Stroke in younger adults

Strokes

  • occupational therapists
  • physical therapists
  • speech therapists

A physiatrist might oversee the child’s care.

What Else Should I Know?

At this time, there’s no treatment that can fix brain cells that have died. But undamaged brain cells can learn to do the jobs of cells that have died, especially in young people.

In many cases after a stroke, kids can learn to use their arms and legs and speak again through brain retraining. This process is usually slow and difficult. But kids have an edge over adults because their young brains are still developing. Most kids who have had strokes can interact normally and be active members of their communities.

How Can I Help My Child?

If your child had a stroke, you aren’t facing his or her rehabilitation and future care alone. The doctors and therapists who will work with your child are there to support the whole family. Don’t hesitate to ask questions about your child’s condition or treatment or to ask for help when you need it.

Also look for support groups for parents of kids who have had strokes, such as:

  • Children’s Hemiplegia and Stroke Association
  • University of Colorado Pediatric Stroke Parent Support Group
  • Adelynn Neonatal Stroke Survivor!

The input and support from other parents facing the same challenges can help you find the strength you need to help your child get the best care possible.

Reviewed by: Marcella A. Escoto, DO Date reviewed: December 2018

Cephalic Disorders Fact Sheet

What are cephalic disorders?

Cephalic disorders are congenital conditions that stem from damage to, or abnormal development of, the budding nervous system. Cephalic is a term that means “head” or “head end of the body.” Congenital means the disorder is present at, and usually before, birth. Although there are many congenital developmental disorders, this fact sheet briefly describes only cephalic conditions.

Cephalic disorders are not necessarily caused by a single factor but may be influenced by hereditary or genetic conditions or by environmental exposures during pregnancy such as medication taken by the mother, maternal infection, or exposure to radiation. Some cephalic disorders occur when the cranial sutures (the fibrous joints that connect the bones of the skull) join prematurely. Most cephalic disorders are caused by a disturbance that occurs very early in the development of the fetal nervous system.

The human nervous system develops from a small, specialized plate of cells on the surface of the embryo. Early in development, this plate of cells forms the neural tube, a narrow sheath that closes between the third and fourth weeks of pregnancy to form the brain and spinal cord of the embryo. Four main processes are responsible for the development of the nervous system: cell proliferation, the process in which nerve cells divide to form new generations of cells; cell migration, the process in which nerve cells move from their place of origin to the place where they will remain for life; cell differentiation, the process during which cells acquire individual characteristics; and cell death, a natural process in which cells die. Understanding the normal development of the human nervous system, one of the research priorities of the National Institute of Neurological Disorders and Stroke, may lead to a better understanding of cephalic disorders.

Damage to the developing nervous system is a major cause of chronic, disabling disorders and, sometimes, death in infants, children, and even adults. The degree to which damage to the developing nervous system harms the mind and body varies enormously. Many disabilities are mild enough to allow those afflicted to eventually function independently in society. Others are not. Some infants, children, and adults die, others remain totally disabled, and an even larger population is partially disabled, functioning well below normal capacity throughout life.

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What are the different kinds of cephalic disorders?

ANENCEPHALY is a neural tube defect that occurs when the cephalic (head) end of the neural tube fails to close, usually between the 23rd and 26th days of pregnancy, resulting in the absence of a major portion of the brain, skull, and scalp. Infants with this disorder are born without a forebrain – the largest part of the brain consisting mainly of the cerebrum, which is responsible for thinking and coordination. The remaining brain tissue is often exposed – not covered by bone or skin.

Infants born with anencephaly are usually blind, deaf, unconscious, and unable to feel pain. Although some individuals with anencephaly may be born with a rudimentary brainstem, the lack of a functioning cerebrum permanently rules out the possibility of ever gaining consciousness. Reflex actions such as breathing and responses to sound or touch may occur. The disorder is one of the most common disorders of the fetal central nervous system. Approximately 1,000 to 2,000 American babies are born with anencephaly each year. The disorder affects females more often than males.

