Stroke in the Young

Identify your risk factors and learn how diet, exercise and medication can help prevent a stroke.

Posted on | By Carolyn D. Brockington, MD | Comments ()

Can someone have a stroke if they are young? The simple answer is “yes.” Strokes can occur at any age, but the incidence of stroke increases with age. Although there is no specific definition for “Stroke in the Young,” most consider the group to consist of individuals between the ages of 15 to 45 years old. The good news is many strokes can be prevented. The key to prevention is the identification of one’s own risk factors and successful modification through lifestyle changes which may include diet, exercise and/or medication.

What causes a stroke?

Strokes occur from an interruption of blood flow to the brain. The loss of the blood causes the cells to die and symptoms develop. The symptoms may include sudden numbness or weakness (particularly on one side of the body), confusion, trouble speaking or understanding speech, sudden difficulty seeing in one or both eyes or loss of balance and coordination.

The majority of strokes are “ischemic” caused by a decrease in blood supply to the brain from constriction or obstruction of the vessels. Conversely, 20% of strokes are “hemorrhagic” due to bleeding in or around the brain. 

The symptoms of a stroke are based on the part of the brain affected from the loss of blood flow. In general, the left side of the brain is responsible for the functioning of the right side of the body while the right brain controls the left side. If a part of the left brain does not get enough blood flow, the individual may develop difficulty talking and moving the right side. The symptoms of a stroke occur suddenly (over seconds to minutes) and require immediate medical attention at the closest emergency room.

Incidence and Risk Factors

Since 1994, the prevalence of ischemic strokes has declined in the elderly and middle-age groups while increasing in children, young adults and early middle-age individuals, according to an analysis by the U.S. Centers for Disease Control and Prevention (CDC). The exact reason for the spike in the younger population is unclear, but it is likely the result of many factors including high blood pressure and obesity.

There are several reasons strokes occur in young adults. For example, the individual may have traditional risk factors like high blood pressure or diabetes which require treatment. Generally, the medical evaluation includes an investigation of three main biological systems: vascular (blood vessels), cardiac (heart disease or structural abnormalities) and hematological (blood clotting disorders).

Vascular

Think of the blood circulation system as plumbing. If the “pipes” (blood vessels) are clogged (narrowed from plaque), not enough blood gets to the brain resulting in a stroke. Generally, the arterial problem that develops in young adults occurs from an injury to the vessel rather than excessive plaque formation. The injury to the blood vessel is called a “dissection” and occurs from a tear in the innermost lining of the artery. Blood flows through the tear and “dissects” (travels) between the muscle layers of the artery creating a false channel and obstructing blood flow to the brain. Vascular dissections occur in young, healthy adults from non-violent injuries to the neck. Neck discomfort and symptoms of a stroke may occur as a result of the vessel injury. The diagnosis is made by a doctor through history taking, neurological examination and imaging (brain and blood vessels). In many cases, the vascular injury is treated medically (with blood thinners).

Cardiac

Heart disease is a cause of stroke in all ages. In some instances, the stroke in a young adult may have resulted from a previously unrecognized structural abnormality in the heart. One of the most common structural abnormalities is a patent foramen ovale (PFO). PFOs are “holes in the heart,” which can potentially allow blood clots to travel through the heart to the brain circulation causing a stroke. In the general population, the prevalence of PFOs is about 25%. With individuals who develop a cryptogenic stroke (stroke of unknown cause), the prevalence of PFOs increases to approximately 40%. This finding is especially true in people less than 55 years old. Testing of the heart (echocardiography) is used to make the diagnosis. At present, there is some debate regarding the appropriate long-term treatment for a patient with a stroke due to a PFO, but in many instances, medication is recommended.

Hematological

Strokes can result from blood-clotting disorders. Hypercoagulable states (thrombophilias) include a variety of different inherited or acquired medical conditions that have the potential to cause abnormal blood clotting. Examples of inherited coagulation abnormalities include conditions like antithrombin III deficiency and protein C and S deficiencies. Secondary hypercoagulable states are acquired disorders in individuals with clinical conditions known to be associated with an increased risk of clotting including pregnancy, use of oral contraceptives and some malignancies. A thorough medical evaluation, with a discussion of individual and family risk factors, is advised if a hypercoagulable state is suspected. Blood testing is needed to confirm the diagnosis. Depending on the cause, different treatments are used.

Conclusion

Regardless of age, everyone should know their stroke risk factors. Many strokes can be prevented by modifying one’s risk factors and engaging in a healthy lifestyle. Strokes are medical emergencies, but there is effective treatment available. If you or someone you know is showing signs of a stroke, call 911 immediately to get a prompt evaluation and appropriate treatment.

Article written by Carolyn D. Brockington, MD
Dr. Brockington is a board-certified stroke neurologist and director of the Stroke Center at Mount Sinai St. Luke’s- Mount...