Tuesday, January 16, 2018
Health

Too young to have a stroke?

On a snowy morning in 2010, Jolene Morton headed to work early, thinking she would be safer with fewer cars on the roads. Shortly after arriving, she started slurring her words while talking on the phone and then she dropped the receiver. In a flash, everything went blank. "All I saw in my head was a dark room with dust bunnies," Morton says.

She struggled to speak as her supervisor helped her lie down on the floor. Morton, at 33, had suffered a stroke, long considered a rarity in someone so young. Ischemic strokes, which account for about 90 percent of all strokes, result when clots or fatty deposits block blood flow to the brain. Morton's doctors never found a clot, only a narrowing in an artery that feeds brain areas critical for motor control, sensory perception and speech.

Over several months, Morton, who worked at a home-nursing agency in West Chester, Pa., slowly learned how to walk, talk and feed herself again. Today she spends afternoons in bed, exhausted from seizures and chronic pain that followed the stroke.

Strokes in younger adults typically result from rare conditions, including tears in artery walls (called dissections) or defects in the heart that release clots. Strokes in older adults usually result when a lifetime of bad habits ravages the vascular system. But strokes, long on the decline among the elderly, appear to be rising among younger adults.

About 10 percent of the nearly 800,000 strokes that Americans suffer each year occur in people younger than 50, according to recent studies.

No national registry tracks strokes, leaving researchers to find trends in regional studies, hospitalization records and health surveys. But their discoveries show a troubling trend. In 2010, a study in the journal Stroke found that the stroke rate tripled in 35-to-54-year-old women between 1988 and 2004. The next year, the Centers for Disease Control and Prevention reported that hospitalizations for ischemic stroke increased by more than a third in 15-to-44-year-olds in the 14-year period that ended in 2008. In 2012, a review of hospital records in the Midwest found a 44 percent jump in strokes between 1993 and 2005 among people younger than 55. The same year, researchers at Kaiser Permanente in Northern California reported an "alarming" increase in ischemic strokes among people age 25 to 44 between 2000 and 2008.

Mary George, who led the CDC study, was troubled to see so many young stroke patients with conditions that could have been prevented or treated with medications. Nearly a third of the 15-to-34-year-olds and more than half of 35-to-44-year-olds had high blood pressure, which is the leading risk factor for stroke.

Nina Solenski, an associate professor of neurology at the University of Virginia, says that the message that exercising and eating wisely can reduce high blood pressure seems to be getting through to older people, only to be lost on the young.

When Solenski started practicing 20 years ago, she rarely saw young stroke patients. But in recent years, they have been showing up with high blood pressure, diabetes and other conditions once associated with old age. "It's actually kind of frightening," she says.

• • •

Young men and women share the same cardiovascular risks from unhealthy behaviors. But women are more prone to migraines, and they are uniquely vulnerable to pregnancy-related complications and hormones found in birth control pills, all of which increase stroke risk.

Morton ate well and exercised, but she started smoking at 19. She got migraines soon after her first pregnancy in 2000, and had taken birth control pills and Lupron, a synthetic hormone, to control endometriosis.

Lupron comes with a warning that women with clotting disorders or a history of stroke should avoid the drug. But Morton didn't find out she was positive for factor V Leiden — a mutation linked to clotting problems — until after her stroke.

Six months later, she got pregnant. "My doctors weren't pleased about that," she recalls. Pregnancy, combined with her history of smoking, migraines and a potential clotting disorder, placed her at risk of recurrence.

At 28 weeks, Morton was put on bed rest; she delivered twins within six weeks. She slowly started feeling better, and even went back to work briefly. Then one day in the fall of 2011 she woke up feeling as though she had "been hit in the back of the head." She lost her balance and couldn't see clearly. "I went to the hospital and they said, 'Oh, you've got a migraine,' and sent me home."

Soon after leaving the hospital, Morton started having seizures. She hasn't been able to work since. She can't afford the medications to control her pain or seizures and hasn't found a doctor who can help her. "It's an invisible illness," she says. "If your ability to process information is damaged, they're so much more apt to write you off or say you have an emotional problem."

Morton, once proud to be the sole breadwinner for her family, moved her family back to her home town of Altoona, where they live with her grandmother.

• • •

About 15 to 30 percent of stroke survivors live with permanent disabilities, according to the CDC. Previous studies found lasting disability in only 3 to 7 percent of young people, whose more resilient brains allow for better recovery. But a recent study found that 12 percent of survivors age 50 and younger failed to recover their independence after 10 years.

A major stroke can kill nearly 2 million brain cells a minute. That's why patients who receive such treatments as anti-clotting drugs within three hours of initial symptoms fare better. But the rising rates of stroke in young people and its sometimes subtle symptoms may be catching clinicians off guard.

A recent review of the hospital records of 180,000 stroke patients found that women coming to emergency rooms with complaints of headaches or dizziness were about 30 percent more likely than men with such complaints to get diagnosed with migraine or ear infection. But, compared with those 75 and older, patients younger than 45 who sought treatment for these symptoms faced a nearly sevenfold risk of misdiagnosis, according to the study, published in Diagnosis. More than a quarter of these patients returned with clear signs of stroke within 48 hours.

"We can't say with certainty that any one patient was misdiagnosed," acknowledges David Newman-Toker, the Johns Hopkins neurologist who led the study. "But we know that the risk of major stroke is greatest in the 72 hours after a minor stroke," he says.