The cause of anencephaly is unknown. Although it is believed that the mother’s diet and vitamin intake may play a role, scientists agree that many other factors are also involved.

There is no cure or standard treatment for anencephaly and the prognosis for affected individuals is poor. Most infants do not survive infancy. If the infant is not stillborn, then he or she will usually die within a few hours or days after birth. Anencephaly can often be diagnosed before birth through an ultrasound examination.

Recent studies have shown that the addition of folic acid to the diet of women of child-bearing age may significantly reduce the incidence of neural tube defects. Therefore it is recommended that all women of child-bearing age consume 0.4 mg of folic acid daily.

COLPOCEPHALY is a disorder in which there is an abnormal enlargement of the occipital horns – the posterior or rear portion of the lateral ventricles (cavities or chambers) of the brain. This enlargement occurs when there is an underdevelopment or lack of thickening of the white matter in the posterior cerebrum. Colpocephaly is characterized by microcephaly (abnormally small head) and delayed development. Other features may include motor abnormalities, muscle spasms, and seizures.

Although the cause is unknown, researchers believe that the disorder results from an intrauterine disturbance that occurs between the second and sixth months of pregnancy. Colpocephaly may be diagnosed late in pregnancy, although it is often misdiagnosed as hydrocephalus (excessive accumulation of cerebrospinal fluid in the brain). It may be more accurately diagnosed after birth when signs of microcephaly, delayed development, and seizures are present.

There is no definitive treatment for colpocephaly. Anticonvulsant medications can be given to prevent seizures, and doctors try to prevent contractures (shrinkage or shortening of muscles). The prognosis for individuals with colpocephaly depends on the severity of the associated conditions and the degree of abnormal brain development. Some children benefit from special education.

HOLOPROSENCEPHALY is a disorder characterized by the failure of the prosencephalon (the forebrain of the embryo) to develop. During normal development the forebrain is formed and the face begins to develop in the fifth and sixth weeks of pregnancy. Holoprosencephaly is caused by a failure of the embryo’s forebrain to divide to form bilateral cerebral hemispheres (the left and right halves of the brain), causing defects in the development of the face and in brain structure and function.

There are three classifications of holoprosencephaly. Alobar holoprosencephaly, the most serious form in which the brain fails to separate, is usually associated with severe facial anomalies. Semilobar holoprosencephaly, in which the brain’s hemispheres have a slight tendency to separate, is an intermediate form of the disease. Lobar holoprosencephaly, in which there is considerable evidence of separate brain hemispheres, is the least severe form. In some cases of lobar holoprosencephaly, the patient’s brain may be nearly normal.

Holoprosencephaly, once called arhinencephaly, consists of a spectrum of defects or malformations of the brain and face. At the most severe end of this spectrum are cases involving serious malformations of the brain, malformations so severe that they are incompatible with life and often cause spontaneous intrauterine death. At the other end of the spectrum are individuals with facial defects – which may affect the eyes, nose, and upper lip – and normal or near-normal brain development. Seizures and cognitive impairment and development may occur.

The most severe of the facial defects (or anomalies) is cyclopia, an abnormality characterized by the development of a single eye, located in the area normally occupied by the root of the nose, and a missing nose or a nose in the form of a proboscis (a tubular appendage) located above the eye.

Ethmocephaly is the least common facial anomaly. It consists of a proboscis separating narrow-set eyes with an absent nose and microphthalmia (abnormal smallness of one or both eyes). Cebocephaly, another facial anomaly, is characterized by a small, flattened nose with a single nostril situated below incomplete or underdeveloped closely set eyes.

The least severe in the spectrum of facial anomalies is the median cleft lip, also called premaxillary agenesis.

Although the causes of most cases of holoprosencephaly remain unknown, researchers know that approximately one-half of all cases have a chromosomal cause. Such chromosomal anomalies as Patau’s syndrome (trisomy 13) and Edwards’ syndrome (trisomy 18) have been found in association with holoprosencephaly. There is an increased risk for the disorder in infants of diabetic mothers.

