How to Identify Stroke Symptoms As a Young Adult

Ten percent of strokes occur in adults under the age of 45.[1] For this reason, it is important to be able to recognize signs and symptoms that may indicate you (or another person) are having a stroke and not to dismiss the possibility based on age. If you believe you (or another person) are having a stroke, it is also key to seek emergency medical attention immediately so that treatment can be initiated in a timely fashion.

Part 1 - Recognizing Stroke Symptoms

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→ Call 911 or the emergency services in your area if you think you (or another person) are experiencing a stroke. If you believe you (or another person) are having a stroke, it is key to receive emergency medical evaluation as soon as possible. This is because effective treatment of a stroke is time-dependent; in other words, the sooner medical treatment is received, the better the outcome and the fewer long-term health consequences that are likely to result from the stroke.

→ Treatment for a stroke caused by a blood clot in the brain must occur within three hours of the onset of symptoms.

→ The faster you get treatment, the better your chances are of avoiding severe, permanent brain damage. If you wait too long, you will no longer be eligible for the drug.

→ Early treatment may be even more beneficial when administered to young stroke patients.

2

→ Do not ignore early symptoms. If you are in your early 20's, you probably don't think symptoms like unexplained fatigue, jaw pain, or dizziness are related to a stroke — most people think of strokes as something that happens to much older adults. Do not dismiss your symptoms or wait to see if they will go away — get treatment now.

→ Strokes have actually been on the decline amongst adults over 65, but the number of strokes among people under 45 has increased by one-third.

→ If you are experiencing the sudden, unexplained symptoms of a stroke — no matter how old you are — seek medical help immediately.

3

→ Be aware of numbness and/or tingling of the face, arm, or leg. A person having a stroke may notice sudden weakness, numbness, tingling, or paralysis developing, most likely on one side of the body and not the other. It may be localized to a single area, such as the arm, or one side of the face, or it may span a larger area.

→ One strategy to assess for arm weakness is to ask a person to lift both arms above their head. Then, see if they can hold them up for 10 seconds. If one arm falls or slumps, this could be a sign of weakness and an indication of a stroke.

4

→ Watch for trouble speaking. One of the hallmark signs of a stroke can be trouble speaking. It may be slurred words, confusion, or trouble understanding others. The medical term for difficulty speaking is called "aphasia."

→ Aphasia results from lack of blood flow to the area of the brain that controls language and communication (as a result of the stroke).

→ Aphasia may resolve in the days to weeks following the stroke, or it may remain as permanent brain damage. It depends on the extent of damage caused by the stroke, as well as the length of time that the language and communication centre of the brain was deprived of blood flow (due to the blockage from the stroke).

→ Speech therapy is often given following a stroke to help people regain communication skills as quickly and effectively as possible.

→ You can assess for stroke-related aphasia in another by asking them questions and seeing if they respond appropriately, and/or seeing if they are able to follow and understand instructions from you.

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→ Notice changes in balance and coordination. A person experiencing a stroke may begin to feel unsteady while walking, or have a sudden onset of dizziness. Dizziness or imbalance is a worrisome sign indicating a potential stroke. It is important to sit or lie down to prevent falling, and to have someone call for immediate medical help.

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→ Observe any visual changes. If a person is having any visual disturbances, including blurred vision, double vision, or blackened vision in one or both eyes, it may be a sign of a stroke. It is important to understand that the symptoms of a stroke all depend upon which area of the brain has reduced (or cut off) blood supply - the area that is affected is what will lead to specific symptoms.

→ If the area of the brain responsible for vision is partially or fully deprived of blood flow, this is when a person will experience visual symptoms.

→ As with most symptoms of a stroke, a person's vision will likely improve (and may even return fully to normal) following the stroke, as the brain recovers. It may, however, take a few days to a few weeks for recovery to occur.

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→ Look for a facial droop. If you believe you may be having a stroke, stand in front of a mirror and try to smile. If one side droops more than the other (in a way that is abnormal for you), this could be a sign of a stroke.

→ If you are observing for a possible facial droop in another, ask them to smile and take note if their smile is uneven (if one side appears higher than the other). This is an indication that they may be having a stroke.

→ Similarly, if the muscles on one side of the face seem paralyzed or unable to move properly, this is a sign of a potential stroke.

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→ Note that any of these symptoms may indicate a possible stroke. One of the key features of strokes are that they present differently in different cases. This is because the symptoms of a stroke are directly related to which area of the brain is deprived of blood flow. The areas that are deprived of blood flow will dictate the symptoms that ensue (for instance, if the movement area is affected, you will experience weakness; if the language area is affected, you will experience communication problems; if the visual area is affected, you will experience vision problem, etc.).

→ Therefore, if you notice ANY of the signs or symptoms described in this article — or notice these signs and symptoms in another — seek medical help immediately.

→ It is not necessary to have all of the symptoms in order for a stroke to be occurring.

