I just read that startling statistic in a report noting that while stroke incidence is going down in the elderly, it's going in the opposite direction -- up -- in the younger set. The American Stroke Association reported at its 2010 conference that the percentage of Americans who have a stroke between the ages of 20 and 45 climbed to 7.3% in 2005 from 4.5% in 1994. Wanting to understand more fully what's behind this worrisome trend, I placed a call to Steven R. Messe, MD, assistant professor of neurology and director of the vascular neurology fellowship at the Hospital of the University of Pennsylvania.
What Makes Young People Vulnerable?
According to Dr. Messe, strokes in young people often don't have the same root causes as they do in older folks. Rather than hardening of the arteries (arteriosclerosis) or vascular risk factors (such as high blood pressure), when a person younger than 45 has a stroke, it's likely due to one of the following three causes:
Dissection of the artery. More common in younger stroke victims than older ones, this refers to a separation or tearing of the inner wall of the carotid or vertebral arteries in the neck leading to a blood clot. It may be the result of a "trauma" (though that can be a misleading term since the aggravating factor can be as seemingly harmless as craning to paint a ceiling, doing a yoga pose or leaning back to have your hair washed in a sink, which is so common it has a name -- the well-known "beauty parlor stroke") or a genetic predisposition for weak connective tissue.
Dangerous lifestyle habits. Well-known risk factors for stroke include obesity (leading to poorly controlled diabetes, elevated cholesterol and high blood pressure), smoking and drug abuse. Of particular danger are stimulating drugs, such as cocaine and amphetamines, that ramp up blood pressure and have a direct effect on cerebral circulation, including inflamed blood vessels and vasospasm.
Hypercoagulability. People who have a higher-than-normal tendency to form clots are at higher risk for stroke, no matter their age. This could be from a genetic bleeding disorder (such as thrombophilia) or from medications, such as contraceptives.
While the range of potential causes is different, the types of strokes young people suffer are the same as for their elders: ischemic stroke, hemorrhagic stroke and transient ischemic attack (TIA).
What's the Outcome?
While younger people can be left with permanent disability after stroke, that's less likely to be the case than with their elders -- youth brings a healing advantage. Paradoxically, however, a young person who has a major stroke involving a large volume of brain is less likely to survive it.
Why? Normal aging brings some brain shrinkage, naturally creating space between the brain and skull that can accommodate some swelling after a stroke. Younger brains, on the other hand, are "big and full," Dr. Messe said, and there's no place for the swelling to go. Emergency surgery quickly performed -- removing a portion of the skull to make space for swelling -- can be lifesaving and will up the odds of recovery.
Reminder: Symptoms of Stroke
The following are symptoms of stroke whatever the person's age. If you suspect stroke, time is of the essence -- having one or more of these symptoms demands prompt medical action. Call 911 quickly and request transport to a stroke-certified hospital, if possible.
•Sudden numbness or weakness of the face, arm or leg, especially if it is on one side.
•Sudden confusion or trouble understanding or talking.
•Sudden trouble seeing in one or both eyes.
•Sudden trouble walking, dizziness, lack of balance or coordination.
•Sudden severe headache with no known cause.
And remember, even if these symptoms pass quickly, it is important to get in touch with the doctor immediately. Stroke is serious, no matter how old -- or young -- you are.
Steven R. Messe, MD, assistant professor of neurology, director of vascular neurology fellowship, Hospital of the University of Pennsylvania, Philadelphia.