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

Strokes and stroke-like symptoms can occur at any age. Here are the warning signs.

Hailey Bieber
Photo: Getty Images

Model Hailey Bieber made headlines over the weekend after being rushed to a Palm Springs hospital for "stroke-like" symptoms, which were later linked to a small blood clot in her brain.

The fact that someone so young experienced stroke-like symptoms is shocking to many, particularly because strokes are most often associated with older individuals. But the reality is that 15% of strokes impact those between the ages of 18 and 55—and those cases may be trending upward: A 2019 study published in the journal Neurology found that incidence of stroke in young people rose by 23% in one decade, between 1998 and 2010.

When sharing the details surrounding her health scare on Instagram, 25-year-old Bieber did not specify exactly what symptoms she experienced prior to her emergency hospital admission.

"On Thursday morning, I was sitting at breakfast with my husband when I started having stroke-like symptoms and was taken to the hospital," Bieber said in a statement. "They found I had suffered a very small blood clot to my brain, which caused a small lack of oxygen, but my body had passed it on its own and I recovered completely within a few hours."

It also remains unclear what may have triggered Bieber's stroke-like symptoms. Whatever the cause may have been, 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.com.

"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."

There are two main types of stroke: ischemic stroke and hemorrhagic stroke, according to the Centers for Disease Control and Prevention (CDC).

Ischemic stroke is the most common type of stroke and makes up about 87% of all strokes. This type of stroke occurs when a blood clot blocks the flow of blood and oxygen to the brain. The blockage sometimes occurs when an artery becomes too narrow for enough blood to pass through it, which is called stenosis. Stenosis is caused by a buildup of blood clots and plaque—a mixture of fatty substances and cholesterol—on the inner walls of the artery. The causes of this stroke include smoking, high blood pressure, obesity, high cholesterol levels, diabetes and excessive alcohol intake.

Hemorrhagic strokes are less common and make up the remaining 13% of strokes. Albers said there are two types of hemorrhagic strokes—intracerebral hemorrhage (the most common, which occurs when an artery in the brain bursts) and subarachnoid hemorrhage (the less common type, which occurs when an aneurysm causes bleeding around the surface of the brain). The leaked blood can put too much pressure on the brain cells, which can in turn damage the cells. The main cause of this type of stroke is high blood pressure, being overweight, excessive amounts of alcohol, smoking, stress and a lack of exercise.

There's also what's known as a transient ischemic attack—sometimes known as a mini-stroke or TIA—which occurs when the blood supply to the brain is temporarily disrupted. Though the symptoms of these transient strokes mimic acute strokes, the National Institute of Neurological Disorders and Stroke (NINDS) says all signs should be taken seriously and evaluated by a medical professional. 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 and chair, Department of Preventive Medicine at Northwestern University's Feinberg School of Medicine, told Health.com.

How to Identify a Stroke

Though incidence of stroke is on the rise among young people, about 30% of adults under the age of 45 don't actually know what the warning signs of stroke look like, according to a 2020 survey conducted by the AHA.

Being able to identify a stroke or stroke-like symptoms early is crucial to better outcomes. According to the CDC, fast recognition and treatment can lessen any brain damage potentially caused by a stroke. That's why experts urge people to remember the phrase: B.E. F.A.S.T. to remember and easily spot the signs of stroke. (Previously, the advice was to simply remember F.A.S.T., but according to research published by the AHA 2017, adding those two extra signs to the mnemonic could help people identify more early signs of stroke).

B: Balance/leg weakness. (Is the person having difficulty standing up?)

E: Eyes/vision. (Is the person having trouble seeing?)

F: Face. (Does the person have face drooping, or is one side of the face numb?)

A: Arm. (Is one arm/side of the body weak or numb?)

S: Speech. (Is the person having difficulty speaking?)

T: Time. (If you notice any of these symptoms, it's time to all 9-1-1.)

These signs aren't necessarily an all-inclusive list of stroke symptoms—severe headache, for example, is another stroke-like symptom not included in the mnemonic. The signs and symptoms of stroke can also 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 the 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?

The National Institute of Health (NIH) reported about 795,000 people in the United States have strokes each year and of these incidents, 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 are almost at two times the risk of having a stroke compared to white individuals
  • The older you get, the more at-risk you become of having a stroke. Three-quarters of strokes occur in people ages 65 and older.
  • Men are more likely to have a stroke than women are.

In addition, the American Stroke Association says a person's risk of stroke nearly doubles every 10 years after the age of 55.

But again, while the risk of stroke increases as we grow older, Bieber's case makes abundantly clear that stroke-like symptoms can impact anyone, at any age. There may also 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 is 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."

Stroke Prevention Tips

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 processed foods, said Dr. Lloyd-Jones. It's also a good idea to consume lots of fruit, vegetables, and protein. 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 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, but shouldn't be taken during an active stroke situation.)

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.)

Treatment for strokes, meanwhile, 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 will often use blood thinners, an effective way of removing blood clots and restoring blood flow to the brain to save brain tissue. If there's a bleeding problem in the brain (hemorrhagic strokes), treatment often consists of a rapid CT scan of the head and potentially surgery, which can remove any blood and relieve pressure on the brain.

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