Recognizing the Risk
Most people probably think of strokes as primarily afflicting the elderly.
Neurologists used to think of them that way, too – until they started seeing a surprising increase in strokes among younger people, according Michel Torbey, MD, MPH, chair of UNM’s Department of Neurology.
“When we were in training, the idea that you would think of stroke as a differential diagnosis for someone before 40 was unusual,” Torbey says. “It was associated with someone who had a genetic predisposition to form clots. But now, it’s really not even a question that young people can have strokes.”
Several factors appear to be contributing to the problem.
One is IV drug use, Torbey says. The use of dirty needles can lead to infection – which in turn can cause inflammation, increasing the risk for ischemic stroke. In those cases, a clot in an artery prevents blood from reaching brain tissue, starving it of oxygen.
Other drugs, like cocaine, are stimulants that can increase blood pressure, increasing the risk for a hemorrhagic stroke, in which a vessel bursts and blood leaks into the brain, Torbey says.
At the same time, obesity is a significant risk factor for a growing number of young people, Torbey says. Coupled with drug use, obesity also increases the stroke risk.
“You have this 30-year-old who’s doing drugs,” Torbey says of these patients. “You try to think of him as 30 years old, but realistically, their blood vessels are like a 60-year-old.”
Illicit drug use poses an additional risk, because “if you’re intoxicated or you’re not at a conscious level where you realize that you’re having a problem, then it’s tough for you to seek help,” Torbey says.
Stroke symptoms are seldom painful, so people may wrongly assume they’ll simply go away, he adds. Precious time may be lost before a stroke patient receives medical care, increasing the risk of death or long-term disability.
The growing incidence of stroke among young people also poses unique treatment challenges for doctors, who are unsure whether it’s safe to treat them with the medications that are used on older patients, he says.
For example, doctors often administer tPA, a drug that dissolves blood clots, to patients suffering from ischemic stroke. But clinical trials testing the safety and efficacy of new medications like tPA explicitly exclude active drug users – so it’s unclear how those medications might affect people who are also using illicit drugs.
“Is it helping them, or is it actually harming them?” Torbey says. “We think it’s helping, but we don’t know.”
The uncertainty underscores the need to create patient registries to record the medical histories and outcomes of younger stroke patients and enable researchers to verify whether treatments are effective.
“We certainly can look at how they behave clinically by creating a database and tracking them to see whether their outcome is the same or not,” Torbey says.