Each year, 795,000 people experience a stroke, and thousands are at risk of having one in the future. Although most people who have strokes are older than 60, up to 10 percent of all strokes occur in those under age 45. This includes infants, high school students, and young adults. No matter the age demographic, you can recognize the sign of a stroke with the universal acronym F.A.S.T.
Signs and Symptoms
Recognizing the signs of stroke in young adults is similar to determining if an older adult is experiencing a stroke. The F.A.S.T. test has become the universal identification tool to examine three main signs of stroke: facial/arm weakness and speech disturbance. The F.A.S.T. acronym stands for:
F: Face drooping – does one side of the face droop, or is it numb. Ask the person to smile. Is the person's smile uneven?
A: Arm weakness – is one arm weak or numb? Ask the person to raise both arms; does one arm drift downward?
S: Speech difficulty – is speech slurred when the person talks?
T: Time to call 911
Source: American Stroke Association
BE FAST Test
The BE FAST acronym expands the traditional F.A.S.T. tool to better use with younger people who may not initially present the conventional signs of a stroke. BE FAST stands for:
B: Balance – a sudden loss of balance or coordination
E: Eyes – sudden vision loss in one or both eyes and having double vision
F: Face – any dropping on one side of the face
A: Arm – sudden weakness or drifting in one arm or leg
S: Speech – slurring or difficulty speaking or understanding words
T: Time – quickly call 911 if you or anyone else around you experience any of the symptoms
Causes of Strokes in Young Adults
Strokes are the leading cause of death in the United States. They are a primary cause of severe disability for older adults. Although older adults have been the primary population experiencing strokes, they have been on the rise in younger adults. Over the last decade, there has been a 44 percent increase in younger adults hospitalized due to a stroke.
There are two types of stroke: ischemic and hemorrhagic. Hemorrhagic strokes are relatively rare and only makeup about 13 percent of strokes. Hemorrhagic strokes occur when a weakened blood vessel ruptures and bleeds into the surrounding brain; as the blood pools and accumulates, it compresses the surrounding brain tissue.
Ischemic strokes are the most common type of stroke across all populations. They are caused by artery-blocking blood clots that travel to the brain. The primary causes of ischemic strokes in younger adults are very similar to those causes in older adults. Diabetes, high blood pressure, high cholesterol, obesity, and cigarette smoke can all cause atherosclerosis. This is cholesterol-filled plaque that hardens in the arteries and restricts blood and oxygen flow, leading to stroke.
Other conditions that can lead to an increase in the risk of stroke in young adults include:
- Congenital heart disease
- Blood clotting disorders
- Sickle cell disease
- Metabolic conditions
- Kidney disease
- Drug abuse
- Artery tears
Stroke Prevention for Young Adults
Young adults have an advantage in making adjustments to health behaviors and reducing risk factors that can help prevent stroke. They can also reduce the severity if a stroke does occur. The primary way to reduce the risk of stroke is to maintain a healthy diet and weight. Regular physical activity, a nutritious diet of fruits and vegetables, and a limiting intake of saturated and trans fat and cholesterol can significantly reduce the risk of ischemic stroke. Additionally, maintaining a healthy lifestyle can lower your risk for diabetes, high cholesterol, and high blood pressure.
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Stroke Treatment For Young Adults
Treatment for stroke in young adults is the same as stroke treatment in older populations. With ischemic strokes, the main goal is blood clot removal which can be achieved through medication and medical treatments.
Medical treatment with a tissue plasminogen activator known as alteplase is considered the gold standard of stroke treatment. Alteplase is a thrombolytic medication administered through an IV in the arm. It works to dissolve the clot and improve blood flow.
Endovascular procedure — which means procedure inside the blood vessel — is a more invasive way to remove the clot in eligible patients. In the procedure, doctors use a wire device called a stent retriever. The retriever is threaded with a catheter through an artery in the groin and to the blocked artery in the brain. After reaching the brain, the attached stent then opens and grabs the clot.
Recovery from Stroke
Young adults typically recover from stroke damage better than older adults, especially if no other underlying health conditions are present. Experts have found that improved recovery is connected to the younger brain's ability to use undamaged circuits to compensate for damaged circuits. In older patients, the ability of the brain to use intact circuits and overcompensate for the damage is much more difficult.
