What You Need to Know About Strokes in Young Adults

Strokes are not exclusive to a certain age group. Find out the warning signs of stroke and how to prevent them at any age.

Posted on | By Carolyn D. Brockington, MD

Many people believe stroke occurs only in the elderly. So, if I am young and healthy, I don’t have to worry about it, right? Wrong. The truth is, although the incidence of stroke increases with age, a stroke can occur at any age.

The good news is up to 80% of strokes are preventable. The key to prevention is the identification of stroke risk factors and successful modification through lifestyle changes which may include diet, exercise and/or medication.

Recently, the Centers for Disease Control (CDC) reported stroke had dropped from the nation’s fourth-leading cause of death to the fifth. Outstanding news! Although the drop in the mortality rate is likely due to many factors, one significant reason is the effectiveness of prevention strategies and an increased level of stroke awareness in the community.

The Causes of Stroke

Strokes occur from an interruption of blood flow to the brain. The sudden loss of the blood causes the cells to die and symptoms develop. Since the symptoms of a stroke occur suddenly (over seconds to minutes), it requires immediate medical attention at the closest emergency room.

How to Spot a Stroke

Knowing the signs of a stroke and calling 911 immediately gives the patient the best chance for a positive outcome. Presently, there are more treatments available for stroke than ever before, but time is critical. Time is brain loss. As each minute goes by during a stroke left untreated, 1.9 million neurons die resulting in a permanent brain injury. That is why it is so crucial to spot the signs of a stroke quickly and get prompt medical assistance at the closest hospital.

The American Stroke Association, a division of the American Heart Association, launched a new initiative called Together to End Stroke to help everyone learn how to prevent, treat and beat stroke. Together to End Stroke teaches the acronym F.A.S.T as an easy way to recognize the most common stroke warning signs and what to do if you suspect someone may be having a stroke.  So remember, act FAST:

F – Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile.

A – Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S – Speech Difficulty: Is the speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence like “The sky is blue.” Is the sentence repeated correctly?

T – Time to call 9-1-1:  If the person shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.

Additional stroke signs include:

Sudden, severe headache: With no known cause, a headache unlike any other.

Sudden trouble walking: Difficulty walking straight or walking like you are drunk.

Sudden loss of balance or coordination: Difficulty picking up or holding onto objects or sudden difficulty writing or signing your name.

Sudden trouble seeing in one or both eyes: Sudden loss or dimming of vision or double vision.

Sudden confusion or trouble understanding: Sudden difficulty comprehending what someone is saying to you.

The key is the symptoms appear suddenly. They do not occur over months, but develop over seconds to minutes. The most important thing to remember is to get prompt treatment before more of the brain is lost. Call 911 immediately and go to the closest hospital for treatment.

Stroke in Young Adults

There are several reasons strokes occur in young adults. The stroke evaluation includes an assessment of three main biological systems: vascular (blood vessels), cardiac (heart disease or structural abnormalities) and hematological (blood clotting disorders) to find the cause. In addition, the doctor looks for traditional risk factors like high blood pressure (hypertension) and diabetes.

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, which 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. Some neck discomfort and symptoms of a stroke may occur as a result of the vessel injury. A doctor can determine this by conducting a thorough history, performing a neurological examination and obtaining 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). These 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, which 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, and 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.

The Take-Home Message

Anyone can have a stroke at any age, but many strokes can be prevented. Know your stroke risk factors and modify them appropriately by engaging in a healthy lifestyle and taking medication (if necessary). A stroke is an emergency. There is no time to waste. Act fast and call 911 immediately. You may save someone’s life and brain.

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...