When the actor Frankie Muniz, who starred in the hit sitcom “Malcolm in the Middle,” told his Twitter followers Tuesday that he’d been hospitalized after suffering a “ministroke,” he joked “Have to start taking care of my body! Getting old!”
But Muniz, whose birthday is today, is all of 27 -- hardly old -- and certainly not the age most of us, including most doctors, think of when we think "stroke patient."
In fact, while the mid-20s isn’t the typical age at which strokes strike, everybody, from newborns, to teenagers, to the elderly can suffer a blocked vessel that prevents blood from reaching the brain and causing a damaging stroke or a milder episode called a transient ischemic event (TIA), a “ministroke.”
The Centers for Disease Control and Prevention figures from 2010 show that approximately 664,000 Americans between 18 and 44 suffered strokes. According to the American Heart Association, .3 percent of men and .5 percent of women ages 20-39 suffered strokes between 2005 and 2008. A study released in October in the journal Neurology revealed that rate of strokes in younger people – defined by the study as 20-54 – rose significantly. Among the population studied, in the states of Ohio and Kentucky, whites were diagnosed with strokes at a rate of 26 per 100,000 in 1994, but 48 per 100,000 by 2005. The rate among African-Americans rose from 83 to 128 per 100,000.
The researchers speculated the trend could be the result of both better diagnostics and increasing rates of obesity, high blood pressure, and diabetes.
But TIAs and strokes still happen most often in older people because the elderly are much more likely to have accumulated fatty plaques, atherosclerosis, in their arteries. This build-up can lead to a blockage when the vessel closes off, or when a piece of the plaque breaks away and flows into a smaller vessel, blocking it. If that happens in a vessel leading to the brain, it can cause a stroke.
Atherosclerosis is much less common in young people, Dr. Heather Fullerton, the director of the pediatric stroke and cerebrovascular disease center at the University of California, San Francisco, told NBCNews.com. But a variety of conditions can lead to TIAs and strokes.
For example, she said, trauma can cause a tear in a vessel leading to a blood shortage in the brain. Infections that cause systemic inflammation have been linked to ischemic events in young people. Chicken pox is a prime suspect, but, Fullerton said, other inflammatory diseases appear to be linked.
“This relationship between infection and stroke explains lots of strokes we see in children and young adults,” she said. “It’s related to the way inflammation can cause injury to vessels.”
Other genetic diseases like sickle cell anemia, and neurofibromatosis can lead to TIAs and strokes.
Sometimes, suggested R. Kevin Rogers, assistant professor of cardiology and vascular medicine at the University of Colorado School of Medicine, the cause is more prosaic. For example, a “paradoxical embolism,” a small clot originating somewhere in the body, like, say, the lower leg, can find its way to a blood vessel in or leading to the brain.
And then, sometimes, he said, doctors never find a cause. “Then we might call it a ‘cryptogenic’ stroke,” he said. That’s another way of saying doctors have no idea.
One risk for a younger person having a stroke is that, given the patient’s age, a doctor may not suspect stroke, leaving it undiagnosed.
Overall, a 20-something person who suffers a TIA or stroke is faced with a good news/bad news situation. The bad news, Fullerton said, is that “the early phases of the event are actually more dangerous for a young person and even more likely to be fatal,” than in an older patient.
That’s because the brain tends to swell when it’s suffered a stroke and young people have big, plump, brains filling their skulls, leaving little room for swelling. As we age our brains atrophy – they shrink – giving us more room to accommodate swelling.
The good news is that young brains are also more plastic. They can compensate better for damage to one area, meaning they can create new wiring around damage to lessen the impact and risk of deficits.
Young and old people who have TIAs and strokes are provided much the same treatment in the initial phases of the event. As soon as possible, patients are usually given a drug, called a thrombolytic, to break up any clot and get the blood flowing again.
Whether or not somebody is one blood thinners, the risk of future TIAs and strokes are elevated in most people who’ve had one. The ongoing risk is why doctors often put stroke patients on blood thinners, blood pressure and lipid-lowering medications. According to Rogers, though, doctors are often reluctant to prescribe lifelong blood thinners to younger people.
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