The Rising Tide of Young Stroke

Many people think of stroke as a disease affecting mostly older people. But according to an editorial published in the Journal of the American Medical Association, stroke is no longer considered a disease of old age. In fact, there is a rising tide of strokes in adults aged 20 to 54 years, especially in certain ethnic populations.

And while the incidence of stroke overall is decreasing, a study using the population of 1.3 million in the Greater Cincinnati/Northern Kentucky region of the US estimated the rate of stroke among people under age 55 has increased to nearly one in five. In young adults, likely risk factors for stroke include: diabetes; obesity; and recreational tobacco, drug, and alcohol use; as well as high cholesterol and genetics.

Strokes occur when there is a lack of blood flow to a part of the brain causing brain cells to die or become damaged. When brain cells become damaged or die because of a stroke, there may be symptoms elsewhere in the body, in areas that are controlled by these brain cells. The cause and severity of strokes can vary greatly. The three types of strokes include:

• ​​​​​​​Ischaemic stroke – occurs when blood flow to part of the brain is blocked. Even a few minutes without oxygen-containing blood can cause brain cells to die. This is the most common form of stroke in older adults
• ​​​​​​​Haemorrhagic stroke – type of stroke caused by bleeding in the brain and damaged brain cells. This form of stroke seems to be more common in younger people
• ​​​​​​​Transient ischaemic attack, or TIA – sometimes called a “precursor stroke,” this occurs when blood flow to a portion of the brain is blocked only for a short time resulting in a mini-stroke

Stroke can be a life-changing event. The time it takes to recover from a stroke varies — it can take weeks, months, or even years. Some people recover completely, while others may become disabled for a long time, or even permanently.

Misdiagnosis in Younger People

Unfortunately, younger people may think that a stroke could never happen to them. Even medical providers, including emergency staff, may misdiagnose a stroke or TIA in a young person as a migraine, seizure, peripheral neuropathy, or anxiety.

It is important to keep in mind that about 20% of people who experience a first stroke between ages 40 and 69 are at high risk for having another stroke within five years. So, if you think you may have had a mini-stroke, or any of the symptoms of stroke, it is crucial to seek medical attention—even if the symptoms have passed.

Recognising the Signs and Acting Quickly

The signs of stroke are similar regardless of age. However, younger people often present with vague symptoms and may not be diagnosed as easily when compared to older adults who experience stroke symptoms. According to the American Heart Association, the acronym F.A.S.T. is an easy way to remember the sudden signs:

F: Face Drooping – One side of the face droops or is numb. Ask the person to smile. Is the person's smile uneven?

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

S: Speech Difficulty – Speech is slurred. The person may be unable to speak or hard to understand. Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly? Is it easy to understand?

T: Time to make an emergency call – If someone shows any of these symptoms, even if the symptoms go away, call 000 (Australia) or 111 (New Zealand) right away. Say that you think the person is having a stroke. Get the person to the hospital immediately. Check the time so you'll know when the first symptoms appeared.

The most important thing to remember, young or old, is that if you think you are having a stroke make that emergency call immediately, as time is critical. Brain cells start dying very quickly when they don’t get enough oxygen.

A person having a stroke needs medical help right away in order to avoid or minimise permanent damage. Do not wait for symptoms to go away. The most helpful information that you can give to medical personnel involves timing: When was the person last feeling okay? How long have the symptoms been happening? It may help to remember the saying: time lost is brain lost. In the instance of a stroke, every second counts.

Lowering Your Risk for Stroke

In many cases a stroke can be prevented with a few simple healthy lifestyle changes, such as eating a balanced diet, exercising regularly and getting your blood pressure checked. These can all make a very big difference. There are many ways young people can lower their risk for stroke, primary by adopting healthy habits including:  

• Stop smoking. People who smoke have double the risk of having a stroke compared to those who don't smoke
• Lose weight. Being obese raises the likelihood of having high blood pressure, high cholesterol, and diabetes, all of which can increase your risk of having a stroke
• Eat healthy and get fit. No matter your age, speak with your doctor about a healthy diet and exercise plan to keep you in good shape
• Monitor your blood pressure and cholesterol. High blood pressure, which is a major risk factor for stroke, can increase your risk of stroke by at least one and a half times. High cholesterol also affects blood flow to the brain and can lead to a stroke
• Know the risks when taking birth control. Talk to your doctor about the risk for stroke when taking birth control pills
• ​​​​​​​Limit alcohol to one or two drinks a day. Having more than two alcoholic drinks a day can raise your risk of stroke by 50 percent, according to the National Stroke Association

Lisa Tarasenko, PharmD, is a Senior Medical Director at Pfizer.

Last reviewed 08/10/2019