Stroke: Prevention, identification and treatment in youngsters

Strokes were the second most common cause of death and the third most common cause of disability in the world as recently as 2020.

KOCHI:  Stroke is increasing in incidence and causing significant morbidity and mortality, especially in the developing world. A recent article in The Lancet has shown alarming results: Strokes are becoming more common and are becoming more common in young adults, i.e. people below the age of 55 years. 

Strokes were the second most common cause of death and the third most common cause of disability in the world as recently as 2020. This trend is expected to continue for a few decades. First, let’s understand what a stroke is. A stroke occurs when the blood supply to a part of the brain is suddenly interrupted. This interruption can lead to damage in the brain because it doesn’t receive the oxygen and nutrients it needs. There are two primary types of strokes:

Blood vessel block: This is the most common type. It happens when a blood vessel in your brain gets blocked, usually by a blood clot or fatty deposits.

Blood vessel burst: It occurs when a blood vessel in your brain bursts, causing bleeding into the brain tissue. It can create pressure and damage the brain cells.

Risk factors for young adults
Strokes in younger individuals, while less common than in older adults, can happen due to various reasons. The most prominent risk factors for young adults especially are:

1. Heart disease
2. High blood pressure
3. Lifestyle choices: Smoking, drug abuse, and excessive alcohol consumption 
4. Diabetes
5. Obesity
6. Increased salt consumption in packaged food
7. Genetics
8. Oral contraceptives

What you can do to reduce your risk of having a stroke? It’s important to remember that prevention is crucial. Here are some steps that can be taken:

Control blood pressure: Regularly check your blood pressure and work with your healthcare provider to manage it.

Healthy lifestyle: Maintain a balanced diet, exercise regularly, and avoid smoking and excessive consumption of alcohol.

Diabetes management: If you have diabetes, it’s crucial to work closely with your healthcare provider to keep it under control.

Weight management: Maintain a healthy weight through diet and exercise, which can reduce the risk of high BP and other stroke-related factors.

Cardiovascular screening: If you have a family history of stroke or heart conditions, consider early screening and risk assessment.

Medication adherence: If you are prescribed medications for underlying conditions, such as hypertension, diabetes, or heart issues, take them as directed.

Birth control choices: Women should consult their healthcare providers to choose birth control methods that minimize stroke risk.

Time is the most important element when treating strokes and that means early recognition. So, How do you recognise a stroke? The following may be seen alone or in combination in a person who had a stroke: 

1. Numbness or weakness of the face or limbs, 
2. A change in the way a person smiles with face deviation 
3. Slurred speech 
4. Inability to talk or understand others, 
5. Headache with vomiting 
6. Seizures (fits).

Stroke and treatment of brain disorders in general is not easy. It requires neuro-specific knowledge by doctors specialised in these diseases, as well as knowledge and experience in investigations and treatments. It is important that patients reach hospitals that care for patients with stroke regularly. 

One of the first investigations is a CT scan or an MRI scan to identify the type of stroke (blood vessel burst/blood vessel clot). Based on this, treatment varies.

Most young adults with a stroke can be treated with medication, and for the blood vessel block category, they may need block removal medications (thrombolysis) and even keyhole procedures (Thrombectomy).

A minority with very large strokes end up needing major open neurosurgical procedures when medical management alone is not enough. These patients tend to develop severely raised pressures inside their brains due to the stroke. The neurosurgeon of the care team may recommend a life-saving surgery, often a Decompressive Craniectomy, which will help reduce the brain pressures and prevent further worsening and complications. 

With advanced tools such as Neuroendoscopy and Neuronavigation (which allows the surgeon to operate with computer guidance), even deep bleeds can be removed completely in select patients using a keyhole approach. 

In conclusion, while strokes in young adults are relatively unknown, they can happen. By understanding the causes, and risk factors, and taking preventive measures, you can significantly reduce your risk. And if, by chance, a stroke occurs, it’s reassuring to know that there are effective treatments available. 

Remember, your health is in your hands, and the choices you make can make all the difference. Time is the most critical factor. If you notice or experience any of the warning signs described above, make sure to get it checked immediately.

The writer is the head of neurosurgery at VPS Lakeshore Hospital

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