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Number of Stroke Cases in Middle Age Rising Fast

Stroke is often seen as a condition that only affects the elderly, but stroke among younger adults is a growing problem that could have serious health effects.

Each May during Stroke Awareness Month, medical professionals and health organizations educate the public about stroke prevention, detection, and patient care. It’s an important effort, as stroke kills more than 130,000 people each year in the United States, making it the fifth leading cause of death.

About 80% of strokes are ischemic strokes, which happen when the blood supply to part of the brain is shut off or reduced – usually by blockage of an artery in the brain from a blood clot. This causes brain cells to die as they are starved of oxygen. In the past 10 years, the number of ischemic strokes among people age 45 and under has grown 44%.

Coping With the Unexpected

Dawn Williams
Dawn Williams and son Parker Williams

On average, younger stroke patients tend to see better physical recovery than do older patients. However, the burden of disability often falls harder on younger patients, in some cases due to how disruptive stroke can be at a relatively young age. Dawn Williams, internal communication manager for UAB Medicine’s Marketing and Communications Department, understands this all too well. She had a stroke in October 2014 at the age of 34.

“I was having terrible headaches radiating up the left side, the kind that just stop you cold sometimes,” says Williams, now 38. “I chalked it up to sleep deprivation, caring for a four-month-old and a five-year-old, and stress. After waiting an entire week, I went to UAB Urgent Care. The nurse there discussed with me for almost 30 minutes the tiny details of the pain I was having, but I just thought she was being extra thorough. I recall wondering why in the world she was talking about symptoms of a stroke. It wasn’t anything I had ever considered. I learned later that, in her prior experience as an emergency nurse, she had learned to spot the less obvious signals — ones not immediately associated with stroke. I was referred to the UAB Comprehensive Stroke Center, where scans revealed that I had in fact had a stroke.”

Williams’ scans indicated that she had experienced vertebral arterial dissection (VAD). VAD refers to the formation of a tear along the inside wall of an artery. As the tear continues, it forms a small pouch that gathers blood, often causing blood clots or other blockages that lead to an ischemic stroke or a transient ischemic attack (TIA). Sometimes called a mini-stroke, a TIA usually lasts only a few minutes and causes no permanent damage. VAD is one of the most common identifiable causes of stroke in those ages 18-45, but it is difficult to detect and diagnose. Without treatment, young patients with VAD may suffer serious neurologic complications or even death.

Williams credits the UAB Medicine staff with saving her life that day, but her problems did not end there. Just before Christmas the same year, she experienced another arterial dissection. With her condition seriously deteriorating, she was admitted to the Neurosciences Intensive Care Unit for observation to determine if surgery was needed. She recovered from the potentially life-threatening episode without needing surgery, but she was told that she would require ongoing observation and would face significant lifestyle changes. She currently is under the care of UAB Medicine neurologist Michael Lyerly, MD.

“My life is very different now,” Williams says. “My immune system has suffered, perhaps because of the trauma of the arterial dissections. My medical care now is excellent but time-consuming. I saw my neurologist, Dr. Lyerly, my primary care physician, and a GI and a rheumatologist for the first two years to monitor medications. Now I get pain blocks every three months. I’m coming up on five years of seeing some type of specialist every 90 days. I also have the ongoing concern about another stroke. I’m never not thinking about it, and so I describe all this as my ‘new normal.’ Should I get a massage and risk some pressure on my neck? Should I get on this ride at Six Flags with my boys? Is this exercise move safe? Since we don’t even know the cause of what happened, I can’t say, ‘Well, I was doing this thing that caused a stroke; going forward I won’t do that anymore.’ It’s the unknown that is so scary.”

A Coming Crisis

For many young stroke victims, what Williams calls a “new normal” can be especially challenging. Unlike older stroke patients who may have retired, have support mechanisms in place, and sometimes have a less-demanding lifestyle, those in the prime of their careers and family responsibilities often face devastating obstacles. Given the greater loss of productivity and quality of life that stroke at a young age can cause, some predict a coming social crisis if this patient population continues growing at the current rate. Dr. Lyerly says he sees this potential problem in his practice.

Michael Lyerly, MD
Michael Lyerly, MD.

There has been an increase in stroke mortality, in general, beginning around 2014,” Lyerly says. “This affects young patients now, likely driven by the fact that we are seeing traditional risk factors, such as high blood pressure and diabetes, earlier than we expect. We live in the ‘Stroke Belt,’ which ranges from the Carolinas over to Texas, where you see both the highest incident rate and the highest mortality rate. Alabama is one of the highest-risk states in the nation. Research studies indicate that diet in the South plays a large role. If you increase obesity and related vascular issues, then you increase stroke risk among that same young population.”

In some young people, stroke is caused by factors different than those typically seen in older patients. Some factors are related to traumatic injury or injury to a blood vessel itself, certain genetic conditions, and some rare heart conditions. Trauma can affect the blood vessels leading to the brain, which may lead to a blockage or blood clot, which can cause stroke. Additionally, research suggests that younger stroke victims are more at risk because they may neglect traditional stroke symptoms that an older person might take more seriously.

“If someone in their 30s or 40s reports, as we often hear, ‘the worst headache they’ve ever had,’ or complains of severe pain in the face or neck, they probably aren’t going to put stroke at the top of their list of causes,” Dr. Lyerly says. “That’s true for doctors, too. With young patients complaining of neurological issues, there are many other considerations, including multiple sclerosis, trauma to the brain, and metabolic issues. The good news is that recognition is improving for patients and professionals. Public education campaigns have helped everyone understand the signs and symptoms of stroke and how to detect them. We certainly have seen that through the development of the UAB Comprehensive Stroke Center, and we’ve made great strides in training our practitioners to consider stroke in patients, regardless of age.”

Time Matters

Dr. Lyerly emphasizes the importance of getting to the nearest hospital as quickly as possible in potential stroke cases, as modern therapies designed to unclog blood vessels are time-sensitive. The longer the brain goes without blood supply, the more likely it is that the patient will suffer damage or irreversible injury.

“All of our medical teams are trained to work extremely fast toward diagnosis to determine if a patient is a candidate for those technologies we now have to restore blood flow to the brain.” Dr. Lyerly says. “We emphasize the phrase, ‘time is brain.’ For every minute that treatment is delayed, more neurons are lost.”

UAB Medicine was the first hospital in Alabama to be certified as a Comprehensive Stroke Center. Click here to learn more about the Stroke Center, factors that affect your stroke risk, and how to identify the signs and symptoms of stroke.