Stroke is commonly thought of as an affliction of old people. But strokes can strike people of any age, including infants, children, and young adults. Nearly one-quarter of the 795,000 Americans who suffer a stroke each year are under age 65.

Clinicians often separate the “young” into two categories:

• Children ages 14 and younger.
• Young adults ages 15-44.

Both ages groups can suffer from the two major types of stroke:

• Ischemic strokes, which are caused by clots of plaque that block blood flow to the brain and account for 87 percent of all strokes
• Hemorrhagic strokes, which result when a blood vessel in the brain ruptures and leaks blood into and around the brain.

Stroke is the third-leading cause of death in the United States, and accounts for more than 140,000 deaths each year. In addition, stroke is the nation’s leading cause of serious, long-term disability.

Increased Risks Seen in Young People

Until recently, it was thought that teens and young adults accounted for 5-10 percent of all strokes. But a 2011 report from the U.S. Centers for Disease Control and Prevention suggests that this proportion is increasing.

Researchers analyzed data from the Nationwide Inpatient Sample of the Healthcare and Utilization Project to find people hospitalized for stroke. Between 1995 and 2008, they found that the number of young adults ages 15-44 hospitalized for stroke increased by more than 33 percent.

The researchers also found that young stroke victims had high rates of traditional risk factors for stroke. Among ischemic stroke patients, nearly one in three of those ages 15-34 had high blood pressure as did more than half of those ages 35-44. One in four women ages 15-34 were smokers and so were one in three men ages 15-44. In addition, many of the patients were obese and had high cholesterol.

In a related 2011 study, Canadian researchers studied 84 young men and 84 young women ages 18-35 who had no cardiovascular risk factors or family history of premature heart disease. They identified premature and hidden hardening of the arteries (atherosclerosis) in about 80 percent of the subjects, confirming earlier research showing a high rate of such subclinical atherosclerosis in young Americans killed in war or in car accidents.

Atherosclerosis significantly increases the risk of heart, disease, stroke, and death.

The researchers also found that a high waist circumference was a better predictor of atherosclerosis than body mass index (BMI) because it is associated with a large amount of dangerous visceral fat enveloping the heart, liver, and other internal organs. A waist circumference above 40 inches in men and above 35 inches in women is associated with an increased risk of chronic diseases such as type 2 diabetes, heart disease, stroke, high blood pressure and some cancers.

Lifestyle May Increase Risk of Early Stroke

Smoking is the most important modifiable risk factor for stroke, and is directly responsible for a higher proportion of strokes in young adults than in older adults. Smokers have a double risk of ischemic stroke compared to nonsmokers.

Other modifiable risk factors that may be especially prevalent in younger people include:

• Heavy alcohol consumption.
• Use of illicit drugs such as cocaine and crack cocaine, marijuana, amphetamines, and heroin.
• Illegal anabolic steroids used by bodybuilders to increase muscle mass.
• Legal drugs such as caffeine, L-asparaginase, and pseudophedrine found in over-the-counter decongestants and weight-loss products.

Head and neck injuries – more prevalent in the young – also can cause strokes. For example, a blow to the head from an accident or a rough contact sport can cause brain bleeding similar to a hemorrhagic stroke.

Neck injuries can cause ischemic strokes, especially when there is a sudden and severe extension or rotation of the neck that causes spontaneous tearing (dissection) of the vertebral or carotid arteries. Such tearing can result from neck calisthenics, improperly performed chiropractic manipulation, and practices such as “bottoms up” drinking.

Strokes resulting from neck injuries are commonly known as “beauty parlor syndrome.” The term refers to the strokes that sometimes occur after people’s necks are extended backwards over a sink for a hair washing.

Medical Conditions Associated With Stroke

Obesity, high blood pressure, diabetes, and heart disease aren’t the only medical conditions that can increase stroke risk. In young adults, other medical conditions associated with stroke include:

• Pregnancy.
• Heart malformations.
• Infections.

In children, sickle cell syndrome (SCD) is the most common cause of stroke. Among those with SCD, strokes occur in an estimated 17-24 percent, usually between the ages of 3 and 10. Ischemic stroke is most common in patients under age 15 and over age 30 while hemorrhagic stroke most often occurs in those ages 20-30.

A recent study by the National Heart, Lung, and Blood Institute suggests that blood transfusions may help prevent strokes in high-risk children with SCD.

Prevention Is Key

Most strokes can be prevented. Experts warn that even young, seemingly indestructible young people aren’t immune to the bad effects of poor lifestyle choices. To reduce the risk of an early stroke, they recommend:

• Quitting smoking.
• Drinking only in moderation.
• Avoiding illicit drugs.
• Avoiding sports and other activities associated with head and neck injuries.
• Losing weight to reduce visceral fat and achieve a healthy BMI (18-25).
• Eating a healthy, balanced diet.
• Engaging in regular exercise.
• Getting screened for medical conditions associated with stroke.
• Receiving appropriate treatment for medical conditions.

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