How To Identify Strokes and Stroke-Like Symptoms—Even in Young People

The fact that a young person can experience signs of a stroke is shocking to many people, mainly because strokes are most often associated with older adults.

The reality is that up to 15% of strokes impact people between 18–55 years old. The number of strokes in the population appears to be changing. A study published in 2019 found that the incidence of stroke in young people rose by 23% between 1998–2010.

Therefore, it's essential to recognize the signs of this type of health crisis, no matter how old you are.

What Is a Stroke?

A stroke is a brain injury that results in a loss of blood flow to part of the brain. Brain cells can die within a few minutes if they are not getting enough blood flow. The result can lead to lasting damage, long-term disability, and even death.

Blood flow to the brain is critical. Take action right away if you notice signs of a stroke. The faster you act if someone is having a stroke, the less likely that person is to have permanent damage—and you could save a life.

Types of Stroke

There are two types of stroke: ischemic and hemorrhagic strokes. There is also an ischemic event called a transient ischemic attack, or a near stroke, that lasts only a few minutes and reverses itself in time.

Ischemic Stroke

Ischemic stroke is the most common type, making up about 87% of strokes. Ischemic stroke occurs when a blood clot blocks blood flow and oxygen to the brain, similar to what happens during a heart attack.

In some cases, the blockage develops when an artery becomes too narrow for sufficient blood to pass through, called stenosis. Stenosis happens when blood clots and plaque—a mixture of fatty substances—build up inside the artery.

Hemorrhagic Stroke

Hemorrhagic strokes are less common and make up 13% of strokes. There are several types of hemorrhagic strokes, including:

• Intracerebral hemorrhage: This is the most common type of hemorrhagic stroke. Intracerebral bleeding involves bleeding inside the brain, which occurs when a blood vessel in the brain bursts.
• Subarachnoid hemorrhage: Often, this happens when an aneurysm causes bleeding around the brain's surface. Blood thinners, bleeding disorders, or head injuries may cause subarachnoid bleeding. In some cases, the cause is unknown.
• Subdural hemorrhage: This is bleeding between the brain and a protective layer of tissue surrounding the brain, called the dura. Head injuries are often the cause of both subdural bleeding.
• Epidural hemorrhage: This is bleeding between the outside of the dura and the skull. Like subdural bleeding, head injuries often cause epidural bleeding.

The leaked blood can put too much pressure on the brain cells during a hemorrhagic stroke. In turn, that pressure can damage the cells.

Transient Ischemic Attack

A transient ischemic attack—sometimes known as a mini-stroke or TIA—occurs if the blood supply to the brain is temporarily disrupted. TIA symptoms always pass by the 24-hour mark. Though, symptoms are impossible to distinguish from acute strokes.

Therefore, you should take all stroke-like symptoms seriously and contact a healthcare provider as soon as possible. A mini-stroke may be a warning sign for a more severe stroke in the future.

Risk Factors

The major risk factors are the ones that put you most at risk of developing a stroke. For all strokes, these include:

• High blood pressure (hypertension)
• Diabetes
• Heart and blood vessel diseases (such as conditions that cause blood clots or blockages like coronary heart disease, atrial fibrillation, heart valve disease, and carotid artery disease)
• High LDL ("bad") cholesterol
• Smoking
• Brain aneurysms or poorly formed connections between arteries and veins that can break open (arteriovenous malformations or AVMs)
• Viral infections and conditions that cause inflammation (such as lupus, rheumatoid arthritis, and possibly SARS-CoV-2, the virus that causes COVID-19)
• Age, with the highest risk being in infants younger than 1 and older adults
• Sex, with males being more likely than females to have a stroke at younger ages and females being more likely to have a stroke due to birth control pills, hormone replacement therapy, pregnancy, and preeclampsia
• Family history and genetics (that is, having a family member who has had a stroke and your blood type)
• Other health conditions (such as bleeding disorders, sleep apnea, kidney disease, migraine headaches, and sickle cell disease)

Sometimes, other risk factors related to lifestyle may also be involved. They may not increase your risk as much as the major risk factors above, but increase it nevertheless. You may or may not be able to control these additional risk factors, such as:

• Anxiety, depression, and high stress
• Recreational drugs (such as cocaine, amphetamines, and heroin)
• Living or working in areas with air pollution
• Blood thinners and other medications can lead to bleeding
• Unhealthy lifestyle habits (such as eating unhealthy foods, not exercising regularly, drinking alcohol, and sleeping more than nine hours a night)
• Overweight and obesity
  

Signs of a Stroke

The number of strokes is on the rise among young people. Still, about 30% of adults under 45 do not know all the warning signs of stroke. Quickly identifying a stroke or stroke-like symptoms is critical for the best health outcomes. Fast recognition and treatment can minimize the brain damage caused by the stroke.

That is why experts urge people to remember the phrase B.E. F.A.S.T. to spot signs of stroke easily. Previously, the advice was to remember F.A.S.T. According to a study published in 2017, adding those two extra letters to the mnemonic could help people identify more early signs of stroke, specifically problems with balance and vision.

