Stroke is a common cause of death and disability worldwide including India. It results from sudden interruption of blood supply to brain due to either a clot known as “acute ischemic stroke” or by rupture of blood vessel supplying the brain called “ Acute brain hemorrhage”. Traditionally considered a disease of the elderly , it is now being seen increasingly in young adults in the age group of 18 to 45 years. It is observed that , of all the stroke patients at least 15 to 20% occur in young adults, particularly in India. Being affected at the peak of their learning and earning career , the effects of Stroke in young adults are quite devastating to the affected individual, the immediate family, and the society.
What are the symptoms :
Since stroke is a brain attack , it can cause any neurological symptom, but the most commonly recognized are sudden weakness or loss of sensation on one side of body, sudden giddiness, sudden loss of vision, sudden difficulty or inability to speak or understand. These symptoms may be caused by other diseases also, but it is essential to rule out a stroke, as it requires urgent therapy , before the damage to brain becomes permanent.
What are the causes:
The most frequent causes of stroke in young adults are same as in older adults. These include hypertension, diabetes, high cholesterol , high homocysteine and certain heart diseases. Contrary to popular perception , these diseases can begin quite early in life without causing any obvious symptoms. These diseases cause hardening and friability of blood vessel at a relatively young age known as premature atherosclerosis , which makes the blood vessels liable to get blocked or rupture. Migraine and use of oral contraceptives also make a young person susceptible to get a brain stroke. While smoking and alcohol abuse are known causes of stroke in young adults, in last few years many strokes in young adults are being seen occurring as a side effect of recreational drug abuse with marijuana and cocaine. During the recent times Covid 19 infection has also emerged as a cause of stroke in young adults due to clot formation.
Does genetics play a role ?
Family history of strokes does make a person more susceptible to suffer a stroke. However, since stroke occurs as result of genetic-environmental interaction, one can minimize the stroke risk by having a tight control of acquired risk factors, like hypertension, diabetes , obesity ,smoking and others. There are some pure genetic strokes like CADASIL and Fabry’s Disease which occur without the environmental influence. These however are very rare and specific therapies are available for some of them.
What to do when suspecting a stroke ?
On suspecting a stroke, patient must be immediately brought to the nearest “stroke ready hospital” as proper diagnosis and treatment of stroke in first few hours is crucial in determining the long term recovery of these patients. After evaluation, investigations, treatment and observation for first few days in hospital patient undergoes physiotherapy and rehabilitation in an inpatient or outpatient setting with an aim to get back to usual life to the maximum extent possible.
What are the chances of recurrence in stroke ?
Stroke can recur in about 5-10% of patients every year. To minimize the chances of recurrence, stroke patient must be advised to control the underlying stroke risk factors like hypertension, diabetes and high cholesterol and obesity. One also needs to adopt healthy life style with emphasis on healthy nutrition, proper exercise and freedom from addictions. Patients undergoes tests like Brain MRI, Carotid Doppler and 2 D Echo to find the underlying source of the clot. Sometimes more advanced investigations like TEE, DSA , vasculitis and procoagulant profile is also required. Based on the underlying mechanism of stroke, most patients are prescribed some form of blood thinner and lipid lowering therapy on a long term basis , while a small group of patients may need endovascular or surgical procedures in blood vessels of brain, neck and even heart.
What is the take home message ?
Stroke , also known as brain attack, is a suddenly occurring disabling neurological disease resulting from a block or rupture of a blood vessel supplying brain. It can occur in young adults at the peak of their productivity and responsibility. Most of the causes are due to acquired risk factors like hypertension, diabetes, high cholesterol, obesity , smoking , alcohol and substance abuse, while a very small percentage is due to purely genetic causes. The best way for prevention is to screen for the risk factors from 20 years onwards and have a healthy life style comprising regular physical exercise, balanced diet ,regular sleep and stress management. However, if the stroke occurs, patient should be immediately brought to a stroke ready hospital for treatment . After appropriate treatment and rehabilitation, most of patients are able to go back to their usual life and return to work.
Dr. Subhash Kaul
Sr. Consultant Neurologist
KIMS Hospitals, Secunderabad.