A stroke can happen to anyone at any age, regardless of race, gender, previous history, or other common risk factors like obesity and high blood pressure. Stroke in young adults, those between the ages of 18 and 50, accounts for about 15% of the nearly 800,000 strokes that occur in the US every year1. That’s about 120,000 young adult brains.
Strokes in young adults are much more common than you may think. When I was 47, I thought I was much too young. Until I had a TIA and an ischemic stroke in the same year. If you fall into this population, you may be at high risk and not even know it.
How Common is Stroke in Young Adults?
The incidence of stroke in people ages 20-44 has risen from 17 per 100,000 in 1993 to 28 per 100,000 in 20152. Not to say that the remaining life of a 70-year-old is any less precious, but the risks that strokes present to those of us in the so-called prime of our lives cannot be understated.
But we’re young, we exercise, eat right, don’t smoke, don’t drink too much, don’t have diabetes, and generally do all the right things. We don’t have to concern ourselves with strokes.
Or the possibility of long-term disability, anxiety, the burden on our families and caregivers, and the overall community.
Right?
Strokes are equal opportunity brain destroyers and indiscriminate killers. A stroke can happen at any time and to anyone, regardless of age, gender, or even apparent health status.
What is a Stroke?
A stroke happens when a blood clot or a burst blood vessel prevents blood from getting to where it’s supposed to go in your brain. When this happens, your brain starts to die within minutes.
When you’re having a stroke, the part of your brain being supplied by the damaged or blocked blood vessel can’t get the oxygen it needs, and your brain cells begin to die off. And once brain cells die, they’re gone.
Forever.
There’s a saying in the stroke community: “Time is brain,” and I can’t stress enough how powerfully true it is.
Causes and Types of Stroke in Young Adults
A stroke is typically caused by an obstructed or ruptured blood vessel, specifically a blood vessel that supplies blood to the brain. There are two main types of strokes, each with its corresponding root cause: ischemic (blocked blood vessel) and hemorrhagic (burst/ruptured blood vessel).
Ischemic Strokes
An ischemic stroke occurs when an artery that supplies blood to an area of the brain is blocked by either a blood clot or a cholesterol deposit. Ischemic strokes are far less common in younger adults than in older adults3.
Ischemic strokes represent roughly 85% of strokes in the overall stroke population and 60% of strokes seen in patients under 50 4.
Hemorrhagic Strokes
A hemorrhagic stroke occurs when a blood vessel inside the brain bursts, causing blood to leak into spaces around the brain. This can result in pressure building up inside the skull, pressing on and damaging the surrounding brain tissue.
Hemorrhagic strokes comprise about 15% of all strokes, but 40% of strokes in patients under 50 5.
General Risk Factors for Stroke
Many stroke risk factors are lifestyle-related. This means that most, if not all, are entirely avoidable and oftentimes reversible. Historically, general stroke risk factors like the ones I will list below commonly affected the older population, leaving younger adults relatively untouched.
Today, though, due in large part to poor Western diets and a lack of exercise, current research shows that younger adults are now more likely to fall victim to these same risk factors, and in some cases at higher rates than their older counterparts6.
General Stroke Risk Factors
- A diet high in sugar and highly processed foods
- Obesity-related complications
- Type-2 diabetes
- High blood pressure
- Obstructive sleep apnea
- Elevated cholesterol
- Cigarette smoking
- Excessive drinking
- Lack of physical activity
Risk Factors for Stroke in Young Adults
Most of the general stroke risk factors I listed above impact both older and younger adults. There are, however, two stroke risk factors that tend to target the younger population:
- Cervical Artery Dissection
- Patent Foramen Ovale (PFO)
Cervical Artery Dissection
Arterial dissections happen when the inside wall of an artery tears. Blood can then enter the tear and separate the layers of the artery wall. The dissection can create a weak spot that can lead to a life-threatening leak. Damage to the walls of large blood vessels in the neck can disrupt blood flow, leading to clot formation and stroke.
Cervical artery dissection accounts for about 2% of strokes in patients over 65, while it has been seen in as many as 25% of strokes in young adults8. Dissections can occur spontaneously or due to intense physical stress on the neck, such as vigorous coughing, heavy lifting, or vomiting.
Patent Foramen Ovale (PFO)
Patent foramen ovale (PFO) is a hole, or small flap-like opening, in the wall separating the two upper chambers (atria) of the heart. Typically, this hole, called the foramen ovale, seals itself during infancy, but in some cases, it fails to close and remains open throughout a person’s life. About 24-40% of the population has a PFO and does not require any treatment.
Sometimes small blood clots may form in the veins and travel to the heart. Once there, they may go through a patent foramen ovale and into the left side of the heart, where they can travel to the brain and block blood flow. The result is an ischemic stroke.
Preventing Stroke in Young Adults
If you’re one of the unlucky few with the genetics that predispose you to stroke or who have a congenital defect that puts you at higher risk, there’s not much you can do. You’ve been dealt a crappy hand and you’ve gotta play it.
When it come to preventing stroke, it’s essential to focus on the things that you can control.
Making positive lifestyle changes is the single most effective way to lower your risk of having a stroke. Some of the best ways my doctors have shared with me to lower my stroke risk through lifestyle modification include:
- Don’t smoke
- Monitor salt intake
- Exercise – stay physically active
- Keep alcoholic drinks to no more than 3-5/week
- Minimize your intake of processed foods and sugar
My Personal Stroke Journey
I’m living proof that strokes don’t discriminate. In 2021, at the age of 47, I suffered two strokes. That January, I rang in the New Year with a transient ischemic attack (a so-called mini stroke). Later that December, I was gifted a full-blown ischemic stroke for the holidays.
I escaped both with minimal physical damage, but they changed my life forever.
I was young-ish, outwardly healthy, with no obvious risk factors, and a happy obliviousness to strokes.
My TIA was a warning sign, a foreboding omen of what was to come. With quick action, I survived both of my strokes, and now I want to use the time I have left on this planet to tell you about it.
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3 https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024156
4 Why is stroke on the rise in young adults? | Stamford Health
5 Why is stroke on the rise in young adults? | Stamford Health
6 Young adults have strokes for the same reason as older adults | American Heart Association
7 Arterial & Aortic Dissections | UVA Health
8 Prevalence of Cervical Artery Dissection Among Hospitalized Patients With Stroke by Age in a Nationally Representative Sample From the United States – PMC (nih.gov)