First of two parts on strokes in younger people. The second part will appear next Monday in Health & Science.
Brent Wylie was arguing with the doctors in the emergency room at Grady Memorial Hospital in Atlanta. They said he had just had a stroke; he insisted that he had had a few beers and was probably drunk. That's why he had fallen on the sidewalk and was slurring his words.
"I had just graduated from college two months earlier, and I was totally healthy," Wylie, then 23, said. "Strokes didn't happen to people like me."
But Wylie was stunned to learn that he was one of a fast-growing group - men and women under 55 who suffer cerebral vascular accidents, the medical term for strokes. In fact, according to work by Brett Kissela, vice chair of neurology at the University of Cincinnati, the rate of strokes among adults younger than 55, though still uncommon, rose by more than 60 percent between 1993 and 2005. Kissela's research focused on Ohio and Kentucky, but he said the findings "likely reflect what's happening nationally."
Another study from the Centers for Disease Control and Prevention also showed that hospitalization rates for stroke increased by 30 percent for ages 15 to 34 and 37 percent for ages 35 to 44 from 1995 to 2008. In 2007-08 alone, there were more than 27,000 hospitalizations for the most common type of stroke among people 35 to 44.
Heightened vigilance among physicians and better diagnostic methods such as magnetic resonance imaging (MRIs) may contribute to the growing numbers. But Mary C. George, who led the CDC research, found that one in three patients ages 15 to 34 and more than half between 35 and 44 had high blood pressure; about one in four had diabetes. Smoking, obesity, and high cholesterol were common.
Eighty percent of strokes - called ischemic - occur when blood to the brain is cut off. The remaining 20 percent are hemorrhagic strokes, often marked by an unbearable headache that is not a migraine, from bleeding inside the brain.
Smoking thickens the blood, narrows blood vessels, and makes aneurysms rupture, says George C. Newman, director of the stroke program at Einstein Medical Center. High blood sugar from diabetes leaves extra sugars on the proteins and lipids that line blood vessels and impairs their function. Obesity and its frequent companion, sleep apnea, are risk factors because they raise blood pressure and reduce oxygen to the brain.
Cocaine users are especially vulnerable because their blood pressure is inherently unstable. And a "wicked metabolic syndrome - obesity, diabetes, hypertension, elevated cholesterol, and a sedentary lifestyle - is deadly," Newman says.
An independent trigger, especially in young men, may be trauma - a snowboarding accident, a high-speed car crash - which can injure carotid or vertebral arteries and keep blood from reaching the brain.
Women, especially those with a history of migraines, may be candidates if they used oral contraceptives, which make blood clot more quickly. And the heightened tendency of clotting that follows childbirth could precipitate a stroke. "Most of the time, it doesn't happen," says Newman, "but in my chair, you see it more than you wish."
Wylie's doctors, even after extensive studies, are not certain what led to his stroke. He was not overweight, did not smoke, use drugs, or have diabetes. It may have been atrial fibrillation, the too-rapid and irregular twitching of the heart's two upper chambers. That causes clots that can travel to the brain. "It doesn't matter now," Wylie said, "I just want to make sure it doesn't happen again."
Wylie recalls those first days after the stroke as the most bizarre of his life. "One minute I was completely healthy," he says. "Now they were feeding me aspirin, giving me tPA (a drug to break up blood clots), and put a catheter in me. No one told me anything. Everything was a blur. I was freaking out. 'Get me out of here!' "
Three days later, doctors performed a craniotomy, removing bone from the skull to expose Wylie's brain. "They tried to put me under and it didn't work," Wylie says. "So I remember being awake while I heard this buzzing in my ear as they cut my half my skull away. My parents showed up, and I tried to stay calm. But I don't know what it is about seeing your mom that started me bawling."
Wylie remained in the hospital for a month, followed by six weeks in a rehab center before returning to his parents' home in Philadelphia, where he had grown up. "I was in terrible shape, the lowest I had been in my life," he recalls. "I couldn't walk, could use only one arm, and when I smiled, one side of my face would drop. I had to wear a helmet, and I slurred a lot of my words."
Wylie continued his recovery at MossRehab. "I remember the doctor telling my parents that I would never be the same, never walk again, but I refused to believe that."
Four months ago, Wylie abandoned his wheelchair and is preparing to go to law school. No one seeing him now would detect that he is a stroke survivor.
Melissa Muller, an occupational therapist who coordinates Moss' outpatient stroke rehab program, says her support group, formed in September, helps stroke victims like Wylie inch their way back toward physical, mental, and emotional health.
Despite a downpour, 10 people, some in wheelchairs, showed up for the first meeting. "These are young people with their whole lives ahead of them," Muller says. "They want to move on with their lives, to work, to drive, to complete college, start a career, and raise children. The power of group dynamics is amazing. Nobody understands your situation like those in the same shoes."
Valerie Johnson, a former legal secretary, shows up at almost every meeting. She relates that on Feb. 2, 2010, probably about 2 a.m., she awoke, feeling as though she were burning up. She ripped off her pajamas, wandered into her kitchen to get a drink, and lost her balance.
She fell and bashed the left side of her forehead on the refrigerator door. She believes only her prayers to God allowed her to live until the next morning, when a neighbor heard her banging on a chair and called paramedics.
When doctors at Roxborough Memorial Hospital told Johnson she had had a stroke, her reaction was similar to Wylie's. "I was only 44," she said. "I was in total denial. I had never heard of anyone my age having a stroke."
For three days, Johnson couldn't speak and her left side was paralyzed. Still, she says, she never became depressed. "I always had faith I would recover. I knew it was never God's intention that I would be like this."
After seven weeks in the hospital and a rehab center, she was able, with someone supporting her, to take a few steps. She returned to her mother's home for a year before she could live independently.
Now she lives in her own Mount Airy apartment, dresses herself, washes her own clothes, takes herself to the movies, and exercises four days a week at the gym. "I just keep working at it," she says. "I'm determined to enjoy my life."
The American Stroke Association uses the acronym FAST to describe stroke warning signs and course of action: Face drooping, Arm weakness, Speech difficulty, Time to call 911.
George C. Newman, who heads Einstein Medical Center's stroke program, adds sudden headache, confusion, difficulty understanding others, double vision, and vertigo. "Sudden is the hallmark," he warns.
When a stroke is suspected, time is critical. With ischemic strokes, the clot-dissolving drug tPA must be given within three hours. With hemorrhagic strokes, blood thinners such as aspirin or Coumadin must be stopped.
Most stroke patients do well, Newman says. More than half will end up with no disability and can resume normal activities. For others, it is a life-changer.
In any case, prevention is critical. "Stop smoking, lose weight, be treated for sleep apnea," Newman urges. If you have high blood pressure, "stay on hypertensive medication." Just two days off drugs can be deadly.
- Gloria HochmanEndText