B.E. F.A.S.T. describes the following symptoms:

• B: Balance or leg weakness—Is the person suddenly having difficulty standing up or walking?
• E: Eyes and vision—Is the person having trouble seeing?
• F: Face—Does the person have facial drooping, or is one side of the face numb? If you ask the person to smile, is their smile uneven?
• A: Arm weakness—Is one arm or side of the body weak or numb? When you ask them to raise both arms, does one arm drift downward?
• S: Speech—Is the person having difficulty speaking or understanding you?
• T: Time—Call 911 if you notice any of these symptoms.

Those signs are not necessarily an all-inclusive list of stroke symptoms. A sudden severe headache, for example, is another stroke symptom not included in the mnemonic. Take an extremely painful headache as seriously as stroke symptoms if it hits you out of nowhere, and call 911.

Of note, some people, especially women, may also experience fatigue, general weakness, confusion or memory problems, and nausea or vomiting. One study published in 2018 found that women are more likely to present atypical signs of strokes, sometimes leading to delayed recognition and treatment.

How Brain Regions Can Influence Signs of a Stroke

The signs and symptoms of stroke can vary widely depending on what part of the brain is involved. Different parts of the brain control different body functions. Those functions can be affected if a stroke occurs in the areas of the brain that control them.

For example, a stroke in the back of the brain will likely affect vision. That part of the brain processes visual information. In contrast, spinning (vertigo), dizziness, and unsteadiness can occur if a stroke impacts the balance centers of the brainstem, such as in a cerebellar stroke.

Strokes are often further classified based on where in the brain they occur. A cerebellar stroke can be either an ischemic or hemorrhagic stroke that occurs in an area of the hindbrain called the cerebellum. These strokes are relatively rare, accounting for only 1% to 4% of strokes, but make up a rather large percentage of stroke deaths.

The symptoms of cerebellar stroke include vertigo, headache, vomiting, and impaired coordination. Dizziness and vertigo are often missed as stroke signs. The prognosis can be poor if these symptoms are not detected when they first appear.

A stroke affecting only one half of the brain can usually cause symptoms on the opposite side of the body. The right brain controls the left side of the body, and the left brain the right side. You may lose function or control of the right side of the body if a stroke occurs in the left part of your brain.

Symptoms you might see if a stroke affects the left part of the brain include:

• Paralysis on the right side of the body
• Speech and language problems
• Memory loss

In contrast, symptoms you might see if a stroke affects the right part of the brain include:

• Paralysis on the left side of the body
• Vision problems
• Memory loss
  

Who Is Most at Risk for Strokes?

On average, roughly 795,000 people in the United States have strokes yearly. Among them, 137,000 people die. People of all ages and backgrounds can have a stroke. Still, some people in certain demographics may have a higher stroke risk than others.

For example, Black people have nearly double the risk of having a first stroke compared to White people. Generally, Black people have more risk factors for strokes, such as high blood pressure, heart disease, and high cholesterol, than White people.

Social and economic disparities between Black and white people significantly contribute to stroke risk. A lack of access to adequate healthcare services and implicit bias among healthcare providers can have adverse effects on overall health.

Age is another risk factor for strokes. Specifically, older adults have a higher risk than younger people. Stroke risk nearly doubles every 10 years after age 55. Nearly 75% of strokes happen in people older than 65. Nearly 75% of strokes happen in people older than 65. Still, stroke-like symptoms can impact anyone at any age.

Strokes and Health Conditions

Several health conditions can cause strokes. For example, there may be some connection between strokes and stroke-like symptoms and COVID-19.

"COVID-19 can increase inflammation in the body and increase the body's ability to form blood clots, and again, that's the issue with most strokes," Donald Lloyd-Jones, MD, chair of the department of preventive medicine at the Northwestern University Feinberg School of Medicine, told Health.

"In some of the patients where we've seen severe systemic complications, kidney failure, liver problems, heart problems, brain problems are related to this blood clotting that seems to travel with the infection," said Dr. Lloyd-Jones.

People who are most at risk for strokes also have a build-up of health problems like high cholesterol, diabetes, obesity, and smoking over time, Gregory Albers, MD, a professor of neurology and neurological sciences at Stanford University Medical Center, told Health.

"These lead to the build-up of the plaque, the atherosclerotic plaque that people call hardening of the arteries that happens over decades," said Dr. Albers. "That makes sense why stroke is going to occur in older people most commonly when you think about some of the other risk factors for stroke."

An increase in obesity, diabetes, and hypertension among young people may explain why more are having strokes.

Stroke Prevention Tips

Most strokes are preventable. Maintaining good health is one of the most proactive ways to prevent stroke.

