Stroke among young people - what you need to know

Stroke is a serious medical condition that we typically associate with the elderly. But that doesn’t mean it can’t happen in young people. Read on to find out more about why stroke occurs in young people, the signs of stroke in young adults, the risk factors of stroke for young adults and more.

Stroke is a type of cerebrovascular disease, which affects blood flow in the brain. In 2018, cerebrovascular disease was the fourth most common cause of death in Singapore, accounting for 6.0per cent of all deaths in that year.

More often than not, we tend to think of stroke as something that only afflicts the elderly and the infirm. It may thus come as a surprise to learn that stroke can strike in young people as well, with equally serious consequences.

Why do young people have stroke?

Strokes in young people are actually fairly uncommon, comprising only 10 per cent to 15 per cent of all stroke patients.

In the context of stroke, we can understand young adults or young people to refer to those younger than 45 or 49 years of age, a commonly used definition in studies and registries. Beyond this age range, stroke is a disease that’s otherwise par for the course.

For most cases of stroke in young people, the underlying cause often goes undetermined, without any obvious reason. A definite cause is only determined and accounted for in about 20 per cent to 30 per cent of young stroke cases.

Common causes of young stroke include:

Large artery atherosclerosis

Large artery atherosclerosis refers to when the walls of your blood vessels change as a result of inflammation and accumulation of fatty deposits. Areas in your arteries with atherosclerosis are also often described as ‘plaque’.

The condition causes your arteries to narrow, forming blockages and impeding your blood flow. These plaques can also rupture, forming blood clots that go on to block arteries in various parts of your body, including your brain, heart, or leg.

Other than stroke, large artery atherosclerosis can also cause heart attacks, abdominal aortic aneurysms, peripheral vascular disease, and dementia.

ALSO READ: 12 ways to prevent a stroke

Cardiac embolism

Cardiac embolisms refer to when a blood clot forms in your heart and travels in your bloodstream before being lodged in an artery in your body. The blockage can then cause a stroke as the blood supply to vital organs and body parts is cut off.

Small vessel disease

Small vessel disease refers to when the walls of your small blood vessels like capillaries are damaged, leading to reduced blood circulation to your organs.

It primarily affects organs that depend on significant cardiac output, such as your brain, kidney and retinas.

Uncommon causes of young stroke include:

Nonatherosclerotic angiopathies

This refers to diseases of the blood vessels that aren’t caused by fatty deposits along your arteries. Such diseases can include Moyamoya disease, Susac’s Syndrome, and Sneddon’s Syndrome, just to name a few.

Hematologic conditions

This refers to medical conditions that affect your blood. Such conditions include antiphospholipid syndrome, hyperhomocysteinemia, sickle cell disease, leukemia, and lymphoma.

Genetic conditions

There are some genetic diseases that can also contribute to young stroke. They include Fabry disease, Marfan Syndrome, neurofibromatosis, and Sturge-Weber disease.

Inflammatory and infectious disease

Some inflammatory and infectious diseases can also cause young stroke. Some examples include Takayasu disease, HIV, Neurosyphilis, and tuberculosis meningitis.

While the common causes of stroke are largely related  to arterial disease, given that young stroke is relatively uncommon, it is worthwhile to give greater weight to uncommon causes of stroke when evaluating the causes of young stroke.

ALSO READ: Transient Ischemic Attack (TIA) 101: Symptoms, causes, treatment & recovery

Knowing the signs of stroke in young adults

Slurred speech, sudden numbness and weakness in our arms or legs— everyone knows the  classic symptoms associated with. It’s important that we learn to recognise them in ourselves and in our loved ones.

Young people are unlikely to report stroke-like symptoms, as they tend to not appreciate their risk of stroke.  Stroke in young adults is straightforward to diagnose when they present with typical symptoms of stroke seen in older patients as well.

Diagnosis for young stroke becomes challenging when atypical symptoms of stroke are present.

Here are some of them:

Nonlocalising symptoms

• Neuropsychiatric symptoms
• Acute confusional state/delirium
• Depressed level of consciousness

Abnormal movements

• Chorea
• Hemiballismus
• Dystonia
• Unilateral Asterixis
• Hemifacial Spasm
• Alien Hand syndrome/deafferentation
• Limb-shaking Transient Ischemic Strokes
• Seizures secondary to stroke

Cranial neuropathies

• Acute hearing loss
• Horner Syndrome
• Third Nerve Palsy
• Seventh Nerve Palsy

Isolated symptoms

• Isolated visual loss
• Isolated headaches

If you find that you or your loved ones are experiencing any of these symptoms you should seek immediate medical attention.

