If You Think You’re Too Young To Have A Stroke, You’re Not

Hello Magazine

On March 12, Hailey Baldwin-Bieber, wife of Justin Bieber, suffered “stroke-like” symptoms while having breakfast at home with her husband. The 25-year old model posted on her Instagram stories, “On Thursday morning, I was sitting at breakfast with my husband when I started having stroke-like symptoms and was taken to the hospital.”

She continued, “They found I had suffered a very small blood clot to my brain, which caused a small lack of oxygen, but my body had passed it on its own and I recovered completely within a few hours. Although this was definitely one of the scariest moments I’ve ever been through, I’m home now and doing well, and I’m so grateful and thankful to all the doctors and nurses who take care of me!”

And according to Twitter, Justin Bieber had just canceled his World Tour after testing positive for COVID-19 just a few weeks before, making many wonder, could the two health conditions be related?


Young People and Strokes: What You Need to Know 

Although most young people believe that having a stroke is close to impossible, the fact of the matter is that there is no such thing as being too young to suffer a stroke. Of course, stroke risk is raised as you get older, but strokes in younger folk such as babies, children, and adolescents still occur. In fact, according to a February 2020 journal, Stroke, there is between 10 to 15 percent of strokes that happen in people aged 18 to 50. For most experts, they consider 45 and younger as a “young age” to have a stroke.

Despite the overall rate of stroke decreasing, more so for those 65 years in age and above, apparently it has increased among the younger and middle-aged generation.

Another study published in November of 2019 in the Stroke journal, a county-by-county analysis found that ‘between 2010 and 2016, strokes among middle-aged people increased in 3 times as many U.S. counties as strokes in people over age 64.’ Moreover, these statistics are no longer confined to the “Stroke Belt,” as the epidemiologists call it. Now, stroke rates are between 2 and 4 times the national average in southeastern United States.


So How Are Strokes Different In Young People

According to doctors, the type of strokes they observe in younger people are typically different from what they see in older patients.

Neurologist and medical director of the Comprehensive Stroke Center at the Cleveland Clinic in Ohio, Andrew Russman, DO, explains, “There are certain heart-related problems that seem to be the causes of stroke in young people that seem to be less of a cause as we get older.” He added that many young people are often unaware that they have an underlying condition that can contribute to a stroke, until they actually have one.

Here are the factors that contribute to younger people having a stroke, which tend to be different from what medical professionals observe in older people that have a stroke, such as:

  1. Patent Foramen Ovale – according to Dr. Russman, about 1 in 4 people have small holes in the two atria of the heart, which are there at birth. But most people normally don’t get screened for it, which means they don’t know they have it in the first place.
  2. Arterial Dissection – Research shows that up to 25 percent of strokes that happen in people below age 45 often occur due to a dissecting blood vessel in the neck. Dr. Russman shares that this can happen for a number of different reasons such as sports-related trauma or whiplash, but most of these dissections occur spontaneously without any trauma. Blood vessels are made of three layers, which are the thin inner layer of cells, the muscular layer, and the fibrous layer. Russman shares, “The thin surface layer can tear, and then the blood can get into that vessel wall. This causes narrowing in the blood vessel and can be the cause of stroke.”

According to the Cleveland Clinic, they share that arterial dissection symptoms can include a headache, double vision or a droopy eyelid, neck and face pain – especially around the eyes, and a sudden decrease in their sense of taste.

  1. Clotting Disorders – With some conditions, such as sickle cell disease, it causes the blood to form clumps that tend to turn into clots, which then causes strokes in young people. Russman elaborates, “Oftentimes a stroke may be the first indication that they had a clotting disorder.”
  2. Substance Abuse – Russman explains that although there are number of different types of elicit substances, cocaine in particular constricts the blood vessels while also increasing the clumping of blood cells, which is what causes clotting, which is why cocaine can contribute to strokes in younger folk. By refraining from drug and heavy alcohol consumption, people can also lessen their risk of having a stroke at any age.


What Are the Factors Young People Can Consider to Lessen Stroke Risk

While having an underlying heart condition is truly out of your control, a number of studies show that there are still risk factors that can contribute to having a stroke later on in life. These are high cholesterol, diabetes, high blood pressure, obesity, which have become increasingly higher in the younger generation. According to the Centers for Disease Control and Prevention (CDC), ‘more than 42 percent of U.S. adults and more than 18 percent of U.S. children are obese.’

Russman said, “If you accept that stroke is increasing in people under age 45, one big reason is probably obesity. Obesity in children and teens is up in America, and that increases the lifetime risk for stroke. Obesity increases the risk for high blood pressure, high cholesterol, and diabetes. These are all important stroke risk factors at any age.”

Russman goes on to say that eating healthy, fresh and unprocessed foods, as well as not drinking sugary beverages, have been associate with a lowered risk of cardiovascular disease. Yet, according to Russman, the most important dietary modification that people need to be aware of is their salt intake. He shared, “If you are predisposed to high blood pressure and you take in a lot of salt, you’ll have a difficult time controlling high blood pressure, which is the leading cause of stroke.”

