Young and healthy? Strokes are still possible for you

Yes, it’s true that most stroke victims are older. But, if you’re young, it’s important to know that stroke can happen to you: About one in seven strokes are in people ages 15 to 49, according to the federal Centers for Disease Control and Prevention (CDC).

You’re more likely to have a stroke if you smoke, drink alcohol excessively or use drugs, or if you have high blood pressure, high cholesterol or diabetes. But even young, healthy people can have hidden risk factors.

For the young, the good news is that strokes in people under 55 are relatively rare when compared with the older population. Read below to learn why you could be at risk, symptoms of a stroke and why it’s important to get quick care.

What is a stroke?

A stroke happens when there is a loss of blood flow to part of the brain, rapidly causing damage to brain tissue.

There are two types of strokes. Ischemic strokes are caused by a blocked blood vessel limiting blood flow in the brain. They are the most common, accounting for 80% to 85% of all strokes. Hemorrhagic strokes, sometimes referred to as “bleeding” strokes, are caused when a blood vessel in the brain bursts.

You may have also heard the term “mini stroke.” Mini strokes are ischemic strokes referred to as “mini” because symptoms resolve within 24 hours. They’re often considered warning strokes, indicating that a more severe stroke is more likely to occur in the future.

Risk factors

Unlike heart attacks, which we often see in people in their the 40s and 50s, strokes do tend to occur later in life. The average age of a stroke patient is in the 70s, and CDC data shows us that your chance of having a stroke roughly doubles every 10 years after age 55.

Fewer than 1% of people ages 20-39 have experienced stroke, according to the CDC’s National Health and Nutrition Examination Survey. Among those ages 40 to 59, fewer than 2% of men and fewer than 3% of women have suffered a stroke.

Older adult risk factors, such as smoking, diabetes, high cholesterol and high blood pressure, can lead to atherosclerosis — plaque buildup in the arteries. That’s typically not found in young people.

Among risk factors in the young is IV drug use, which can lead to endocarditis, an infection in that can affect the heart’s lining, a heart valve or a blood vessel. So, in areas with a higher amount of IV drug use, we do tend to have higher rates of stroke in the young.

Sometimes the cause in young people is unknown. Sometimes it’s related to a heart condition, such as a hole between the heart’s upper chambers, which is found in about one in four people. And there are extremely rare causes of stroke, such as dissection, which is a tear in an artery, or a genetic condition that runs in families and makes it more likely you could experience a stroke.

Unfortunately, people don’t always know they have these conditions and there’s no indication of risk. Sometimes, a relatively healthy young person in their 20s, 30s or 40s has a stroke out of the blue, and we test for things that could predispose them to stroke.

Stroke symptoms to watch for

Symptoms typically come on suddenly and without warning. Further, treatment is more effective the sooner it’s received, and some treatment can’t be administered if there’s too long a delay.

That's why recognition of a stroke symptoms and recognizing that it’s an emergency are important. If you experience or see someone having what you think is a stroke, call 911 and get to the emergency department as soon as possible.

Use the letters in “BE FAST” to help remember and recognize stroke signals and the need for urgency:

• Balance issues, such as trouble walking
• Eye problems, such as double vision or inability to see
• Face drooping or paralyzed
• Arm paralysis or inability to move
• Speech difficulty, such as inability to talk or slurred or incoherent speech
• Time is of the essence — get to an emergency room

More good news for young people

Younger people who have strokes tend to fare better than older people, both in terms of initial injury and recovery. In fact, young people rehabilitate exceptionally well after any kind of brain injury. This is because younger people have a lot of what's called plasticity. Think of plasticity as a reserve or the ability to compensate for injury in relatively young brains.

Still, everyone is different, and recovery after stroke is extremely individualized. Most people of any age do improve over time, with symptoms being at their worst at the time of the stroke.

Stroke prevention

If you’ve never had a stroke, keep in mind the risk factors. If you smoke, quit. If you drink alcohol excessively or use illegal drugs, get help to stop. If you have high blood pressure, high cholesterol or diabetes, get treated so it’s under control. Make sure you eat a well-balanced diet and stay physically active.

The same recommendations apply if you’ve had a stroke, and your physician also will likely prescribe medication to reduce your chances of another stroke.

Stroke treatment and looking forward

Advancements in stroke treatments have been substantial, with the approval in the 1990s of IV medication that can dissolve blood clots that cause sudden strokes. In more recent years, we’ve come even further. In the late 2000s, we began doing mechanical thrombectomy, a minimally invasive surgery that pulls blood clots out of the brain. Initially, the procedure was approved for use in people up to six hours after a stroke, but just four years ago the window was expanded to 24 hours.

Each of these advancements has been a game changer in terms of stroke treatment, allowing us to treat more and more people who’ve had strokes. With the expansion to 24 hours for surgery eligibility, we've found that the number of patients who are eligible for treatment has now doubled.

Further studies are going on now to improve existing treatments or find new treatments.