centre.
Data capture was guided by a structured spreadsheet developed from a literature review. Extracted variables included demographics (age, sex, region of origin), comorbidities (hypertension, diabetes mellitus, hyperlipidaemia, coronary artery disease, atrial fibrillation), admission vitals and glucose, BMI, imaging findings, stroke subtype (ischemic stroke, non-traumatic intracerebral hemorrhage, and non-traumatic subarachnoid hemorrhage), treatments (intravenous thrombolysis, anticoagulation, mechanical thrombectomy), and outcomes including survival. Final stroke subtype and aetiology were recorded based on the treating neurologist’s documented diagnosis and ICD-10 coding; the investigators did not perform a de novo TOAST adjudication.
Included were patients younger than 50 years presenting with clinical features consistent with stroke and neuroimaging confirmation. The electronic identification via ICD-10 codes was followed by manual review to verify eligibility and to extract additional clinical details. Specific exclusion criteria were not detailed beyond failure to meet the imaging-confirmed stroke diagnosis.
The study was approved by the Research Ethics Committee at the University of Sharjah (REC-23-01-23-01-F) and the Ministry of Health and Prevention Research Ethics Committee (MOHAP/DXB-REC/ J.J.J /No.74 / 2023). Given the retrospective design, informed consent was waived. Data collection occurred between 10 July 2023 and 12 January 2024.
A total of 419 patients met inclusion criteria. The cohort was predominantly male (78.28%). The largest regional group was South Asian patients (63.96%), followed by patients from the Middle East and North Africa region (19.33%). Stroke subtype breakdown was: ischemic stroke in 50.12% of patients, intracerebral hemorrhage in 27.21%, and non-traumatic subarachnoid hemorrhage in 22.67%.
The most prevalent comorbidities were hypertension (45.45%) and diabetes mellitus (24.42%). Other cardiovascular comorbidities, including hyperlipidaemia and coronary artery disease, were also reported. Reperfusion therapies were used infrequently: intravenous thrombolysis was administered in 9.41% of patients and mechanical thrombectomy in 0.24%. The overall in-hospital mortality reported was 12.68%.
Statistical analysis identified a significant association between coronary artery disease and mortality (p < 0.001). Ethnicity-related findings included a higher likelihood of large-artery atherosclerosis among South Asian patients: odds ratio 2.19 (95% CI 1.11–4.30, p = 0.02) compared with non–South Asian patients. These specific associations were reported as part of the study’s multivariable assessments.
The authors highlight a high burden of modifiable cardiovascular risk factors among young adults with stroke in this UAE centre, particularly hypertension and diabetes mellitus. Ischemic stroke was the most frequent subtype, and reperfusion interventions were rarely used in this cohort. The observed ethnic association with large-artery atherosclerosis in South Asian patients suggests population-specific patterns of stroke aetiology that may warrant tailored preventive and diagnostic strategies. The study underscores the need for targeted primary and secondary prevention efforts and additional region-specific research to address the growing impact of metabolic and vascular risk factors in younger populations.
As reported by the authors, limitations inherent to the retrospective single-centre design include reliance on ICD-10–based case identification and extraction of final stroke subtype and aetiology from treating clinicians’ documentation rather than a centralized, blinded adjudication using formal TOAST criteria. Advanced cardiac monitoring (e.g., implantable loop recorders) was not available at the centre, which may limit detection of paroxysmal atrial fibrillation. The study’s generalizability beyond the single tertiary centre and the period 2016–2022 may be limited.
In this retrospective analysis of 419 young adults with stroke admitted to a tertiary UAE hospital, there was a high prevalence of modifiable cardiovascular risk factors, predominance of ischemic stroke, low utilization of mechanical thrombectomy, and an overall mortality of 12.68%. Coronary artery disease was significantly associated with death, and South Asian ethnicity was associated with higher odds of large-artery atherosclerosis. The authors call for targeted preventive strategies and further region-specific research to reduce the burden of young-onset stroke in the UAE.