There is no treatment for holoprosencephaly and the prognosis for individuals with the disorder is poor. Most of those who survive show no significant developmental gains. For children who survive, treatment is symptomatic. Although it is possible that improved management of diabetic pregnancies may help prevent holoprosencephaly, there is no means of primary prevention.

HYDRANENCEPHALY is a rare condition in which the cerebral hemispheres are absent and replaced by sacs filled with cerebrospinal fluid. Usually the cerebellum and brainstem are formed normally. An infant with hydranencephaly may appear normal at birth. The infant’s head size and spontaneous reflexes such as sucking, swallowing, crying, and moving the arms and legs may all seem normal. However, after a few weeks the infant usually becomes irritable and has increased muscle tone (hypertonia). After several months of life, seizures and hydrocephalus may develop. Other symptoms may include visual impairment, lack of growth, deafness, blindness, spastic quadriparesis (paralysis), and intellectual deficits.

Hydranencephaly is an extreme form of porencephaly (a rare disorder, discussed later in this fact sheet, characterized by a cyst or cavity in the cerebral hemispheres) and may be caused by vascular insult (such as stroke) or injuries, infections, or traumatic disorders after the 12th week of pregnancy.

Diagnosis may be delayed for several months because the infant’s early behavior appears to be relatively normal. Transillumination, an examination in which light is passed through body tissues, usually confirms the diagnosis. Some infants may have additional abnormalities at birth, including seizures, myoclonus (involuntary sudden, rapid jerks), and respiratory problems.

There is no standard treatment for hydranencephaly. Treatment is symptomatic and supportive. Hydrocephalus may be treated with a shunt.

The outlook for children with hydranencephaly is generally poor, and many children with this disorder die before age 1. However, in rare cases, children with hydranencephaly may survive for several years or more.

INIENCEPHALY is a rare neural tube defect that combines extreme retroflexion (backward bending) of the head with severe defects of the spine. The affected infant tends to be short, with a disproportionately large head. Diagnosis can be made immediately after birth because the head is so severely retroflexed that the face looks upward. The skin of the face is connected directly to the skin of the chest and the scalp is directly connected to the skin of the back. Generally, the neck is absent.

Most individuals with iniencephaly have other associated anomalies such as anencephaly, cephalocele (a disorder in which part of the cranial contents protrudes from the skull), hydrocephalus, cyclopia, absence of the mandible (lower jaw bone), cleft lip and palate, cardiovascular disorders, diaphragmatic hernia, and gastrointestinal malformation. The disorder is more common among females.

The prognosis for those with iniencephaly is extremely poor. Newborns with iniencephaly seldom live more than a few hours. The distortion of the fetal body may also pose a danger to the mother’s life.

LISSENCEPHALY, which literally means “smooth brain,” is a rare brain malformation characterized by microcephaly and the lack of normal convolutions (folds) in the brain. It is caused by defective neuronal migration, the process in which nerve cells move from their place of origin to their permanent location.

The surface of a normal brain is formed by a complex series of folds and grooves. The folds are called gyri or convolutions, and the grooves are called sulci. In children with lissencephaly, the normal convolutions are absent or only partly formed, making the surface of the brain smooth.

Symptoms of the disorder may include unusual facial appearance, difficulty swallowing, failure to thrive, and severe psychomotor retardation. Anomalies of the hands, fingers, or toes, muscle spasms, and seizures may also occur.

Lissencephaly may be diagnosed at or soon after birth. Diagnosis may be confirmed by ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI).

Lissencephaly may be caused by intrauterine viral infections or viral infections in the fetus during the first trimester, insufficient blood supply to the baby’s brain early in pregnancy, or a genetic disorder. There are two distinct genetic causes of lissencephaly – X-linked and chromosome 17-linked.

The spectrum of lissencephaly is only now becoming more defined as neuroimaging and genetics has provided more insights into migration disorders. Other causes which have not yet been identified are likely as well.

