Younger People More At Risk For Stroke

Strokes can occur at any age, and they claim a life every four minutes.

By Dr. Sanjay Gupta

Stroke is a leading cause of disability and death, claiming more than 137,000 lives in this country every year. According to the U.S. Centers for Disease Control and Prevention, someone suffers a stroke every 40 seconds, and a person dies of stroke every four minutes. Your risk of having a stroke increases as you get older, but many people don’t realize that strokes can occur at any age. In fact, younger people are more at risk for having a stroke than ever before.

A report in the journal Neurology found that 15 percent of the most common types of stroke occur in teenagers and young adults. “The impact of strokes in this age group is devastating to the adolescent or young adult, their families, and society,” said report co-author Jose Biller, MD, a neurologist at Loyola University Medical Center.

A stroke occurs when blood flow to the brain is interrupted, which can cause brain cells to die. Ischemic strokes, which account for 85 percent of all cases, are triggered by a blocked artery, as opposed to hemorrhagic strokes involving a burst blood vessel. The common risk factors for stroke include high blood pressure, diabetes, smoking, heart disease, obesity, and high cholesterol.

A lot more young people have more than one of these risk factors,” said Michael Mullen, MD, an assistant professor of neurology at the Hospital of the University of Pennsylvania in Philadelphia. “Obesity is a common theme. Hypertension is also a major problem now, and it’s under-diagnosed or under-treated in the younger population.

As Dr. Mullen points out, "younger people should control what stroke risk factors they can and live a healthy lifestyle." But there are other, less common, causes of stroke such as an arterial dissection, or tear in the inner-most lining of the artery.

“A lot of people think these things only happen if you’re in a car accident or from some major trauma, but it can happen with a relatively minor injury,” said Carolyn Brockington, MD, director of the Stroke Center at Roosevelt Hospital in New York City. "If you move your neck in an unusual way it can happen. I've had patients who have had dissections by flipping their hair while drying it or doing a yoga pose."

Another stroke risk factor is a congenital heart defect known as patent foramen ovale (PFO). PFO occurs when a flap-like opening in the heart, common during fetal development, doesn’t close after birth. This opening between the two upper chambers of the heart can allow a blood clot to travel to the brain. PFO can be diagnosed with an echocardiogram, or ultrasound of the heart.

Studies have shown birth control pills may raise the risk of stroke. The hormone estrogen contained in contraceptive pills increases the levels of clotting factors in the blood. While the risk of getting a blood clot is small for most women, it can be a concern for women with a history of stroke or clotting disorders.

"Each woman has to talk with their doctor and make that choice for herself," said Brockington. "And for anyone on oral contraceptives, smoking will also increase their risk for blood clots and stroke."

Regardless of age, experts stress the importance of spotting the symptoms of stroke and gettingimmediate treatment. "One of the major problems is that people don't recognize the symptoms, so they don't come to us in time for us to treat them," said Dr. Mullen. "Stroke is so common that if you're not helping yourself, you could help save someone else."

The American Stroke Association recommends using the acronym “FAST” to recognize and respond to a stroke:

• F for face: Is one side of the face drooping or stuck in place?
• A for arms: Can both arms be raised, or does one drift downward?
• S for speech: Is speech slurred or garbled?
• T for time: Call 911 immediately if you or someone has the above symptoms.

When caught early enough, a common treatment for stroke is an injection of TPA, an enzyme found naturally in the body that helps dissolve blood clots. TPA, or tissue plasminogen activator\ needs to be administered within the first few hours in order to be effective. In some cases, a neurosurgeon may be able to remove the clot through surgery.

"Stroke is a time-sensitive condition, no matter your age," said Mullen. "[Everyone] should learn the signs and symptoms."