Think You're Too Young for a Stroke? Think Again.
Think You're Too Young for a Stroke? Think Again
Find out about the causes of stroke in people younger than 45, and how to prevent it.
Medically Reviewed by Samuel Mackenzie, MD, PhD
For most young people, the chance of having a stroke seems like an impossibility — but there is no such thing as being too young for stroke. Your stroke risk increases with age, but stroke in young people, including infants, children, adolescents, and young adults, does happen. In general, however, most experts consider a young stroke age to be under 45.
Even though the overall rate of stroke is decreasing, it is increasing for young and middle-aged people. A study published in October 2012 in the journal Neurology looked at stroke trends in the Greater Cincinnati area in 1993, 1994, and 2005. They found that the average age of stroke decreased from 71 in the mid-nineties to 69 in 2005. While those younger than 55 accounted for about 13 percent of all strokes in 1993 and 1994, that number rose to nearly 19 percent in 2005.
One reason for increased detection may be the use of MRIs for picking up early changes in the brain after a stroke — a technology that wasn't as widely used 20 years ago. On the other hand, several studies have shown that many of the risk factors that make someone susceptible to stroke, such as high blood pressure, high cholesterol, diabetes, and obesity, are becoming more common in younger people. The Centers for Disease Control and Prevention recently conducted a study examining whether or not younger people are truly experiencing more strokes, and while their full report hasn't been released yet, their early conclusions seem to indicate that the higher number of strokes may be linked to an increase in risk factors.
Here are some statistics for annual incidence of stroke in those younger than 45 in the United States:
- From birth to age 19, there are nearly 5 strokes for every 100,000 children.
- Stroke in all people under 45 ranges from 7 to 15 per 100,000.
How Stroke in Younger People Is Different
Treating and managing stroke in people younger than 45 requires a different approach because you need to look for different causes. "Compared with stroke in older people, stroke in the young is a different beast," says S. Ausim Azizi, MD, PhD, a professor and the chair of neurology at Temple University Medical School in Philadelphia.
There are several types of stroke, but all of them are caused by decreased blood supply to the brain. The most common type is an ischemic stroke, and they're either caused by a blood clot in the brain's blood vessels, or a blood clot that develops outside the brain and travels to those vessels.
"Cardiogenic causes account for more stroke in young adults. Another cause to watch out for in young people is drug use, especially intravenous drugs," says Dr. Azizi. Cardiogenic causes may include rheumatic heart disease, heart valve abnormalities, and being born with a hole between the right and left side of the heart, called a patent foramen ovale.
"Up to 25 percent of stroke under age 45 is caused by a dissecting blood vessel in the neck. This is a small tear in a big blood vessel that causes a clot to form and travel to the brain. Other stroke causes that have been linked to younger stroke age include migraine, pregnancy, birth control pills, and smoking," says Andrew Russman, DO, a neurologist and the medical director of the Comprehensive Stroke Center at the Cleveland Clinic in Ohio.
Stroke Prevention and Recovery in Younger People
"If you accept that stroke is increasing in people under age 45, one big reason is probably obesity,” says Dr. Russman. “Obesity in children and teens is up in America, and that increases the lifetime risk for stroke. Obesity increases the risk for high blood pressure, high cholesterol, and diabetes. These are all important stroke risk factors at any age."
It's never a bad time to employ these stroke prevention strategies:
- Work with your doctor to identify underlying diseases.
- Exercise regularly and maintain a healthy weight.
- Eat a diet low in saturated fat and high in fruits, vegetables, and whole grains.
- Start controlling high blood pressure and high cholesterol at an early age.
- Recognize and control diabetes.
- Avoid alcohol, drugs, and smoking.
One of the big differences between stroke in older people and younger peopleis recovery. Stroke in young people can mean a lifetime of recovery and a loss of many productive years. "About 15 to 30 percent of people who have a stroke have some long-term disability. The good news is that a 30-year-old has a better rate of recovery than an 80-year-old because of better brain plasticity," the brain's ability to adjust and learn new skills, says Russman.
A review article on ischemic stroke recovery in young adults, published in the journal Stroke Research and Treatment, found that recovery is much better for younger people than for older adults.
Here are some findings from research reviewed in the article:
- Survival is more than 90 percent at five years compared with 40 percent for old age stroke.
- Ninety percent are able to live independently compared with about 40 percent of old-age stroke.
- 50 to 70 percent are able to return to work after a stroke.
- Five-year stroke recurrence rates are half what they are for the elderly (15 percent vs. 30 percent).
"The key to managing stroke in young people is to identify and treat the underlying causes. Reducing risk factors, just as in older stroke, is the key to preventing a first stroke or a recurrent stroke," says Russman.