Stroke Before Age 45

We think of stroke as something that happens to older people. But every year, about 70,000 Americans under age 45 have strokes.

About 10 to 15 percent of strokes occur in children and adults under age 45, and that number is rising.

There are two types of stroke: ischemic and hemorrhagic. The biggest increase is being seen in ischemic strokes that result from artery-blocking blood clots that travel to the brain. Ischemic strokes are the most common type of stroke. Hemorrhagic strokes, which happen when a blood vessel in or near the brain ruptures, are far less common.

What Causes Stroke in Younger People?

Some of the risk factors for stroke in younger adults are different than those found in older adults, but many are the same—smoking, heavy drinking, diabetes, high blood pressure and high cholesterol. Bad health habits are not the only causes of strokes in young people, however. Other conditions can bring about strokes before age 45, including several that are inherited.

Even when inherited conditions raise your chances of having a stroke, there may be actions you can take to reduce your risk.

Blood Disorders

Some people develop or inherit conditions that cause blood to clot (coagulate) more easily, which can increase the risk of an ischemic stroke.

Coagulation problems can be inherited, and some are detectable with a blood test. So if you or a close relative has developed blood clots, talk to your doctor about possible tests and treatments.

Heart Conditions

Some people are born with or develop heart conditions that can cause or allow blood clots in the heart to travel to the brain.

A small percentage of strokes in young adults are caused by a very common condition called patent foramen ovale. About 25 percent of people have PFO, which develops when a hole between the heart's chambers doesn’t close during the first few months after birth. Doctors can diagnose PFO with a simple echocardiogram. However, because the vast majority of people with PFO never have a problem, doctors seldom treat it unless you have symptoms.

Aneurysms

Aneurysms form when blood vessel walls weaken and form bubbles that can rupture, causing hemorrhagic strokes. Some people are born with blood vessel malformations. Research shows that there are also genes and inherited conditions that increase risk. Aneurysms can occur at any age, but ruptured aneurysms most commonly affect people between ages 30 and 60.

Inheritance plays a more-than-significant role in aneurysm formation, and smoking dramatically increases that risk.

Talk to your doctor if a parent, brother or sister has experienced an aneurysm. There are tests and treatments available that can reduce your chances of experiencing a ruptured aneurysm.

Polycystic Kidney Disease

This kidney disorder, which runs in families, causes cysts to form on the kidneys. Because kidneys filter blood, the cysts can cause blood vessel disorders, including high blood pressure and aneurysms.

People with polycystic kidney disease have a 50 percent higher risk of aneurysms, so it’s important to receive regular medical care that includes controlling high blood pressure. PKD is inherited, so if a close relative has experienced a brain aneurysm, your doctor may also recommend regular screening to check if aneurysms are forming.

Migraine

Migraine is a neurological disorder most known for the headaches it causes. Thought to be inherited, migraine can (rarely) cause ischemic and hemorrhagic strokes. Migraine increases stroke risk in young people. The risk increases as people age because the more migraine attacks a person has, the higher the risk of stroke.

Smoking greatly increases stroke risk in people with migraine. Women with migraine who take birth control pills or hormone replacement therapy also increase their risk of stroke. And in women with migraine who smoke and take birth control pills, the risk of stroke is significant.

“Besides not smoking or taking hormones, the best way people with migraine can lower their risk of stroke is by reducing the number of migraine attacks they have. There are medications available that help prevent attacks. Talk to your doctor about seeing a headache specialist for preventative treatment.

Artery Tears

Another underappreciated cause of stroke in the young is dissection (tearing) of neck blood vessels. This can happen spontaneously or be related to trauma, even minor trauma. Diagnosis requires a high degree of clinical suspicion especially if there is head or neck pain or a history of trauma.

The slight tears can result in blood clots forming and either blocking the artery or breaking off and traveling to the brain. Rarely, the tears may cause aneurysms. Migraine and other hereditary conditions can cause tears, but they are most often connected to mild trauma or overextending the neck.

These are the rare strokes that most commonly affect young, healthy people — especially athletes. There’s nothing you can do to prevent this type of stroke. What you can do is get to immediate medical care if you experience dizziness that comes on out of nowhere, sudden head or neck pain, or facial pain or numbness. Don’t ignore the symptoms and assume they’ll go away.

Drug Abuse

Older people are not the only one who have strokes. Certain health conditions can also cause strokes in the young.

Birth Control Pills

Birth control pills slightly increase stroke risk in all women. Smoking pushes the risk considerably higher. It's important to remember that birth control pills alone present a small risk and needs to be balanced against the risk of an unwanted pregnancy.

Poor Health Habits

With an identifiable cause, most strokes in young adults are related to the same poor health habits that lead to strokes in older adults: diabetes, hypertension, smoking, etc.

Health Maintenance as Prevention

If you have signs or symptoms suggestive of stroke, you need to get evaluated. Remember, the vast majority of strokes are preventable — but only if you seek medical care in a timely fashion. Get regular checkups and be proactive about prevention. If you follow these guidelines, there’s a good chance you can avoid having a stroke at any age.”

See Six Simple Ways to Reduce Your Stroke Risk for helpful stroke prevention tips.

BE FAST to Spot a Stroke

With stroke, you need to BE FAST. Time is critical for a stroke victim. Each minute, two million brain cells die. Learn the signs of stroke, and use Sutter’s BE FAST materials to spread awareness.

Discover more about how to spot a stroke.