Stroke is a serious medical emergency no matter your age and medical help needs to be administered as soon as possible in all cases to ensure the best possible outcome for the affected individual.

Risk factors of stroke in young adults

There are certain risk factors for stroke in young adults that we should all be familiar with.

Women specific risk factors

Some risk factors for young stroke are specific to or more common for women. They include:

• Use of contraception containing estrogen
• Pregnancy
• Migraine with aura (more common)

Cardiovascular risk factors

Cardiovascular risk factors for young stroke include:

• Hypertension
• Dyslipidemia
• Diabetes
• Atrial fibrillation
• Cardiomyopathy
• Valvular Heart disease
• Obesity
• Infective endocarditis
• Congenital Heart Disease

Lifestyle risk factors

Lifestyle risk factors for young stroke include:

• Smoking
• Physical inactivity
• Poor diet
• Heavy or heavy-episodic alcohol consumption
• Drug use (methamphetamine, cocaine, heroin, etc.)

If you or your loved ones have any of these risk factors, you should be on the watch out for stroke and speak to a medical professional.

ALSO READ: Vaping and smoking tied to stroke risk in younger adults

How strokes in young people can be different

Other than the classic and atypical symptoms of stroke, stroke onset in adolescents and children are usually accompanied by a headache or seizure.

It is important to take note of this fact, as this could easily lead to a misdiagnosis of the stroke as a migraine or other condition, causing neglect. Consequences can be serious without timely medical intervention in the case of stroke.

Factors young people can control to reduce stroke risk

So what can we do to reduce our stroke risk? For young people, as their bodies are healthier and generally more robust, the number of factors that can be controlled to reduce stroke risk is higher than for seniors.

Accordingly, young adults should take the utmost care in reducing their stroke risk in whatever way they can to avoid becoming victims of stroke.

The easiest way to control your stroke risk is to control your lifestyle factors. They include:

• Quitting smoking
• Leading an active lifestyle
• Eating a healthy and balanced diet
• Moderating or avoiding  alcohol consumption
• Refraining from substance abuse

Reducing stroke risk doesn’t have to be a lonely endeavour either. Consider getting your friends and family to embark on these lifestyle changes together and have fun while doing so.

Recovering from a stroke

In the event that you do suffer from a stroke, you should also familiarise yourself with certain aspects of stroke recovery.

Recovery time for everyone is different. It is important to bear in mind that recovery can take weeks, months, or even years. Some people are able to recover fully, but others may suffer from long-term or lifelong disabilities.

You should not be disheartened by this, but try your best to work towards recovery with support from your family and friends.

As you recover, you may find yourself making great progress in regaining your independence. You may, however, continue to face certain problems:

• Paralysis (inability to move some parts of the body), weakness, or both on one side of the body.
• Trouble with thinking, awareness, attention, learning, judgment, and memory.
• Problems understanding or forming speech.
• Trouble controlling or expressing emotions.
• Numbness or strange sensations.
• Pain in the hands and feet that worsens with movement and temperature changes.
• Trouble with chewing and swallowing.
• Problems with bladder and bowel control.
• Depression.

These problems can be frustrating to experience during your recovery and you should remember to be patient with yourself. Seek support and help as and when you need and don’t be afraid to reach out to others.

Stroke rehabilitation

Stroke rehabilitation can involve several kinds of therapy.

These include:

Speech therapy

Speech therapy helps those with problems producing or understanding speech.

Physical therapy

Physical therapy employs exercises to help you relearn your movement and coordination skills that you may have lost after the stroke.

Occupational therapy

Occupational therapy is focused on improving daily activities, such as eating, drinking, dressing, bathing, reading, writing, and toileting.

Stroke is a serious medical emergency with potentially dire consequences that we should all strive to avoid. Hopefully with this guide you’ve learnt more about stroke in young adults and how to avoid the risk of stroke for yourself and your loved ones.

This article was first published in Homage.