Lissencephaly may be associated with other diseases including isolated lissencephaly sequence, Miller-Dieker syndrome, and Walker-Warburg syndrome.

Treatment for those with lissencephaly is symptomatic and depends on the severity and locations of the brain malformations. Supportive care may be needed to help with comfort and nursing needs. Seizures may be controlled with medication and hydrocephalus may require shunting. If feeding becomes difficult, a gastrostomy tube may be considered.

The prognosis for children with lissencephaly varies depending on the degree of brain malformation. Many individuals show no significant development beyond a 3- to 5-month-old level. Some may have near-normal development and intelligence. Many will die before the age of 2. Respiratory problems are the most common causes of death.

MEGALENCEPHALY, also called macrencephaly, is a condition in which there is an abnormally large, heavy, and usually malfunctioning brain. By definition, the brain weight is greater than average for the age and gender of the infant or child. Head enlargement may be evident at birth or the head may become abnormally large in the early years of life.

Megalencephaly is thought to be related to a disturbance in the regulation of cell reproduction or proliferation. In normal development, neuron proliferation – the process in which nerve cells divide to form new generations of cells – is regulated so that the correct number of cells is formed in the proper place at the appropriate time.

Symptoms of megalencephaly may include delayed development, convulsive disorders, corticospinal (brain cortex and spinal cord) dysfunction, and seizures. Megalencephaly affects males more often than females.

The prognosis for individuals with megalencephaly largely depends on the underlying cause and the associated neurological disorders. Treatment is symptomatic. Megalencephaly may lead to a condition called macrocephaly (defined later in this fact sheet). Unilateral megalencephaly or hemimegalencephaly is a rare condition characterized by the enlargement of one-half of the brain. Children with this disorder may have a large, sometimes asymmetrical head. Often they suffer from intractable seizures and mental retardation. The prognosis for those with hemimegalencephaly is poor.

MICROCEPHALY is a neurological disorder in which the circumference of the head is smaller than average for the age and gender of the infant or child. Microcephaly may be congenital or it may develop in the first few years of life. The disorder may stem from a wide variety of conditions that cause abnormal growth of the brain, or from syndromes associated with chromosomal abnormalities.

Infants with microcephaly are born with either a normal or reduced head size. Subsequently the head fails to grow while the face continues to develop at a normal rate, producing a child with a small head, a large face, a receding forehead, and a loose, often wrinkled scalp. As the child grows older, the smallness of the skull becomes more obvious, although the entire body also is often underweight and dwarfed. Development of motor functions and speech may be delayed. Hyperactivity and cognitive impairment are common occurrences, although the degree of each varies. Convulsions may also occur. Motor ability varies, ranging from clumsiness in some to spastic quadriplegia in others.

Generally there is no specific treatment for microcephaly. Treatment is symptomatic and supportive.

In general, life expectancy for individuals with microcephaly is reduced and the prognosis for normal brain function is poor. The prognosis varies depending on the presence of associated abnormalities.

PORENCEPHALY is an extremely rare disorder of the central nervous system involving a cyst or cavity in a cerebral hemisphere. The cysts or cavities are usually the remnants of destructive lesions, but are sometimes the result of abnormal development. The disorder can occur before or after birth.

Porencephaly most likely has a number of different, often unknown causes, including absence of brain development and destruction of brain tissue. The presence of porencephalic cysts can sometimes be detected by transillumination of the skull in infancy. The diagnosis may be confirmed by CT, MRI, or ultrasonography.

More severely affected infants show symptoms of the disorder shortly after birth, and the diagnosis is usually made before age 1. Signs may include delayed growth and development, spastic paresis (slight or incomplete paralysis), hypotonia (decreased muscle tone), seizures (often infantile spasms), and macrocephaly or microcephaly.

