Recurrent ischemic stroke in a young female patient with uncontrolled hyperhomocysteinemia

Over the past 40 years, the incidence of ischemic stroke in young adults (18–44 years) has tripled worldwide. Recent Russian and international studies on ischemic stroke in young patients demonstrate the significant role of genetic factors in embolism. Among the most common hereditary causes of thrombosis are thrombophilias, one of whose manifestations is hyperhomocysteinemia (9.5%). We present a clinical case of a 41yearold woman. Her history included smoking and alcohol abuse; she denied hereditary and chronic diseases and had never taken combined oral contraceptives. In 2021, at age 37, under severe stress (heavy workload) and a sharp rise in body temperature to 40 °C, she suffered an ischemic stroke. During hospitalization, hyperhomocysteinemia (326.0 µmol/L) was detected for the first time. With treatment, her condition stabilized with minimal neurological sequelae. She was discharged with recommendations for continuous antiplatelet, antihypertensive, and lipidlowering therapy, as well as B vitamins. She demonstrated poor compliance: she did not see a neurologist or hematologist and did not have her blood homocysteine level monitored for three years. In 2024, she stopped antiplatelet therapy on her own, leading to a recurrent ischemic stroke. After repeat hospitalization, her condition stabilized with minimal neurological sequelae, and her adherence improved. Young patients often demonstrate poor compliance to medical recommendations and followup, which underscores the need for an active monitoring system for this cohort. Recommendations for primary care physicians on managing such patients are provided.