Even the young
Normally associated with older people, strokes are becoming more common in young adults. The mystery is why.
The night arrived like so many before it, with no harbinger of danger.
Katie Jerdee was a 20-year-old soccer-playing, life-by-the-tail Northeastern University sophomore out for a run with her teammates. And then:
She lunged uncontrollably. Cars hurtled forward. Her head throbbed. Her right arm and leg went limp. She clutched a stop sign like it was life itself.
An ambulance ride later, Jerdee found herself in the Brigham and Women’s Hospital emergency room. Diagnosis: stroke.
“When they said stroke, especially being a finance major, I had no idea what a stroke was,’’ Jerdee recalled of that November 2006 evening. “I thought it was just something grandparents get. And most of the time, they would die from it or have huge disabilities.
“That’s what really freaked me out: Am I going to be in a wheelchair the rest of my life? Am I ever going to be able to talk correctly again?’’
Few diseases evoke an image of gray hair and furrowed wrinkles more surely than stroke. And, in fact, stroke rates remain highest among the oldest Americans. But a provocative study presented last month found that younger adults are being hospitalized with strokes caused by vascular blockages — called ischemic strokes — at significantly higher levels than they were less than a generation ago.
Researchers from the Centers for Disease Control and Prevention discovered, for example, that among men 35 to 44 years old, there was a 47 percent increase in the rate of hospital stays attributed to ischemic strokes from the mid-1990s to the mid-2000s.
The question is, why — and that remains a medical mystery.
The answer could reflect better diagnosis and more precise detection. It could also suggest something about the consequences of a super-sized society (although there’s hardly unanimity on that point).
What can’t be denied is this: More young adults and adolescents are undergoing treatment for a disease that, left untreated, can impair speech, rob mobility, and cause the brain to fade inexorably.
“Seeing those increases, particularly in the adolescents and younger adults, we thought, is certainly a finding that deserved further study,’’ said Dr. Mary George, a medical officer in CDC’s heart disease and stroke prevention division.
Strokes do their damage in two ways. The more common form, ischemic stroke, is like the worst traffic jam you can imagine in a blood vessel leading to the brain. Blood flow slows to a dangerous crawl, depriving the brain of oxygen vital for its survival. By contrast, a hemorrhagic stroke resembles a bursting balloon, causing bleeding in or near the brain.
For patients with blockages — and that’s what Jerdee suffered — emergency room doctors have at their disposal a potent clot-busting drug known as tPA. Time is crucial: The intravenous medication must be given three to 4 1/2 hours from symptoms emerging. That’s what happened with Jerdee.
The ability to figure out who’s having a stroke, what kind, and whether clot-smashing drugs are appropriate has improved dramatically in the past 10 to 15 years, neurologists said. That enhanced capability — most notably with a sophisticated medical snapshot machine called an MRI — may go a long way in explaining why younger people today are more likely to be diagnosed with a stroke and admitted to hospitals.
“We’re now recognizing strokes where in the past we didn’t know they existed,’’ said Dr. Martin Samuels, top neurologist at Brigham and Women’s Hospital.
Years ago, when young patients showed up complaining of numbness or blurred vision or slurred speech, they were sometimes dispatched without knowing exactly what was wrong. Now, Samuels said, the same patient would prompt doctors to declare, “Let’s take this person and let’s look for every possible cause of stroke and prevent them from having another stroke.’’
So, in the view of Samuels and Dr. Lee Schwamm, vice chairman of neurology at Massachusetts General Hospital, the increase in ischemic strokes among the young becomes a simple matter of the more you look, the more you find.
But other specialists are intrigued, and concerned, by the possibility that the rise in diagnoses may be a legacy of the nation’s bulging waistline. After all, soaring blood pressure and high cholesterol — potential consequences of obesity — are the well-known handmaidens of stroke.
“Younger people are heavier — this is a national epidemic,’’ said Dr. Viken Babikian, codirector of the stroke service at Boston Medical Center. “That might be part of the reason this is happening.’’
In his practice at the Cleveland Clinic, Dr. Gabor Toth encounters stroke patients in their 30s and 40s with what he describes as “shockingly uncontrolled’’ hypertension, cholesterol, and diabetes.
“When you hear of a 42-year-old with a stroke, you raise your eyebrows and think maybe something else is going on, maybe genetic,’’ Toth said. “Then, when you go see them, they look 10, 15 years older than what they are, they smoke like a chimney, their blood pressure is 200, their cholesterol is uncontrolled.’’
But something entirely different appears to be unfolding among older adults, no longer so convinced of their invincibility. Their rate of ischemic stroke hospitalizations has actually been falling.
Schwamm attributes that to stroke awareness campaigns as well as increased vigilance about the importance of taking medications, including aspirin, that tamp down the embers that can spark into a stroke.
“I’m really worried about the 15- to 44-year-olds, because they’re being exposed to increased risks of obesity and diabetes, and yet they’re most likely not being exposed to the preventive therapies,’’ said Schwamm, who fears neglecting those conditions early in life will put patients at risk for stroke as they age.
Katie Jerdee had none of the obvious stroke risk factors.
On that night when her brain went haywire, she inventoried the possible causes. Maybe I’m dehydrated. Maybe I landed on an electrified manhole cover.
Her brain kept swelling. When it stopped and when therapy started, she had to relearn how to comb her hair, hold a spoon, trace letters. She had age on her side: Young brains, given the right care, almost always figure out a way to recover sufficiently to restore functions.
Doctors never pinned down precisely what caused her stroke, Jerdee said. They speculate it might be related to a blood clotting disorder. They also discovered she has a form of hereditary high cholesterol not detected by usual testing.
To see her, you could never imagine what happened that evening in the Fenway neighborhood. Sometimes, when Jerdee, now an analyst at a Back Bay venture capital firm, gets unusually weary, her coordination will flag. “It’s just something I’ve accepted,’’ she said.
Right now, she’s marking the days until the Boston Marathon. This will be her fourth. She will run with the contingent known as Tedy’s Team, as in Tedy Bruschi, the hard-charging former linebacker for the
Stephen Smith can be reached at email@example.com.