Individuals with porencephaly may have poor or absent speech development, epilepsy, hydrocephalus, spastic contractures (shrinkage or shortening of muscles), and cognitive impairment. Treatment may include physical therapy, medication for seizure disorders, and a shunt for hydrocephalus. The prognosis for individuals with porencephaly varies according to the location and extent of the lesion. Some patients with this disorder may develop only minor neurological problems and have normal intelligence, while others may be severely disabled. Others may die before the second decade of life.

SCHIZENCEPHALY is a rare developmental disorder characterized by abnormal slits, or clefts, in the cerebral hemispheres. Schizencephaly is a form of porencephaly. Individuals with clefts in both hemispheres, or bilateral clefts, are often developmentally delayed and have delayed speech and language skills and corticospinal dysfunction. Individuals with smaller, unilateral clefts (clefts in one hemisphere) may be weak on one side of the body and may have average or near-average intelligence. Patients with schizencephaly may also have varying degrees of microcephaly, delayed development and cognitive impairnment, hemiparesis (weakness or paralysis affecting one side of the body), or quadriparesis (weakness or paralysis affecting all four extremities), and may have reduced muscle tone (hypotonia). Most patients have seizures and some may have hydrocephalus.

In schizencephaly, the neurons border the edge of the cleft implying a very early disruption in development. There is now a genetic origin for one type of schizencephaly. Causes of this type may include environmental exposures during pregnancy such as medication taken by the mother, exposure to toxins, or a vascular insult. Often there are associated heterotopias (isolated islands of neurons) which indicate a failure of migration of the neurons to their final position in the brain.

Treatment for individuals with schizencephaly generally consists of physical therapy, treatment for seizures, and, in cases that are complicated by hydrocephalus, a shunt.

The prognosis for individuals with schizencephaly varies depending on the size of the clefts and the degree of neurological deficit.

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What are other less common cephalies?

ACEPHALY literally means absence of the head. It is a much rarer condition than anencephaly. The acephalic fetus is a parasitic twin attached to an otherwise intact fetus. The acephalic fetus has a body but lacks a head and a heart; the fetus’s neck is attached to the normal twin. The blood circulation of the acephalic fetus is provided by the heart of the twin. The acephalic fetus can not exist independently of the fetus to which it is attached.

EXENCEPHALY is a condition in which the brain is located outside of the skull. This condition is usually found in embryos as an early stage of anencephaly. As an exencephalic pregnancy progresses, the neural tissue gradually degenerates. It is unusual to find an infant carried to term with this condition because the defect is incompatible with survival.

MACROCEPHALY is a condition in which the head circumference is larger than average for the age and gender of the infant or child. It is a descriptive rather than a diagnostic term and is a characteristic of a variety of disorders. Macrocephaly also may be inherited. Although one form of macrocephaly may be associated with developmental delays and cognitive impairment, in approximately one-half of cases mental development is normal. Macrocephaly may be caused by an enlarged brain or hydrocephalus. It may be associated with other disorders such as dwarfism, neurofibromatosis, and tuberous sclerosis.

MICRENCEPHALY is a disorder characterized by a small brain and may be caused by a disturbance in the proliferation of nerve cells. Micrencephaly may also be associated with maternal problems such as alcoholism, diabetes, or rubella (German measles). A genetic factor may play a role in causing some cases of micrencephaly. Affected newborns generally have striking neurological defects and seizures. Severely impaired intellectual development is common, but disturbances in motor functions may not appear until later in life.

OCTOCEPHALY is a lethal condition in which the primary feature is agnathia – a developmental anomaly characterized by total or virtual absence of the lower jaw. The condition is considered lethal because of a poorly functioning airway. In octocephaly, agnathia may occur alone or together with holoprosencephaly.

Another group of less common cephalic disorders are the craniostenoses. Craniostenoses are deformities of the skull caused by the premature fusion or joining together of the cranial sutures. Cranial sutures are fibrous joints that join the bones of the skull together. The nature of these deformities depends on which sutures are affected.

BRACHYCEPHALY occurs when the coronal suture fuses prematurely, causing a shortened front-to-back diameter of the skull. The coronal suture is the fibrous joint that unites the frontal bone with the two parietal bones of the skull. The parietal bones form the top and sides of the skull.