And that's what Newman-Toker saw: Hundreds of patients who arrived at the hospital in the midst of an obvious stroke had been discharged within the previous week with diagnoses of benign headache or dizziness, suggesting that they had been having a minor stroke that was missed.

Unlike obvious stroke signs such as weakness on one side and slurred speech, headaches and dizziness can have many causes, Newman-Toker says. And stroke still strikes primarily older people, so clinicians are less likely to consider it in a young patient. "Even though we're progressively making ourselves fatter and sicker at an early age," he says, "it's the people you least suspect that are going to be missed."

Misdiagnosis is the primary complaint Kelli Smith of Cape May, N.J., hears as moderator of an online support group for young stroke survivors at StrokeNet. Two minutes after a chiropractic neck manipulation in 2009, Smith, a 35-year-old mother of two, started feeling dizzy. Glancing at her husband and the chiropractor, she saw four people. Then she passed out.

The rarity of stroke following chiropractic adjustment makes it difficult to know if the neck manipulation was to blame. Whatever the cause, Smith still suffers crippling headaches from double vision and vertigo.

Most disconcerting, Smith recalls nothing from her childhood, knows her parents by name only and can't remember the first nine years of her marriage or giving birth. She's in the midst of a divorce, but she feels lucky to be alive. Basilar artery dissections are rare but deadly: Up to 95 percent of patients die without immediate treatment. Smith is more worried about the people she counsels every day.

"I can't tell you how many times I hear stories from people who had clear signs of stroke but the doctors tell them they're too young," Smith says. Then they end up with devastating health deficits and can't go back to work but can't qualify for financial assistance to pay their bills and feed their families, she says. "It's heartbreaking."

Liza Gross, a journalist based in Kensington, Calif., blogs about science for KQED.

Comments
Pinellas is at the center of a rise in Florida flu outbreaks

Pinellas is at the center of a rise in Florida flu outbreaks

Feeling a little sniffly or scratchy or stuffed up? It may be the flu, and you don’t want to wait around to see a doctor this year. This is not the time to write off flu-like symptoms, Tampa Bay area health officials and doctors warn. The influenza v...
Updated: 8 hours ago

CDC says ‘There’s lots of flu in lots of places.’ And it’s not going away anytime soon.

A nasty flu season is in full swing across the United States, with a sharp increase in the number of older people and young children being hospitalized, federal health officials said Friday.The latest weekly data from the Centers for Disease Control ...
Published: 01/12/18
Mease Countryside Hospital begins $156M expansion project

Mease Countryside Hospital begins $156M expansion project

SAFETY HARBOR — Mease Countryside Hospital is launching a $156 million expansion to build a four-story patient tower with all private rooms and a four-story parking garage.The tower will include 70 private patient rooms, a 30-bed observation unit, cr...
Published: 01/11/18
Flu shot? This is why you should still get one this year

Flu shot? This is why you should still get one this year

This year’s flu season is shaping up to be a bad one. Much of the country endured a bitterly cold stretch, causing more people to be crowded together inside. The strain that has been most pervasive, H3N2, is nastier than most. And, we’re being told, ...
Published: 01/11/18
He was 21 and fit. He tried to push through the flu — and it killed him.

He was 21 and fit. He tried to push through the flu — and it killed him.

Kyler Baughman seemed to be the face of fitness. The 21-year-old aspiring personal trainer filled his Facebook page with photos of himself riding motorbikes and lifting weights. He once posted an image of a kettlebell with a skeleton, reading: "Cros...
Published: 01/11/18
Serena Williams tells scary story of childbirth complications

Serena Williams tells scary story of childbirth complications

The image on the cover of the February issue of Vogue features Serena Williams proudly showing off her adorable daughter.The story she tells of the changes wrought on her life by the arrival of Alexis Olympia, whom she calls by her middle name and ...
Published: 01/11/18
‘Pregnancy centers’ draw scrutiny as lawmakers seek to elevate their status

‘Pregnancy centers’ draw scrutiny as lawmakers seek to elevate their status

Annie Filkowski used to see the signs during her drive to school each morning. "Free pregnancy tests," they said.So when she feared she might be pregnant at 16, shortly after starting to have sex with her boyfriend, she remembered them. And walked in...
Published: 01/10/18
Updated: 01/12/18
Analysis: St. Petersburg ranked among 'worst places to die'

Analysis: St. Petersburg ranked among 'worst places to die'

Where do you want to die? When asked, the vast majority of Americans answer with two words: "At home." Despite living in a country that delivers some of the best health care in the world, we often settle for end-of-life care that is inconsistent wit...
Published: 01/10/18
Obamacare enrollment remained strong in Florida, despite obstacles

Obamacare enrollment remained strong in Florida, despite obstacles

While health insurance sign-ups through the Affordable Care Act dipped slightly across the nation for 2018, Floridians bought plans at nearly the same levels as last year despite a much shorter enrollment period, a smaller budget for promotion and re...
Published: 01/10/18
Defending against this season’s deadly flu: 5 things to know

Defending against this season’s deadly flu: 5 things to know

The nation is having a Terrible, Horrible, No Good, Very Bad flu season.Flu is widespread in 46 states, according to reports to the U.S. Centers for Disease Control and Prevention (CDC).Nationally, as of mid-December, at least 106 people had died fro...
Published: 01/09/18