To stay healthy and reduce your risk of stroke, take the following steps:

• Don't smoke: Not smoking is one of the best things you can do to prevent stroke. Plus, not smoking also comes with many other health benefits. For every five cigarettes you smoke, your stroke risk can increase by 12%.
• Stay physically active: Exercise can reduce your risk of stroke by 25% to 30% compared to not staying active. Any exercise helps, even if it is 10 minutes a day. Find an activity you enjoy, whether running, cycling, walking, or even dancing.
• Monitor your blood pressure: Hypertension, or high blood pressure, is one of the leading causes of strokes. You can control blood pressure by making lifestyle changes or taking medication.
• Make healthy diet choices: As you age, you may notice that you gradually gain weight. Weight gain is not necessarily bad. Though, paying attention to food quality is essential. The American Stroke Association promotes the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets as ways to make healthy food choices.
• Get started: The earlier you start, the better. Around 10% to 15% of all strokes occur in people younger than 50. The same factors that cause stroke in older adults—high blood pressure, high cholesterol, obesity, and diabetes—cause stroke in younger people.

The Centers for Disease Control and Prevention (CDC) has a mnemonic, the A.B.C.S., to help people know how to prevent stroke.

A.B.C.S. describes the following prevention tips:

• A: Aspirin—This medication can help reduce the risk of stroke for people in certain high-risk groups. Do not take aspirin during an active stroke situation. Check with a healthcare provider before making aspirin part of your stroke prevention plan. The risks outweigh the benefits for many people. Typically, healthcare providers do not advise aspirin for most people with no history of heart attack or stroke.
• B: Blood pressure—Control and monitor your blood pressure.
• C: Cholesterol—Control and monitor your cholesterol.
• S: Smoking—Quit smoking as soon as possible, or never start.

Stroke Treatment

If possible, visiting a designated stroke center is best if you or someone else has a stroke. Still, do not delay calling 911. Getting treatment as early as possible is key to increasing health outcomes.

Likewise, do not dismiss signs of a stroke that go away within 24 hours. Getting evaluated while you have symptoms is best. Still, consult a healthcare provider even if symptoms subside. Those signs could indicate a TIA and put you at risk for a more severe stroke.

Stroke treatments largely depend on the health impacts you have, said Dr. Lloyd-Jones.

Ischemic Stroke Treatments

Ischemic stroke treatments include:

• Tissue plasminogen activator (tPA): This is one of the most common medicines to treat ischemic strokes. tPA breaks up blood clots in the brain. A healthcare provider administers tPA through a vein in the arm.
• Anticoagulants and blood thinners: These medicines keep blood clots from growing and new ones from forming. Examples of blood thinners include aspirin or clopidogrel.
• Thrombectomy: This surgery removes blood clots from the vessels to help blood flow to the brain. A healthcare provider places a catheter into the groin to reach the blocked vessel.
• Angioplasty and stenting: A healthcare provider can inflate a balloon inside the catheter to open the vessel during a thrombectomy.
• Stent retriever: In contrast to angioplasty and stenting, a healthcare provider can use a stent retriever. This wire mesh, placed inside the catheter, retrieves the blood clot.

Generally, ischemic stroke treatments depend on when symptoms begin. For example, healthcare providers must administer tPA within three hours. In contrast, retrieval of the blood clot using thrombectomy has a longer time window than tPA.

Hemorrhagic Stroke Treatments

In contrast, hemorrhagic stroke treatments may include:

• Blood pressure medicine: This helps lower and control your blood pressure, reducing stress on your brain's blood vessels.
• Vitamin K: This helps stop bleeding.
• Aneurysm clipping: This procedure stops bleeding and prevents the aneurysm from bursting using a metal clip.
• Coil embolization: A healthcare provider inserts a catheter into the groin to reach the aneurysm. Then, they insert a tiny coil through the catheter and into the aneurysm. The coil forms a blood clot, blocks blood flow, and keeps the aneurysm from bursting.
• Blood transfusion: This helps replace lost blood.
• Draining fluid: A healthcare provider can alleviate pressure in the brain by draining fluid.
• Surgery: Different surgeries can drain blood, remove part of the skull, or get rid of AVMs. AVMs are made up of arteries and veins, which can burst inside the brain.
• Radiation: Like surgery, radiation can get rid of AVMs.
• Supportive care: A healthcare provider may administer breathing support, a feeding tube, fever-reducing medicines, and other care.

A Quick Review

A stroke is a brain injury in which blood flow to the brain becomes suddenly disrupted. There are two types of strokes: ischemic and hemorrhagic strokes. A stroke can happen at any age, so it's essential to know the signs of a stroke. Remember the mnemonic B.E. F.A.S.T. for early treatment and the best health outcome.

Often, healthcare providers do not know the exact cause of a stroke. There are several risk factors for strokes, and some are modifiable to a degree. Remember the mnemonic A.B.C.S. to know your risk factors and maintain good health to prevent strokes as much as possible.

Healthcare providers can use the National Institute of Health (NIH) Stroke Scale to identify stroke symptoms, choose the best treatments, and predict health outcomes.