Zizzo sometimes struggles to remember everyday words like cupboard or pen but remembers to take her cholesterol medication every day to help prevent another stroke.
Before the stroke happened three years ago, she didn’t know her cholesterol numbers and thought that she was too young to worry about it.
“They told me I had a stroke, but I didn’t believe that,” she recalls. “I was 28 years old. Nobody has a stroke at 28. It just seemed impossible.”
Avoiding screening tests
Young adults are putting off certain screening tests, such as tests for cholesterol, blood pressure, and blood sugar, until they are older.
Those screening tests can give physicians a good idea about stroke risk, according to neurologist Diana Greene-Chandos, M.D., director of neurocritical care at The Ohio State University Wexner Medical Center.
“Compared to 20 years ago, incidence of stroke is rising in young adults to a significant degree,” she tells SELF.
A recent study in JAMA Neurology found ischemic stroke hospitalization rates are increasing for both men and women under age 45.
In women ages 18 to 34, the hospitalization rates for acute ischemic stroke rose 31.8 percent (from 4.4 per 10,000 hospitalizations in 2003-2004 to 5.8 per 10,000 hospitalizations in 2011-2012), while the rate in women aged 35 to 44 rose 30 percent (from 27.5 per 10,000 hospitalizations to 35.8 per hospitalization).
One factor for women might be contraceptive use. Hormonal birth control methods have been associated with slightly increased risk of blood clots, and blood clots account for 87 percent of all strokes, though the absolute risk of blood clots while on birth control remains low.
However some neurologists say that birth control isn’t the main culprit. Instead, it’s likely because of large increases in the common stroke risk factors like hypertension, lipid disorders, diabetes, tobacco use, and obesity.
The study in JAMA Neurology found an increase for each of these varies. Lipid disorders – also known as high cholesterol – is increasing the most, from about 12 percent to 21 percent. In addition, the prevalence of having three to five stroke risk factors more than doubled for women under 45.
Ironically, stroke risk is actually decreasing for older adults, according to Koto Ishida, M.D., director of NYU Langone’s Comprehensive Stroke Center. That’s because the same risk factors that are booming in young people—things like cholesterol and blood pressure—are usually being managed in those over age 50.
How to identify stroke on younger adults
FAST is the acronym for spotting a stroke. That stands for facial drooping, arm weakness, speech difficulties and time to call 999.
But not all strokes look like a classic FAST incident, says Dr. Greene-Chandos. Older adults tend to be affected in larger blood vessels, she notes, making them more likely to have the “big stroke symptoms” like facial drooping and incomprehensible speech.
Younger adults, though, are more likely to have clots thrown from other areas of their bodies and those clots travel through smaller blood vessels. Dr. Greene-Chandos says this difference often leads to stroke symptoms like numbness or headache.
“People tend to shake off these signs because we’ve all had numbness from sleeping in a funny position, or sitting on a leg wrong, leading to that sudden dead feeling,” she notes. In those kinds of moments, the nerves get compressed and when they’re released, the numbness should turn very quickly to that tingling pain of your limb coming back online.
With stroke, though, there’s numbness without pain. Dr. Greene-Chandos adds that women having a stroke are also more likely to have debilitating headaches, and that people who suffer from regular migraines are actually at greater risk for strokes in general. Even hiccups that don’t resolve could be a stroke symptom, she notes.
Having a stroke without realizing it
Before having a full-on stroke, Zizzo remembers smaller signs that something was wrong. She recalls having narrow visions and feeling weak. When she stood in line at checkout, she remembers everything feeling weird and just “off”, but she could still communicate in a way that didn’t raise any alarms, and she walked to her car without difficulty.
“It’s possible to have a small stroke and not realize it,” says Dr. Greene-Chandos. “You could even have multiple strokes and have no outward symptoms. But over time, the changes in your brain could affect your memory and speech significantly.”
Having one stroke significantly raises your risk for more, she notes, especially if the underlying factors for the stroke aren’t addressed. For example, if Zizzo didn’t get her high cholesterol under control, she would likely have been at higher risk for another stroke.