Background: The increasing incidence of stroke in younger people underscores the urgent need for research to elucidate the underlying risk factors and causes. To date, the vast majority of studies of stroke in young people have been conducted in European and North American regions.  
Aim of the work: To characterize the neurovascular findings and associated risk factors for stroke in young and middle-aged patients at Almoosa Hospital in Saudi Arabia.
Methods: We retrospectively analyzed data from consecutive patients with ischemic stroke and transient ischemic attack aged 25 to 60 years who underwent detailed cardiocerebrovascular examination.
Results: The study included 182 patients, most of whom [89%] presented with stroke and 11% with transient ischemic attack. The mean age was 51.2±8.4 years [25-60 years], 62.6% were men, mean BMI was 30.7±5.4, 41.2% were smokers, 52.7% were diabetic, 60.4% had hypertension, and 38.5% had dyslipidemia. Cardiac risk factors were valvular heart disease [34.1%], ischemic heart disease [16.5%], cardiac thrombi [8.8%], and septal defects [4.4%]. Magnetic resonance imaging revealed anterior circulation infarction in 47.3% and posterior circulation infarction in 14.3%, whereas both anterior and posterior circulation infarction were found in 27.5%. Neurovascular imaging of the neck was performed in 102 patients, with 16.5% having mild stenosis, 7.7% moderate stenosis, 9.9% severe stenosis 8.8%, and 5.5% complete stenosis. Carotid arteries duplex examination revealed insignificant stenosis in 15.4% and significant stenosis in 6.6%. Type 2 diabetes, hypertension, and dyslipidemia had a major impact on the extent of stenosis, whereas DM 2 and dyslipidemia were significantly more common in patients with increasing degrees of stenosis.
Conclusion: In this study young patients with ischemic stroke had different cerebro-vascular risk factors and etiologies compared with previous cohorts, indicating the need for tailored prevention interventions that take into account regional epidemiological data on cerebrovascular health.