ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Stroke in Young Adults in The Middle East and North Africa (MENA) region: what is the difference from elsewhere? A report from sixteen centers experiences
Amal M Al Hashmi 1
Yahia Imam 2
Mehdi Farhoudi 3
Elyar Sadeghi 3
Andoerza Ghoreishi 4
Abdulkarim Al Mutairi 5
Khaled Mohamed Sobh 6
Atilla Ozcan Ozdemir 7
Erdem Gurkas 8
Hani Humaidan 9
Hosam Al-Jehani 10
Faiza Mushtaque 11
Vinitha Leeleamani 12
Salma Said 13
Hany Helal 14
Noora Al Jahwari 15
Abeer Sabry Safan 2
Rasha KM Abumustafa 2
May Al Hamid 16
Farid Aladham 17
Ossama Yassin Mansour 13
Haytham Hussein Mohammed Osman 18
Sachin Jose 19
Ehab Shawky 14
1. Ministry of Health (Oman), Muscat, Oman
2. Hamad Medical Corporation, Doha, Qatar
3. Tabriz University of Medical Sciences, Tabriz, Iran
4. University of Zanjan, Zanjan, Iran
5. Prince Sultan Military Medical City, Riyadh, Saudi Arabia
6. Al Hussain Hospital , Al Azher University, Cairo, Egypt
7. Eskisehir Osmangazi University, Eskisehir, Türkiye
8. Latfi Hospital, Istanbul, Türkiye
9. Salmaniya Medical Complex, Manama, Bahrain
10. Imam Abdurrahman Al Faisal University, Damam, Saudi Arabia
11. Ministry of Health of Oman, Muscat, Oman
12. Ministry of Health of Oman, Sohar, Oman
13. Alexandria University, Alexandria, Egypt
14. Tanta University, Tanta, Egypt
15. Ministry of Health of Oman, Muscat, Oman
16. King Fahad Hospital, Riyadh, Saudi Arabia
17. Specialty Hospital, Amman, Jordan
18. The National Rabit University, Khartoum, Sudan, Khartoum, Sudan
19. Oman Medical Specialty Board (OMSB), Muscat, Oman
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Abstract
Background: Stroke at a young age is on the rise globally. The diverse range of underlying etiologies and risk factors for stroke in young adults make it challenging. There are very limited papers in this regard from our Middle East and North Africa (MENA) region. Objectives: Identifying risk factors, etiologies and treatment offered to young stroke patients in the MENA region. Method: A five-year multicenter retrospective study across nine MENA countries (2018–2022) was conducted. Multinomial logistic regression was applied to evaluate associations between vascular risk factors and stroke subtypes (adjusted for age, sex, and country). Results: 16 centers participated including 3971 patients, 65.5 % were male. Hypertension (HTN) was the most common risk factor among all stroke subtypes (38%). Diabetes mellitus (DM) and HTN, were the most frequent risk factors for ischemic stroke (IS) and Intracerebral hemorrhage (ICH)). Smoking and HTN were common in subarachnoid hemorrhage (SAH). All patients had either Cerebral Computed topography (CT) angiogram or Carotid Doppler ,32.6% of 67.4% showed positive results. A total of 2441 (61.9%) patients had Transthoracic Echocardiogram (TTE) and /or Transesophageal Echocardiogram (TEE). 11.2% of the patients showed abnormalities. The antiphospholipid screening tests were done in 31.4 % of the patients and were positive only in 3.5 %. IS was the most common stroke subtype 63.6%, followed by (ICH)19.2%. Undetermined etiology (UDE) was the most common underlying etiology of IS in 22.2%. Intravenous thrombolysis therapy (IVT) was given in 8.5% of patients. Mechanical thrombectomy (MT) was performed in 3.7%. Anticoagulation therapy was offered in 20% of patients. Endovascular treatment(EVT) was performed in 5.2% of patients. Surgical intervention including clipping or hemicortectomy or hematoma evacuation was done in 5.6% of patients. Conclusion: This study offers the first regionally coordinated effort to examine the risk factors, and etiologies of stroke in young adults across the (MENA) region. The data clearly reflects not only the high burden of disease but also striking variability in patient profiles and healthcare responses between countries. Emerging non-traditional risk factors, and persistent diagnostic limitations, point to the complexity of tackling stroke in the young. Yet, in this complexity lies opportunity.
Summary
Keywords
Stroke, Stroke subtypes, young adults, Risk factors, etiology, Mena
Received
25 June 2025
Accepted
10 December 2025
Copyright
© 2025 Al Hashmi, Imam, Farhoudi, Sadeghi, Ghoreishi, Al Mutairi, Sobh, Ozdemir, Gurkas, Humaidan, Al-Jehani, Mushtaque, Leeleamani, Said, Helal, Al Jahwari, Safan, Abumustafa, Al Hamid, Aladham, Mansour, Osman, Jose and Shawky. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Amal M Al Hashmi
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