Doesn't Just Strike Older Adults
By Dr. Robert J. Wityk, ABCNEWS.com
In many patients,
particularly in the 40-50 year old range, strokes are due to premature
atherosclerosis, the same disease which causes heart attack and
"hardening of the arteries."
typically have risk factors for atherosclerosis, such as hypertension,
diabetes, smoking and elevated cholesterol. Often there is a family
history of stroke or heart disease at a young age.
are several times more likely to have a stroke at a young age than
whites, even if risk factors are taken into account. The reason
for this difference is not known.
also occur in young patients without risk factors for atherosclerosis,
but the causes are diverse and can be difficult to diagnose given
the uncommon nature of these diseases.
In the evaluation
of a young stroke patient, physicians evaluate three basic areas
to determine the cause: the heart, the blood vessels supplying the
brain, and the blood clotting system.
heart disease is a leading cause of stroke in children. People with
artificial heart valves must often be kept on anticoagulants ("blood
thinners") to prevent clots from forming on the valves.
conditions, such as mitral valve prolapse, may produce clots,
but these are infrequent and can usually be managed with medicines
such as aspirin effectively.
a heart valve, referred to as endocarditis, is a serious
medical condition that can cause bits of infected clot to travel
to the brain, causing both stroke and aneurysms.
can occur in patients with damaged heart valves (e.g. with a history
of rheumatic fever) or can occur on normal valves in people who
abuse intravenous drugs using contaminated needles or non-sterile
source of clots in the heart is a patent foramen ovale (PFO)
a small hole in the heart that potentially allows blood from
the veins to get into the arteries.
PFO's are present
in everyone at birth, but close off in about 80 percent of people.
This means that about 20 percent of young adults have a PFO as a
potential source of a clot.
this remains controversial, as the chance of having a stroke from
a PFO is quite small. However, for patients with recurrent problems
due to a PFO, closure of the hole or use of blood thinners may be
A variety of
diseases of the blood vessels leading to the brain can cause stroke
in young adults.
dysplasia is a condition in which there is thickening of the
wall of blood vessels anywhere in the body. When it occurs in the
arteries in the neck, alteration of blood flow or small clots can
dissection causing stroke is a condition that seems most common
in people around the age of 40.
The inner lining
of the artery tears, leading either to complete blockage of the
artery or formation of a clot that can travel into the brain.
can occur due to trauma to the head or neck, or can occur spontaneously
with minor activity such as sneezing or head turning.
The cause of
this condition is not entirely clear, and why it occurs most commonly
in this age group is unknown.
Richard Harris had this type of stroke. Even though with his age,
low blood pressure and low cholesterol, he would be considered at
low risk for a stroke.
is a rare condition where there is inflammation of the blood vessels
in the brain. This is sometimes associated with inflammation in
other blood vessels in the body, or sometimes the inflammation is
limited to the brain alone.
There are a
number of blood disorders that cause stroke due to an excessive
tendency for the blood to clot. Many of these are rare inherited
anemia is the most common blood disorder that causes stroke
in young adults and children.
syndrome is a disorder that is associated with systemic lupus
erythematosis and can cause blood clotting any where in the body.
There are a
variety of common factors that may rarely lead to stroke in young
adults. Patients with migraine, for example, may on rare occasions
have a stroke during a migraine attack.
The use of
oral contraceptives is associated with stroke. The overall risk
is very low, except for women who are older then 35 years old, who
smoke and who have migraine headaches.
medical and neurological evaluation is important in young people
with stroke in order to plan treatment and give a prediction of
the risk of future stroke.
Despite a comprehensive
evaluation using all the current tools of modern medicine, no cause
is found in about 30 percent of young stroke patients.
Stroke in young
adults is often devastating to patients and their families due to
the unexpectedness of the event, as well as the loss of independence
and function occurring in someone in the prime of their life.
younger people tend to have a better chance of recovery, and with
extensive rehabilitation, young stroke patients can learn to adapt
to their deficits and many can return to their previous jobs.
Wityk is an Assistant professor of Neurology and Medicine as well
as Director of clinical stroke services at Johns Hopkins Hospital.
He specializes in strokes and related disorders.
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