OXYCEPHALY is a term sometimes used to describe the premature closure of the coronal suture plus any other suture, or it may be used to describe the premature fusing of all sutures. Oxycephaly is the most severe of the craniostenoses.

PLAGIOCEPHALY results from the premature unilateral fusion (joining of one side) of the coronal or lambdoid sutures. The lambdoid suture unites the occipital bone with the parietal bones of the skull. Plagiocephaly is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. It is a common finding at birth and may be the result of brain malformation, a restrictive intrauterine environment, or torticollis (a spasm or tightening of neck muscles).

SCAPHOCEPHALY applies to premature fusion of the sagittal suture. The sagittal suture joins together the two parietal bones of the skull. Scaphocephaly is the most common of the craniostenoses and is characterized by a long, narrow head.

TRIGONOCEPHALY is the premature fusion of the metopic suture (part of the frontal suture which joins the two halves of the frontal bone of the skull) in which a V-shaped abnormality occurs at the front of the skull. It is characterized by the triangular prominence of the forehead and closely set eyes.

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What research is being done?

Within the Federal Government, the National Institute of Neurological Disorders and Stroke (NINDS), one of the National Institutes of Health (NIH), has primary responsibility for conducting and supporting research on normal and abnormal brain and nervous system development, including congenital anomalies. The National Institute of Child Health and Human Development, the National Institute of Mental Health, the National Institute of Environmental Health Sciences, the National Institute of Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse also support research related to disorders of the developing nervous system. Gaining basic knowledge about how the nervous system develops and understanding the role of genetics in fetal development are major goals of scientists studying congenital neurological disorders.

Scientists are rapidly learning how harmful insults at various stages of pregnancy can lead to developmental disorders. For example, a critical nutritional deficiency or exposure to an environmental insult during the first month of pregnancy (when the neural tube is formed) can produce neural tube defects such as anencephaly.

Scientists are also concentrating their efforts on understanding the complex processes responsible for normal early development of the brain and nervous system and how the disruption of any of these processes results in congenital anomalies such as cephalic disorders. Understanding how genes control brain cell migration, proliferation, differentiation, and death, and how radiation, drugs, toxins, infections, and other factors disrupt these processes will aid in preventing many congenital neurological disorders.

Currently, researchers are examining the mechanisms involved in neurulation – the process of forming the neural tube. These studies will improve our understanding of this process and give insight into how the process can go awry and cause devastating congenital disorders. Investigators are also analyzing genes and gene products necessary for human brain development to achieve a better understanding of normal brain development in humans.

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Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

Information also is available from the following organizations:

“Cephalic Disorders Fact Sheet”, NINDS, Publication date September 2003.

NIH Publication No. 98-4339

Back to: Cephalic Disorders Information Page

See a list of all NINDS disorders

Publicaciones en Español

Los Trastornos Encefálicos

Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

Complications and Treatments of Sickle Cell Disease

Vision Loss

Vision loss, including blindness, can occur when blood vessels in the eye become blocked with sickle cells and the retina (the thin layer of tissue inside the back of the eye) gets damaged. Some patients develop extra blood vessels in the eye from the lack of oxygen.

People with sickle cell disease should have their eyes checked every year to look for damage to the retina. If possible, this should be done by an eye doctor who specializes in diseases of the retina.

Treatment

If the retina is damaged by excessive blood vessel growth, laser treatment often can prevent further vision loss.

Leg Ulcers

This usually occurs on the lower part of the leg. They happen more often in males than in females and usually appear from 10 through 50 years of age. A combination of factors cause ulcer formation, including trauma, infection, inflammation, and interruption of the circulation in the smallest blood vessels of the leg.

Leg ulcers can be treated with medicated creams and ointments. Leg ulcers can be painful, and patients can be given strong pain medicine. Management of leg ulcers could also include the use of cultured skin grafts. This treatment is provided in specialized centers. Bed rest and keeping the leg (or legs) raised to reduce swelling is helpful, although not always possible.