The road to recovery looks different for everyone, even young adults. Depending on the severity of the stroke, your provider might suggest physical therapy or rehabilitation to regain strength and cognitive function. This might include participation in fitness activities and group exercise for younger adults. Cognitive rehabilitation might consist of increased socialization and integration back into family and community, with the guidance of a medical team.
Although the physical road to recovery is overall much better for younger adults, there are numerous other challenges young adults can face following a stroke, including uncertainty in career, financial burden, and relying on family, spouse, and friend support networks.
A stroke can lead to temporary or permanent changes in employment. You might face weakness, fatigue, language impairment, and concentration challenges following your return to work. This could lead to seeking out temporary adaptive equipment and changes in work responsibilities.
In young adults, stroke usually occurs years before retirement. Nevertheless, patients typically do not have enough savings to support themselves and their families during stroke emergencies and recovery. This can lead to a shift in family or friend roles and responsibilities as someone else in the dynamic might have to become the primary caregiver.
Another financial aspect to consider when experiencing a stroke at a young age is the cost of treatment and, if needed, rehabilitation. According to the Journal of Stroke and Cerebrovascular Diseases, the average cost of a stroke hospital stay for patients ages 18-64 was between $20,396 and $43,652. Furthermore, the average cost of post-stroke rehabilitation and medications within the first year as an outpatient was an average of $17,081.
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Strokes in Young Adults FAQ(s)
Below are commonly asked questions about strokes in young adults.
What is a mini-stroke?
Mini strokes are a subcategory of ischemic strokes known as a transient ischemic attack (TIA). There is a brief interruption of blood flow to part of the brain or spinal cord during a transient ischemic attack. The interrupted flow causes temporary stroke-like symptoms but does not cause permanent brain cell damage or disability. TIA usually only lasts a few minutes but can persist for up to 24 hours.
Although the severity and risk for permanent damage are significantly reduced, it is essential to seek immediate medical attention since the signs and symptoms are identical to a traditional stroke. For TIA, the F.A.S.T test can still be used to determine your condition.
What happens if a mini-stroke goes untreated?
It's important to note that you should seek medical attention immediately if you are showing signs of a stroke. It is impossible to determine if you have a TIA or traditional stroke with just the F.A.S.T test. Mini-strokes are often early warning signs that you might be at risk for a traditional stroke. Furthermore, conventional stroke risk is significantly higher within 48 hours following a TIA.
If a TIA is left untreated, you run the risk of causing additional damage to your brain cells and a higher risk for traditional stroke and even more significant damage. If you seek medical treatment for your TIA and don't follow your recommended care, you are putting yourself at risk for another stroke and greater cognitive and physical impairment.
What is a silent stroke?
As the name suggests, a silent stroke is an ischemic stroke that does not present any notable signs or symptoms, meaning you could have a stroke without noticing. Silent stroke disrupts the blood supply to the part of your brain that does not control any visible functions like speaking or moving. Most people find out about a silent stroke when they have an MRI or CT scan for an unrelated condition.
Silent strokes can continue for a more extended period than standard strokes and mini-strokes. Furthermore, the damage can be cumulative and permanent given the typical time-lapse between occurrence and medical diagnosis. Additionally, once you have one silent stroke, you are at risk for having multiple down the road; an accumulation of numerous silent strokes can put you at risk for vascular dementia, even in young adulthood.
Being at risk for a stroke is not limited to the older age demographic. With the rise in stroke prevalence amongst young adults, teaching stroke recognition acronyms to younger populations can be a life-saving tool to decrease the time it takes to receive proper care. Fortunately, with the road to recovery being less severe for young adults, it's important to note that life after stroke has a greater chance of returning to normal.
Prioritizing your overall health is a crucial way to prevent strokes. Luckily, Mira offers a low-cost option for you and your family. For as low as $45 a month, members get access to affordable virtual and urgent care visits, up to 80 percent off over 1000 different prescription medications, and same-day lab testing. Put your health first; sign up for Mira today.
Originally from Houston, Texas, Alexandra is currently getting her Master's in Public Health with a health policy certificate at Columbia University. One of her life goals is to own her own art gallery!