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

Strokes and stroke-like symptoms can occur at any age.

Physical therapist helps stroke victim in rehab center

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The fact that a young person can experience signs of a stroke is shocking to many people, particularly because strokes are most often associated with older individuals. But the reality is that up to 15% of strokes impact those between 18 and 55. A 2019 study found that the incidence of stroke in young people rose by 23% in one decade between 1998 and 2010.

Therefore, it's important 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 occurs when there's an abrupt disruption of blood flow to the brain, Gregory Albers, MD, professor of neurology and neurological sciences at Stanford University Medical Center, told Health.

"The brain is very sensitive to getting enough oxygen and glucose through the blood. If you have a blood clot that blocks off the flow, then it will cause an injury to the brain," Dr. Albers said. "It's kind of like a heart attack, but it's happening in the brain rather than the heart."

Types of Stroke

There are two main types of stroke: ischemic stroke and hemorrhagic stroke. There's also what's known as a transient ischemic attack.

Ischemic Stroke

Ischemic stroke is the most common type and makes up about 87% of all strokes. This stroke occurs when a blood clot blocks blood flow and oxygen to the brain.

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.

Some risk factors for this type of stroke include:

Hemorrhagic Stroke

Hemorrhagic strokes are less common and make up 13% of strokes. Albers said there are two types of hemorrhagic strokes.

The first type is intracerebral hemorrhage, which is the most common and involves bleeding inside the brain. This occurs when a blood vessel in the brain bursts.

The second type is subarachnoid hemorrhage, which often occurs when an aneurysm causes bleeding around the brain's surface. Using blood thinners, a bleeding disorder or a head injury may also cause subarachnoid hemorrhage. In some cases, the cause is unknown.

During a hemorrhagic stroke, the leaked blood can put too much pressure on the brain cells, which can, in turn, damage the cells.

Risk factors for this type of stroke include:

  • High blood pressure
  • Genetics
  • Brain aneurysms
  • Obesity
  • Substance misuse
  • Smoking
  • High cholesterol levels
  • Diabetes
  • Lack of exercise
  • Use of blood thinning medications

Transient Ischemic Attack

A transient ischemic attack—sometimes known as a mini-stroke or TIA—occurs when the blood supply to the brain is temporarily disrupted. Though the symptoms of these transient strokes don't last as long, they are impossible to distinguish from acute strokes.

Therefore, all stroke-like symptoms should be taken seriously and evaluated by a medical professional as soon as possible. A mini-stroke may be a warning sign for a more serious stroke in the future.

Chronic risk factors, including diabetes, high blood pressure, smoking, obesity, and unhealthy diet, are some aspects that can trigger these types of strokes, Donald Lloyd-Jones, MD, volunteer president of the American Heart Association (AHA) and chair of the Department of Preventive Medicine at Northwestern University's Feinberg School of Medicine, told Health.

Signs of a Stroke

Though the incidence of stroke is on the rise among young people, about 30% of adults under the age of 45 don't actually know what all the warning signs of stroke look like.

Identifying a stroke or stroke-like symptoms early is crucial to better outcomes. Fast recognition and treatment can minimize the brain damage caused by the stroke.

That's 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 simply remember F.A.S.T., but according to research published by the AHA in 2017, adding those two extra letters to the mnemonic could help people identify more early signs of stroke).

  • B: Balance/leg weakness. (Is the person suddenly having difficulty standing up or walking?)
  • E: Eyes/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/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. (If you notice any of these symptoms, it's time to call 9-1-1.)

These signs aren't necessarily an all-inclusive list of stroke symptoms—a sudden severe headache, for example, is another symptom not included in the mnemonic. If an extremely painful headache hits you out of nowhere, it's important to call 9-1-1 since this could be a sign of a hemorrhagic stroke.

Some people, especially women, may also experience fatigue, general weakness, confusion or memory problems, and nausea or vomiting.

How Brain Regions Can Influence Signs of a Stroke

The signs and symptoms of stroke can vary depending on what part of the brain is involved and what part of the brain has experienced a blood flow disruption, Dr. Albers said. For example, if the back of the brain is affected, you may experience visual problems. If a stroke impacts the balance centers of the brainstem, the result may be spinning, vertigo, and unsteadiness.

"In the left hemisphere of the brain, that's where the language areas live and have control of the right side of the body. Somebody who all of a sudden had trouble with speech and weakness or numbness on the right side of the body that would be typical for a stroke involving the left hemisphere of the brain," Dr. Albers said. "Symptoms are highly variable depending on what part of the brain is affected."

Who's Most at Risk for Strokes?

In the average year, roughly 795,000 people in the United States have strokes, and among them, 137,000 people die. While people of all ages and backgrounds can have a stroke, those who fall into certain categories or demographics are at higher risk, including:

  • African Americans have nearly double the risk of having a first stroke compared to white individuals.
  • Hispanic Americans and American Indian/Alaska Natives are at lower risk than African Americans but are still more likely to experience a stroke than white people.
  • The older you get, the more at-risk you become of having a stroke. A person's risk of stroke nearly doubles every 10 years after age 55. Three-quarters of strokes happen in people above the age of 65.

But again, while the risk of stroke increases as we grow older, stroke-like symptoms can impact anyone at any age.

Strokes and Health Conditions

There may be some connection between strokes and stroke-like symptoms and COVID-19.

"COVID 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," Dr. Lloyd-Jones said. "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."

Those who are most at risk for strokes also have a build-up of health problems like high cholesterol, diabetes, obesity, and smoking over time, Albers said.

"These lead to the build-up of the plaque, the atherosclerotic plaque that people call hardening of the arteries that happens over decades," said 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."

Many experts believe that an increase in obesity, diabetes, and hypertension among young people may explain why more young people are experiencing strokes.

Stroke Prevention Tips

Most strokes are preventable. One of the most proactive ways you can work to maintain good health and potentially help yourself avoid a stroke is by eating healthy. This includes focusing on foods low in sodium and avoiding highly processed foods, said Dr. Lloyd-Jones. It's also a good idea to consume lots of fruit, vegetables, protein, fiber, and whole grains.

Additional steps to take include maintaining a healthy weight, participating in physical activity, and being familiar with your family history of stroke.

"Knowing your numbers in your blood pressure, blood sugar, and blood cholesterol can help you make a plan to control any of those things if they're elevated or out of whack," added Dr. Lloyd-Jones.

The CDC also has a mnemonic to help people know how to prevent stroke—and that's to learn the ABCs of stroke prevention:

  • A: Aspirin. (This medication can help reduce the risk of stroke for people in certain high-risk groups but shouldn't be taken during an active stroke situation. Check with your doctor before making aspirin part of your stroke prevention plan because the risks outweigh the benefits for many people. It's not recommended 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 don't ever start.)

Stroke Treatment

Treatment for strokes depends largely on the health impacts you are experiencing, Lloyd-Jones said. If you have a blood clot that causes a stroke (ischemic stroke), doctors may use medicine or medical procedures to break up blood clots and restore blood flow to the brain to save brain tissue.

If there's a bleeding problem in the brain (hemorrhagic stroke), treatment may include medicine, blood transfusion, draining of excess fluid, and in some cases, surgery to remove blood and relieve pressure on the brain.

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Sources
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