A new study shows that the causes, arterial regions, regression and risk factors for stroke differ between men and women in young individuals who suffer from ischemic stroke. ”The prevalence of variable risk factors was higher in both genders,” said Ielyzaveta Zinchenko from the University Hospital of Strasbourg, France, “and if we look at the differences between the two genders, we can see that males had more significant alcohol and marijuana use risk factors are more pronounced.” In addition, men also had a higher prevalence of the variable risk factors of dyslipidemia, hypertension and diabetes. The results of this study were presented at the 22nd World Congress of Neurology (WCN XXII). The incidence, etiology and risk factors for stroke differed between younger and older patients. Although gender differences do exist in the field of cerebrovascular disease, few studies have addressed gender differences in stroke between younger patients. Zinchenko et al. therefore conducted a prospective study that included patients with ischemic stroke aged less than 45 years between 2005 and 2014. They assessed risk factors, clinical characteristics of the patients, vascular health, structural function of the heart, and clinical manifestations of stroke, in addition to toxicological screening. The mean age of both the male and female groups was about 36 years. There was no significant difference in the prevalence of AF between the male and female groups (2.2% vs 3.7%, respectively; P=0.52), but men had more variable and potential risk factors compared to women. The only cause of stroke that differed between the sexes was carotid artery entrapment. This cause was involved in 8% of men and 15% of women in the study (P=0.006). Women had more strokes in the anterior region (70%, P=0.001) compared to men (52.6%), so conversely, men had more strokes in the posterior region (P=0.002). Only 3% to 4% of patients had strokes in the same region. The clinical symptoms of the patients at the time of hospitalization were essentially similar, but more cerebellar-related symptoms were present in men than in women (5.7% vs 0.6%, respectively; P<0.001) due to the different arterial regions involved. Also after discharge, men had more cerebellar-related symptoms (7% vs 1.2%, respectively, P=0.02) and more dysarthria (13.5% vs 4.5%, P<0.001). "As for functional outcomes, we found no significant differences between men and women, and 90% of patients had good functional regression." Zinchenko reported. At 3 to 6 months, nearly 80% of the modified Rankin score (mRS) in both gender groups reached 0 to 1, with an additional 10% of patients having an mRS score of 2. Very few patients in either group died. She concluded that "gender influences many aspects of ischemic stroke, including stroke risk, incidence, diagnosis, symptoms, and outcome," and noted that while both sexes had a higher prevalence of variable risk factors, men had a particularly high prevalence of lifestyle-related factors, such as heavy alcohol and marijuana use, as well as hypertension, diabetes, and dyslipidemia. The prevalence of these factors was higher in men than in men. Men are thus targeted for more risk factor control, but both sexes may benefit because they may live longer as a result. Zinchenko also suggested that clinicians should be alert to intracranial artery stenosis, which is the second leading cause of stroke (20.5% in men and 18.2% in women), after cardiac embolism (26.2% in men and 27% in women). The conference chair, Didier Leys from the University of Lille, France, said the findings give important information. "Most young ischemic stroke patients have risk factors, and the advice we can give is not to smoke, not to drink alcohol, not to smoke marijuana, and so on. But again, this is a message for the whole population, not just for these patients." He said. Younger people are usually less receptive to advice than older people, so risk factors may be detected at the time of stroke. Therefore, secondary prevention is important, Leys said, "because we know recurrent strokes are much more serious and can present with cognitive impairment and epilepsy and so on."