There's a troubling statistic in the United States when it comes to strokes. Although stroke hospitalizations have declined in recent years among the aged, the opposite appears to be be happening among younger Americans. In a study released Wednesday in the Journal of the American Heart Association, researchers found that between 2000 and 2010, hospitalizations for ischemic stroke, the most common type, dropped nearly 20 percent overall - but among people ages 25 to 44, there was a sharp 44 percent increase in the rate.
Ischemic stroke accounts for about 80 percent of all strokes and occurs when a blood vessel in the neck or brain is blocked. Deprived of blood's oxygen and vital nutrients, brain cells begin to die and the abilities controlled by that part of the brain, like muscular control or speech, are compromised.
Doctors attribute the apparent rise in strokes among younger adults to the same lifestyle risk factors traditionally found in older patients, such as obesity, diabetes and high blood pressure. For other young adults, stroke may be caused by rare conditions, like congenital heart defects, or injury to the arteries in the neck, which can be caused by even minor trauma.
"When people think of stroke, they think of Grandpa who smokes and has high blood pressure," says neurologist Lee Schwamm, director of Massachusetts General Hospital, Acute Stroke Services. "And while he's more likely to have one, it doesn't mean that if you're young and healthy you can't have a stroke too."
Roughly 90 percent of the 800,000 strokes each year in the United States happen to adults age 50 and older, but the new study underscores just how significant the risk is for those who are younger.
The data analyzed includes information on 8 million hospital stays and came from the Nationwide Inpatient Sample, the largest publicly available database in the United States on these patients. The researcher found that stroke hospitalizations decreased in the two oldest age groups: For those 85 and older, stroke hospitalizations went from 2,077 per 100,000 to 1,618; those ages 65 to 84, the ratio dropped from 846 per 100,000 to 605. But for those ages 45 to 64, the rate rose from 149 per 100,000 to 156; and for those ages 25 to 44, from 16 to 23 per 100,000.
The researchers said their results should be interpreted with caution because some people fail to recognize that they are having a stroke and don't seek medical attention, so the number of hospitalizations may be lower than the actual number of people experiencing the condition. Also, among the younger individuals, "we cannot rule out that changes were due to chance since the number of events were small." However, the researchers added that their findings are consistent with smaller regional studies - such as one in Cincinnati and northern Kentucky - that also showed a similar trend of increasing strokes among younger Americans.
Robin Dickinson's case serves as a cautionary tale about why even the young should be vigilant about recognizing symptoms of stroke. At age 31, she was married with two young children and working as a family physician near Denver when she unknowingly suffered two strokes within days of each other. The second sent her to the hospital.
"With both strokes, I instantly started spinning and would fall over if I closed my eyes," she said, "but I dismissed them as migraines."
While the extreme dizziness gradually got better, she says, it never went away. "Like so many other young adults who have suffered a stroke, I was in denial, even though as a doctor I knew what the symptoms were telling me," says Dickinson.
Doctors found the cause of her strokes was due to a tiny tear in a large vessel in her neck that allowed a blood clot to form, break off and limit blood ﬂow to the part of the brain that's responsible for balance and coordination.
After the strokes, which occurred three years ago, Dickinson said her family's life was turned upside down. Extreme dizziness, triggered by fatigue, forced her to severely limit her work schedule. "Our ﬁnances got so bad that we could only afford to eat potatoes, oatmeal and rice, so we went on food stamps," she says.
"Three years later," says Dickinson, "I'm doing better and better, but I still struggle to bring a sense of normalcy back to our family's lives."
With a stroke, time-loss is brain-loss - nearly two million brain cells die every minute a stroke goes untreated, increasing the risk of disability or death. Unsuspecting young adults like Dickinson often delay seeking medical attention. But, this delay can cause them to miss the small, critical window when the clot-busting drug tissue plasminogen activator (tPA) may be administered to rescue dying brain cells and stop further damage. Research shows the sooner the drug is given, the better the results - and after four-and-a-half hours, the window for receiving it closes.
"Unfortunately, not all patients qualify for this drug and not every hospital has the staff to administer it 24 hours a day," says neurologist Salina Waddy, a stroke expert with the National Institutes of Health. "So, the best thing a patient can do is to prevent a stroke in the ﬁrst place." Up to 80 percent of strokes are preventable by managing key risk factors, like eating well, exercising, not smoking and limiting alcohol consumption.
Each year signiﬁcantly more women die from stroke than from breast cancer - and yet many women think of stroke as a man's disease. According to a 2015 national survey, only 11 percent of the 1000 women surveyed could identify female-speciﬁc stroke risk factors, like migraine headaches with aura, hormone-replacement therapy, oral contraception and pregnancy, particularly in the ﬁnal month and postpartum.
In the summer of 2010, new mom Catherine Zalewski, now 34, was getting ready to feed her 6-month old daughter when she felt a sudden wave of exhaustion accompanied by a tingling of pins-and-needles throughout her body. "I didn't know what was going on, just that I felt off and my vision was doubled," says Zalewski. "I remember that I kept missing my daughter's mouth with the bottle."
As a former Mrs. New Jersey and a certiﬁed personal trainer, Zalewski has always been healthy and in shape, so it never occurred to her that she could be having a stroke. After she managed to put her daughter down in her crib, Zalewski climbed into bed herself for a nap, assuming parental exhaustion was to blame for her symptoms.
Seven hours later, her husband returned home, found her in bed and brought her to the hospital. The stroke left her partially paralyzed. For six weeks, Zalewski underwent in-patient rehabilitation, relearning how to walk, talk and dress herself. "It took me weeks to be able to hold my daughter all by myself," she says.
In looking for the cause of the stroke, doctors discovered that Zalewski had a patent foramen ovale (PFO), a hole in her heart that required surgery to close. She had the surgery later that year.
With a successful recovery behind her, Zalewski gave birth to a baby boy last year. "Three months later, I was back at the gym training with a client when I suddenly began to feel a numbing sensation," she says. "My words began to slur, and I quickly realized I was having another stroke - but I couldn't get the words out."
Luckily, the manager of her gym noticed the warning signs and called 911. Within an hour she was given the clot-busting drug tPA. Because of the early intervention, her recovery this time was quick. She was back at home and resuming her normal routine within a week.
While doctors still don't know the cause of her two strokes, Zalewski says she believes it has to do with her pregnancies. "My advice to young mothers is to pay close attention to your own health, too," says Zalewski. "As women we often take care of everyone else ﬁrst - let my story be the lesson of the devastating consequences that can come from putting yourself last."
May is National Stroke Awareness Month. As Catherine Zalewski's story shows, strokes are highly treatable if you act fast. The American Stroke Association teaches the acronym FAST to help you quickly spot a stroke and take quick action:
- Face drooping. Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
- Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
- Speech difﬁculty. Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly?
- Time to call 911. If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Check the time so you'll know when the ﬁrst symptoms appeared.
Special to The Washington Post · Jennifer Breheny Wallace · FEATURES · May 11, 2016 - 7:24 PM