The CDC also says that ’90 percent of American children eat too much salt, averaging an extra 1,000 milligrams (mg) more than the recommended daily limit of 2,300 mg.’ Russman explained, “Fast food and prepared foods are notoriously high in sodium and are best to avoid. If you struggle with access to food other than fast food, you can modify your order, such as asking them to not add salt to your fries.”

Another way to lessen stroke risk is to either cut back on smoking cigarettes, or quit all together. A May 2018 study in the Stroke journal found ‘a strong correlation between the number of cigarettes that men under 50 smoked and their ischemic stroke risk. The researchers concluded that although quitting smoking should be the goal, even cutting back can be an effective way to reduce stroke in men under age 50.’

Moreover, the American Heart Association (AHA) 2021 stroke prevention guidelines also back these claims.


How About Other Risk Factors That Increase Stroke Risk?

The CDC shares that women, particularly Black and Hispanic women, may possibly be at a higher risk. A January 2022 research paper found in the Stroke journal shared that in the young adult age group, which is between the ages of 18 to 45, young women could be disproportionately at a higher risk of ischemic stroke.

Although having a blood clot doesn’t mean you’ll end up having a stroke, there are blood clots that could do enough damage to cause ischemic strokes – much like the one Hailey Bieber experienced. According to Systems Medical Director at the Cardiac Rehabilitation Center at Rush University in Oak Brook, Illinois, Melissa Tracy, MD, share that they can be caused by a few predisposing factors.

Dr. Tracy mentions that hormonal birth control and smoking are two potentially comorbid factors since birth control can increase the risk of blood clots. She shared, “If a woman smokes, she significantly increases her risk for the development of both cerebrovascular (stroke) and cardiovascular events.” A February 2019 studyin MedLink Neurology also confirms that hormonal contraceptives are linked to stroke increase, but that risk is minor unless the patient has other stroke risk factors, like smoking.


Stroke and COVID-19

A study published in February 2022 by the American Stroke Association (ASA) explains how strokes, and specifically blood clots, are connected to COVID-19. Researchers found that ‘adults diagnosed with COVID-19 were more likely to develop clots than those who had not been infected.’

World Thrombosis Day steering committee and associate professor of medicine at Harvard Medical School in Boston, Jean M. Connors, MD, shared, “I am not sure of all of the details of Hailey’s case, but we do know that moderate to severe COVID-19 cases can cause a higher risk for stroke.”

Dr. Tracy continued, “The two have been linked in recent studies, but it’s unlikely that they are comorbid,” Tracy adds. “Most patients who have had a stroke during the COVID-19 pandemic have other risk factors than COVID alone.”

Dr. Connors added, “The important message that we are reminded of with Hailey’s recent scare is that yes, younger people can develop strokes.” She also shares that she wants younger people to understand and recognize the signs and symptoms for both blood clots and strokes.


Signs and What You Should Do If You’re Having a Stroke

ASA suggests that to detect stroke symptoms, you should remember the acronym FAST, which means the following:

F: Face drooping

A: Arm weakness

S: Speech difficulty

T: Time to call 911

Call 911 immediately if you think you’re having a stroke. Rosen says, “With a stroke, time lost is brain lost, so getting to the ER as quickly as possible is the best thing to do. Don’t even think about driving yourself, an ambulance will get you there quicker.”


How To Recovery From a Stroke

There is a big difference in strokes happening in older and younger people, which is recovery. When a young person has a stroke, it can mean a lifetime of recovery and a loss of a number of productive years. A small study conducted in the United Kingdom that was also published in Stroke journal in September 2019 ‘estimated that as many as 44 percent of people under age 65 who experience a stroke will not be able to return to work, most commonly due to having permanent trouble walking.’

Russman explains, “The good news is that a 30-year-old has a better rate of recovery than an 80-year-old because of better brain plasticity,” talking about the brain’s ability to adjust and learn new skills.

AHA also shares that there are a number of different factors that determine how well someone will recover from a stroke, like how the brain was affected, or having caregiver support, or even a person’s health before they had the stroke, as well as rehabilitation assistance, and their own motivation to get better.

Depression also tends to become a factor in stroke survivors in the first few months after a stroke, the AHA also points out, so be sure to watch after your mental health in the same way as watching after physical health. They suggest joining a stroke support group to help.

Russman says, “Every stroke center should screen patients for depression, both by asking them questions in person as well as asking them to fill out a questionnaire that can further screen for depression,” also sharing that those with preexisting depression are at a higher risk of depression after having a stroke.

“Depression can cause some significant impairment in recovery — not just the physical recovery but also how a stroke survivor perceives their recovery. It’s really an expectation that all centers screen stroke patients for depression because it’s so prevalent,” concludes Russman.