Monday, 23 January 2017

Stroke in Young Adults

Our modern life style has put our young adults more at risk in health issues than their elders.
Stroke in young adults is one of the health issues about which we need to create awareness among the general public. This will alert both the young adults as well as their parents/guardians to take preventive measures. Stroke is a public health issue that causes long-term disabilities with emotional and socio economic consequences.

First of all, what stroke is all about?

Stroke is associated with a new onset of rapidly developing symptoms and signs of loss of cerebral function lasting more than 24 hours with no apparent cause other than that of vascular origin. Stroke is of two kinds, one hemorrhagic and second ischemic.In one type, rupturing of blood vessels of the skull occurs. In the other type, bleeding occurs at the spot between the arachnoid membrane and pia mater around the brain. These two are the major causes of stroke in young adults.

Major causes of stroke in young adults and children are different from that of older people.

Strokes develop within 24 hours of onset of symptoms, all occurring within 10 days. Therefore, early suspicion and diagnosis is necessary to prevent stroke. Migraine is an underlying factor for stroke and it also is an acute precipitant of stroke (migrainous stroke). Ischemic stroke risk is higher in females having migraine and using oral contraceptives which are a known independent risk factor for ischemic and hemorrhagic strokes. People aged over 35 with a history of hypertension with smoking habits are prone to get stroke attacks. 


Regardless of age, symptoms for stroke are indicated in the acronym F.A.S.T.  “F” for drooping face on the one side, “A” for arms that cannot be raised, “S” for slurred speech, and “T” for time indicating timely action. The acronym FAST is to help detect stroke symptoms and immediate hospitalization.

General symptoms which are not exhaustive
·       Sudden numbness or weakness of the face, arms, or legs particularly on one side of the body.
·       Sudden confusion, trouble speaking or understanding difficulty.
·       Sudden vision difficulties in one or both the eyes.
·       Sudden severe headache.

General risk factors,also called as modifiable risk factors in young adults

·       Smoking
·       Alcoholism
·       Diabetes
·       Hypertension
·       Dyslipidemia
·       Past history of stroke
·       Rheumatic heart disease with atrial fibrillation
·       Oral contraceptive pills in women
 Uncommon causes of stroke in young adults.

·       Nonatheroscleroticangiopathies
·       Cervicocephalic  arterial dissection
·       Cerebral amyloid angiopathy
·       Moyamoya disease
·       Fibromusculardysplacia
·       Reversible cerebral vasoconstriction syndrome
·       Susac’s syndrome
·       Sneddon’s syndrome
·       Migraine-induced stroke

Hematologic conditions
·       Hypercoagulable state due to deficiencies of protein S, protein C or antithrombin;
·       Factor V Leiden mutation etc
·       Fabry disease
·       CADASIL  (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
·       MELAS
·       Marfan syndrome
·       Neurofibromatosis
·       Sturge-Weber disease

Inflammatory and infectious

·       Vasculitis
·       Temporal arteritis
·       Takayasu disease
·       Bechet’s syndrome
·       Neurosarcoidosis
·       Neurocysticerosis
·       HIV
·       Varicella zoster virus
·       Neurosyphilis
·       Tuberculous meningitis

 Indian scenario
According to a study, about 5.8 million people had been affected by stroke as far back as in 2005. Stroke has emerged as the second most common cause of death. Globally 7.8 million deaths have been estimated to occur due to stroke by 2030.  By 2050, India will be one of the regions where 80 % of stroke events will occur.

Prevention of Stroke
Quit smoking and have regular physical exercise for 20 minutes a day at least three to four days in a week.  Ensure against high blood pressure, high cholesterol levels and blood sugar levels.  Primary stroke prevention in young adults includes aggressive treatment of hypertension, smoking, and dyslipidemia. Secondary stroke prevention involves stroke etiology and treatment of additional risk factors. Secondary stroke prevention aims at prevention and reducing risk of a second stroke after identification etiology of initial stroke as part of stroke rehabilitation.

Although stroke in young adults occurs only in 10-15 % of all stroke patients, this section of the population suffers severe economic consequences as young adults are disabled well before their most productive years. Apart from aggressive treatment and control of risk factors, life style changes can prevent up to 50 % of strokes.


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