Genetics of ischaemic stroke in young adults

• The aetiological diagnosis of stroke in young adults needs a different and more complex diagnostic work up than in older adults.
• Stroke may be a clinical expression of several inherited disorders in humans.
• The most common genetic causes of stroke are CADASIL, Fabry and mitochondrial diseases.
• Recognition of the underlined genetic disorders causing stroke is important for the correct management of the patient.

BackgroundStroke may be a clinical expression of several inherited disorders in humans. Recognition of the underlined genetic disorders causing stroke is important for a correct diagnosis, for genetic counselling and, even if rarely, for a correct therapeutic management. Moreover, the genetics of complex diseases such the stroke, in which multiple genes interact with environmental risk factors to increase risk, has been revolutionized by the Genome-Wide Association Study (GWAS) approach.Scope of reviewHere we review the single-gene causes of ischemic stroke, bringing the reader from the candidate gene method toward the exciting new horizons of genetic technology.Major conclusionsThe aetiological diagnosis of ischemic stroke in young adults is more complex than in the elderly. The identification of a genetic cause is important to provide appropriate counseling and to start a correct therapy, when available. The advent of GWAS technology, such as for other complex pathological conditions, has contributed enormously to the understanding of many of these genetic bases. For success large, well phenotyped case cohorts are required, and international collaborations are essential.General significanceThis review focuses on the main causes of genetically-based ischemic stroke in young adults, often classified as indeterminate, investigating also the recent findings of the GWAS, in order to improve diagnostic and therapeutic management.