When strokes occur at a young age

THERE was a time when certain conditions were tied to the elderly population, but those days are no more. Now, more than ever, millions of people worldwide are affected by conditions like strokes, also known as cerebrovascular accidents.

Dr Jomo James, internist, said a stroke occurs when part of the brain dies because its blood supply has been cut off for too long.

He said there are two main reasons for this sudden cessation of blood supply to the brain, and they include the blood vessel being blocked or closed off from a clot, fat/cholesterol build-up in the walls of the arteries, and less commonly, the rupturing or bleeding of the blood vessels.

The internist said although more frequent in adults, strokes do occur in the younger population, including children, adolescents and young adults. He said the usual causes and risk factors for strokes in this population differ from that of older adults and are sometimes unique, but the underlying risk for the most part are more prevalent in the young population or disease manifestation at an earlier age.

According to Dr James, the risk factors in general can be easily remembered by what he referred to as the 7 C’s.

1. Cardiovascular abnormalities

These can either be congenital or acquired over time. “The congenital heart diseases such as patent foramen ovale or ventricular septal defects can lead to thrombus/clot formation within a deformed heart that can potentially break off and be pumped by the heart through the circulation and in this case, the arteries to the brain. These clots then block smaller arteries which they cannot pass, leading to a stroke. This phenomenon is known as cardiac embolism,” he said.

2. Collagen vascular disease

Dr James said these conditions are autoimmune diseases in which the body literally attacks itself. “Best example is systematic lupus eryhthematous. This can lead to inflammation of the vessels in the brain precluding to clot formation and a clogged artery,” he said.

3. Circulatory disorders

The internist said these are blood haematological disorders of which the most frequent is sickle cell disease. He mentioned that sickle cell disease is the most common cause of stroke in young children, and the rate of stroke is said to occur 300 times more in children with sickle cell than in children without the disease.

4. Cocaine or substance abuse

“These include drugs such as cocaine, methamphetamine, ecstasy and heroin, which can cause stroke due to elevated blood pressure and spasms of blood vessels,” he said.

5. Concussion/trauma

Dr James said any form of trauma, particularly head injuries, can cause arterial damage that disrupts blood flow to areas of the brain leading to a stroke, the more common of which is arterial dissection in which the wall of the artery is ripped apart.

6. Coagulapathy

According to Dr James, this refers to the relative ease in which blood clots or not. He said the usual conditions that cause a person’s blood to clot easily are usually genetic and associated with a strong family history. “These people tend to develop multiple clots in their arteries. The converse in which a person’s blood does not clot easily or is too thin, for example in haemophiliacs, cause stroke by vessel rupture and bleeding,” he said. He added that women on oral contraceptive pills, particular high dose oestrogen, have an increased risk of clot formation and thereby strokes.

7. Cephalgia

This literally means headache, and Dr James said the type of headache that is associated with increased risk of stroke is severe migraines.

The symptoms of stroke vary depending on which part of the brain is affected. They usually include difficulty in speech, abnormal sensation, for instance numbness to one side of the body, or unilateral limb weakness. Dr James said because strokes can be very debilitating, recent focus has been on getting people to recognise it fast in order to get prompt treatment.

“The sooner treatment or evaluation is started the better the outcome in terms of less disability and fewer complications,” he said.

One scheme used for rapid detection of a possible stroke is the FAST system:

F — facial asymmetry, drooping or twisting of face to one side

A — arms , where one arm is weak or droops down when outstretched

S — speech is slurred

T — Time. If any of the above symptoms are present, call emergency services or get to a hospital fast.

Dr James said treatment varies according to the type of stroke, but the general goals are to prevent complications, disabilities, and further strokes. Rehabilitation is also a major factor for people who have suffered strokes.

–Kimberley Hibbert