From Our 2014 Archives
Strokes and the Toll They Take on Younger Adults
By Brenda Goodman, MA
Reviewed by Arefa Cassoobhoy, MD, MPH
Oct. 3, 2014 -- About 10% of the 800,000 strokes that happen in the U.S. each year strike adults younger than 45.
A stroke -- an event where blood flow to the brain is disrupted, either by a blood clot or bleeding -- can be devastating at any age. But when a younger adult has one, they're affected "in the prime of their life, in their most productive years," says Jose Biller, MD. He's the chairman of the department of neurology at the Stritch School of Medicine at Loyola University in Chicago.
And while adults over 65 seem to be having fewer strokes, studies suggest that these "brain attacks" may be on the rise in younger adults.
What's more, many doctors don't recognize stroke symptoms in younger patients, and a delay in diagnosis may lead to more permanent damage.
Struggling to Start Over
That's what happened to Lauren Rushen, who suffered a stroke at 24.
When she finally collapsed on the floor of her parents' home, unable to move her legs, doctors at the local hospital suspected she was abusing drugs and tested her for narcotics, rather than starting the clot-busting drugs that might have prevented permanent brain damage.
"I laid in my small-town ER for 2 hours. And we know now that time is everything," Rushen says. "That's really not where I needed to be spending 2 hours."
People having a stroke who get to the hospital within 4 and a half hours of their attack are eligible to get a drug that can break up a clot in the brain, restoring blood flow.
And studies show younger stroke patients are more likely than their older counterparts to benefit from this early treatment.
But sadly, few are eligible to get it, because they wait to get to the hospital, writing off early symptoms or waiting to see if they'll go away before they seek help. This is especially true for women.
Today, 6 years later, Rushen knows she's lucky to be alive. But sometimes, she misses the life she had before -- the one that included a full-time career, a regular jogging routine, and cute shoes.
One of her arms and a foot are still paralyzed. Instead of jogging, she spends hours each day in physical therapy. Rather than high heels, she wears thick-soled sneakers that help to keep her toes from dragging on the ground when she walks.
She's had to move back home with her parents. Although she still works, it's a part-time job at a church daycare, where her duties are limited for fear she might lose her balance and fall as she's helping the kids. Mostly, she says, she supervises their bathroom trips.
"It's really ironic, because I help the kids fasten their pants when I have my own issues with pants," Rushen says, with a sad chuckle. "You've got to start over, I guess."
An 'Extraordinarily Huge Public Health Challenge'
Her story is a common one. A study published in February in the journal Stroke found that one-third of people who have a stroke before age 50 are unable to live on their own a decade after the event.
"It's an extraordinarily huge public health challenge because we're talking about people who obviously have many years ahead of them, even having suffered a stroke," says Ford Vox, MD. He's a physiatrist at Shepherd Center, a rehabilitation hospital in Atlanta. The number of young stroke patients that hospital has cared for has tripled in just the past 8 years.
There's no single database that tracks strokes in the U.S., so researchers rely on regional or state hospital discharge data -- like that from Shepherd Center -- to try to estimate stroke trends.
The majority of those studies have found increases in stroke rates among younger people, while the most recent one found them declining in older adults, but holding steady for adults under 45.
That July 2014 study in the Journal of the American Medical Association tracked more than 14,000 adults for more than 20 years. It found that stroke rates dropped substantially in people older than 65, but held steady over time in younger adults.
The drop in seniors seemed to be explained by better control of risk factors like high cholesterol, high blood pressure, and cigarette smoking. Among younger adults, though, researchers noted increasing rates of obesity and high blood pressure, two major stroke contributors.
Other studies have shown increases.
Among 35- to 44-year-olds who'd had strokes in that study, nearly two-thirds of men and more than half of women had high blood pressure.
"It was just surprising that we're seeing that high of a rate of traditional risk factors in a younger population and that they're having stroke with those risk factors," says study author Mary George, MD. She's a senior medical officer with the Division for Heart Disease and Stroke Prevention at the CDC.
"It means that obviously, we have to do a better job of prevention," she says.
A Puzzle With Many Pieces
Experts say traditional risk factors seem to be playing a role when strokes happen in people in their mid-30s and mid-40s. But the picture is more complicated for younger adults like Rushen, who often have strokes for other reasons, like physical trauma.
"I was always very athletic. I wasn't overweight or any of those things," she says. "I had no risk factors. I still have no risk factors."
The best guess anyone could come up with was a fender bender she'd been in shortly before her symptoms began.
Doctors think whiplash from the accident caused a tiny tear, called an arterial dissection, inside a large blood vessel in her neck. The injury allowed a blood clot to form that eventually broke off and traveled to her brain.
Two subsequent visits to a chiropractor probably didn't help matters.
"Maybe the whiplash could have weakened the artery and the chiropractor just finished it," she says.
Recently, the American Heart Association (AHA) published a statement warning that neck adjustments done by chiropractors and osteopathic doctors might be linked to an increased risk of stroke.
No one has hard numbers on how often strokes follow neck adjustments, so the link is a controversial one. But the AHA says it felt compelled to issue a statement after hearing about more and more cases like Rushen's from its member doctors.
In fact, any sharp movement of the neck, whether it's at the chiropractor or a yoga studio, can cause an arterial dissection. Even leaning back over the sink at a hair salon can trigger a so-called "beauty parlor stroke."
Another factor that may be driving strokes in younger adults is drug abuse. Amphetamines, including meth, cocaine and marijuana, have all been linked to strokes in young adults.
And French researchers recently reported a stroke tie between the use of human growth hormone in children and the risk of bleeding strokes in adulthood. The use of growth hormones to increase height raised the risk of stroke two to five times, though the overall risk of having a stroke remained rare.
Still, for many young victims, the cause of the stroke simply isn't known. A recent study from 15 cities in Europe found that the cause couldn't be pinpointed in one-third of cases.
"There are a lot of pieces to the puzzle," George says.
Know the Warning Signs
For her part, Rushen says that anyone who's having sudden, unexplained symptoms should seek quick help, no matter what their age.
Not sure what the symptoms are? For strokes, it's helpful to remember the acronym F.A.S.T.
F -- Fallen or drooping face, especially on one side. Ask a person to smile. If they can't raise both corners of their mouth, something is wrong.
A -- The ability to raise arms and keep them there. If one arm drifts downward, something is wrong.
S -- Slurred speech. Have someone repeat a simple phrase. Is their speech slurred or strange?
T -- Impact of time. Call 9-1-1 immediately if you notice any of the above symptoms.
SOURCES: Lauren Rushen, age 30, stroke survivor, Charleston, S.C. Jose Biller, MD, chairman, Department of Neurology, Stritch School of Medicine, Loyola University, Chicago. Ford Vox, MD, physiatrist, Shepherd Center, rehabilitation hospital, Atlanta. Mary George, MD, senior medical officer, division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta. Koton, S. Journal of the American Medical Association, July 16, 2014. George M. Annals of Neurology, November 2011. Singhal, A.B. Neurology, Sept. 17, 2011. American Stroke Association: "Warning Signs of Stroke."