9

→ Consider it a medical emergency if you experience the worst headache of your life. There is one subtype of stroke, called an SAH (subarachnoid hemorrhage), that presents as a "thunderclap headache," which is a sudden onset of the worst headache of your life. It may be accompanied by nausea and/or vomiting. Go to the Emergency Room immediately if you (or another person) are experiencing this.

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→ Record the duration of symptoms. If you notice any signs or symptoms that are worrisome for a stroke, you should seek medical attention immediately. You should also take note of when the symptoms began, and whether they have been constant or intermittent.

→ Just because your symptoms are intermittent or appear to have disappeared does not mean that it was not a stroke.

→ If your symptoms appear to have gone away, it is still advisable to see your family doctor, or to go to a walk-in clinic for assessment if you cannot get a same-day appointment with your family doctor.

→ If your symptoms are constant, proceed directly to the Emergency Room.

→ A "TIA" (transient ischemic attack), also known as a "mini stroke," is stroke symptoms that last for less than an hour (normally for about 5-10 minutes and are then self-resolved).

→ It is impossible to tell a TIA and a full-blown stroke apart until you notice resolution of symptoms, so you should proceed as if it were a full stroke and seek immediate medical care unless and until you find out otherwise.

Part 2 - Seeking Medical Treatment

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→ Go to the hospital immediately if you show any sudden, unexplained signs of a stroke. If you are experiencing signs and symptoms indicative of a stroke, get someone to drive you to the hospital or call 911 immediately. Do not put off calling if your symptoms temporarily resolve, as they may come back.

2

→ Ask your doctor for TPA. TPA stands for tissue plasminogen activator. It is the treatment for an ischemic stroke (a stroke caused by a blood clot), as long as it is given within three hours of the onset of symptoms.

→ Note that the treatment will be different if you are experiencing a hemorrhagic stroke (a brain bleed) rather than an ischemic stroke (a blockage in an artery in the brain as a result of a blood clot).

→ Treatment for a hemorrhagic stroke does not use TPA, and rather involves medications for blood pressure control and to diminish the pressure in the brain while your doctor works to fix the bleed.

3

→ Be aware of mini-strokes. There are occasions when a first time stroke, or TIA (which stands for "transient ischemic attack," otherwise known as a "mini-stroke"), is not too severe and does not cause too much lasting damage. After you have been evaluated by a physician, he may make recommendations as to how to reduce your risk of future strokes.

→ This may include beginning a blood thinning medication or an antiplatelet agent, gaining better blood pressure control, effectively managing diabetes, quitting smoking, beginning an appropriate exercise regime, diagnosing and treating any heart arrhythmias (abnormal rhythms such as atrial fibrillation), and receiving a procedural intervention such as a carotid artery endarterectomy if needed, among other things.

Part 3 - Understanding Causes of A Stroke In A Young Adult

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→ Understand some of the underlying causes of strokes in young adults. Note that if you are a young adult, you are more likely to have an underlying disease that could be responsible for your stroke. Examples of conditions that may predispose you to a stroke include AVMs (arteriovenous malformations, which is a blood vessel abnormality that can be present in your brain and predispose you to a rupture), as well as other blood vessel diseases or clotting disorders that can be inherited or developed at a young age. Additional possible causes of strokes in young adults include:

→ Vasculitis — An inflammatory disorder of the blood vessels.

→ Cerebral vein thrombosis — A blood clot in one of the venous sinuses in the brain, resulting in the symptoms of a stroke.

→ Moya-moya syndrome — A rare condition in which blood vessels at the base of the brain become blocked.

→ Diabetes — A disease that affects insulin production, leading to high sugar levels in the blood.

→ Sickle-cell anemia — A condition in which red blood cells die early, causing a deficiency in healthy red blood cells.

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→ Follow up and check for underlying conditions. Particularly if you are young, your doctor can order tests and investigations to determine if you have an underlying condition, and can treat it accordingly if one is found. If you have demonstrated symptoms indicative of a stroke, ask your doctor for her thoughts about what investigative tests you may be eligible for. Investigations you may receive include:

→ Vascular (blood vessel) studies — This involves using a Doppler ultrasound to assess for any blockages to the arteries.

→ Brain imaging (such as a CT scan or MRI) — This can identify blood clots in the brain and diagnose stroke-related damage.

→ Cardiac evaluations — This examines the heart for abnormalities that may predispose one to blood clot formation and subsequent strokes.

→ Hematologic assessment — This is a blood test that assesses for a variety of stroke risk factors and diagnostic clues.

Warnings

→ Even if you do not have any of the conditions that might pre-dispose you to a stroke, it is still possible — in 25 –30% of young people, the cause of stroke cannot be identified.

→ Strokes among young people are particularly troubling, as they often have many years of life ahead of them, and they must live out these years with permanent (and many times, preventable) damage. One-third of people under 50 who suffered a stroke are unable to live independently 10 years after the stroke.