Monday, January 22, 2018
Health

Strokes afflict more youths

TAMPA — A few years ago, Destin Jinks was in a horse riding competition. She had to leave the ring when her arm and leg on one side suddenly went numb.

"It never entered my mind that it could be a stroke," said Destin's mother, Donna Jinks.

After all, Destin was only 14 years old.

It actually was a mini-stroke, or TIA, caused by a temporary blockage in an artery in the brain. TIAs usually last less than five minutes and don't result in permanent brain damage, but are considered a warning sign for a more dangerous major stroke.

Nearly three-quarters of all strokes strike people over age 65, according to the National Institutes of Health. But even infants can have strokes, and they are becoming more common in younger adults and even teens like Destin, for a wide variety of reasons.

In 1994, 13 percent of strokes in this country occurred in people ages 20 to 54. But according to a new analysis published this month in the journal Neurology, stroke incidence in that group was up to 19 percent in 2005.

Study authors aren't certain, but suggest the cause may be tied to increased obesity, diabetes and high blood pressure in younger people.

Dr. David Rose, a stroke neurologist at the Comprehensive Stroke Center at Tampa General Hospital and an assistant professor of vascular neurology at USF Health thinks other factors may also be at work. For starters, the public is better educated now about stroke symptoms, and are more likely to get to a hospital, where improved imaging techniques aid in more accurate diagnoses.

"Today the images are much sharper and we also have MRIs, so it's like looking at high-def TV instead of old style black and white TV," said Rose, "Naturally we're going to diagnose more strokes."

Rose, who is one of Destin's physicians, says the causes of stroke in younger people are not the same as the causes in their elders.

"For most people under age 55, there's a grab bag of causes and it isn't usually the traditional lifestyle-based risk factors that we associate with stroke in older adults," he said.

Heavy smoking, diabetes, high blood pressure and high cholesterol are all risk factors that are cumulative and can take decades to cause strokes.

"When someone in their teens, 20s and 30s has a stroke, it's a different animal. There are so many other possible causes—things that aren't typical," said Rose.

One of the most common causes is injury to an artery in the neck. A number of scientific studies have found that the damage can be from something as dramatic as a car accident, a bad fall, engaging in combat style sports — or as subtle as a neck twisting golf swing, a jarring rollercoaster ride, or an overly aggressive chiropractic treatment.

"I know this isn't going to make me popular with the chiropractors out there, but I see at least one of these every month or two," said Rose. Unpopular as the idea may be among chiropractors, Rose is hardly alone in his observation. The connection has been well documented in peer-reviewed medical literature over the past decade.

Other causes of strokes in the young include genetically weak arteries; undiagnosed heart-related birth defects; heart rhythm disorders like atrial fibrillation; and blood clotting disorders.

If a young woman has a stroke, doctors suspect smoking while using hormone-based birth control use, a combination that is is a well known contributor to stroke.

And that's not the only combination that can lead to a stroke.

Dr. Ajay Arora, medical director of stroke and neurovascular programs at Morton Plant and Mease Hospitals in Pinellas County, notes that when a person with high blood pressure uses a stimulant such as cocaine, disaster can result. "When I worked at an inner-city hospital in Atlanta it was a big problem, mostly because of its large African-American population and their high incidence of high blood pressure, a major cause of stroke."

Sometimes, despite the best tests and imaging studies, doctors will never find out why a patient had a stroke.

"I had a 30 year old man recently who had a stroke and recovered very nicely," said Arora. "We worked him up with every possible test and couldn't find a cause. His blood just decided to clot that day."

Destin Jinks was eventually diagnosed with a rare disease called moyamoya, which causes blockages in the blood vessels of the brain. Now 18 and a college freshman at USF St. Petersburg seeking a nursing degree, she takes several medications, including an aspirin a day, to prevent TIAs and strokes. She's had one round of surgery to open blood vessels in her brain and likely faces more in the coming months.

"The TIAs were happening about once a month, now it's about four or five a month," she said, "I have to watch it."

Contact Irene Maher at [email protected]

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