Stroke

A stroke can happen if sickle cells get stuck in a blood vessel and clog blood flow to the brain. About 10% of children with SCD will have a symptomatic stroke. Stroke can cause learning problems and lifelong disabilities.

Children who are at risk for stroke can be identified using a special type of exam called, transcranial Doppler ultrasound (TCD). If the child is found to have an abnormal TCD, a doctor might recommend frequent blood transfusions to help prevent a stroke. People who have frequent blood transfusions must be watched closely because there are serious side effects. For example, too much iron can build up in the body, causing life-threatening damage to the organs.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

Sickling of red cells can increase blood coagulation and induce an increased risk of blood clot in a deep vein (DVT), or in the lung (PE) if the blood clot moves from the deep veins. People with SCD have a high chance of developing DVT or PE. DVT and PE can cause serious illness, disability and, in some cases, death.

Prevention and Treatment

Medication is used to prevent and treat DVT and PE. PE requires immediate medical attention. For more information on DVT and PE visit https://www.cdc.gov/ncbddd/dvt/index.html.

Other Possible Complications

  • Damage to body organs (like the liver, heart, or kidneys), tissues, or bones because not enough blood is flowing to the affected area(s).
  • Malnutrition and growth retardation among adolescents can cause a delayed onset of puberty and, in males, infertility.
  • Gallstones.
  • Painful erection of the penis, called priapism, can last less than 2 hours or more than 4 hours. If it lasts more than 4 hours, the person should get urgent medical help. It can lead to impotence.
  • A very rare form of kidney cancer (renal medullary carcinomaexternal icon) has been associated with sickle cell trait.

Links to Other Websites

Sickle Cell Disease Association of Americaexternal icon

National Heart Lung and Blood Institute Clinical Trialsexternal icon

Be The Match – Bone Marrow Transplantationexternal icon

Think You’re Too Young for a Stroke? Think Again

For most young people, the chance of having a stroke seems like an impossibility — but there is no such thing as being too young for stroke. Your stroke risk increases with age, but stroke in young people, including infants, children, adolescents, and young adults, does happen. In general, however, most experts consider a young stroke age to be under 45.

Even though the overall rate of stroke is decreasing, it is increasing for young and middle-aged people. A study published in October 2012 in the journal Neurology looked at stroke trends in the Greater Cincinnati area in 1993, 1994, and 2005. They found that the average age of stroke decreased from 71 in the mid-nineties to 69 in 2005. While those younger than 55 accounted for about 13 percent of all strokes in 1993 and 1994, that number rose to nearly 19 percent in 2005.

One reason for increased detection may be the use of MRIs for picking up early changes in the brain after a stroke — a technology that wasn’t as widely used 20 years ago. On the other hand, several studies have shown that many of the risk factors that make someone susceptible to stroke, such as high blood pressure, high cholesterol, diabetes, and obesity, are becoming more common in younger people. The Centers for Disease Control and Prevention recently conducted a study examining whether or not younger people are truly experiencing more strokes, and while their full report hasn’t been released yet, their early conclusions seem to indicate that the higher number of strokes may be linked to an increase in risk factors.

Here are some statistics for annual incidence of stroke in those younger than 45 in the United States:

  • From birth to age 19, there are nearly 5 strokes for every 100,000 children.
  • Stroke in all people under 45 ranges from 7 to 15 per 100,000.

How Stroke in Younger People Is Different

Treating and managing stroke in people younger than 45 requires a different approach because you need to look for different causes. “Compared with stroke in older people, stroke in the young is a different beast,” says S. Ausim Azizi, MD, PhD, a professor and the chair of neurology at Temple University Medical School in Philadelphia.

There are several types of stroke, but all of them are caused by decreased blood supply to the brain. The most common type is an ischemic stroke, and they’re either caused by a blood clot in the brain’s blood vessels, or a blood clot that develops outside the brain and travels to those vessels.

“Cardiogenic causes account for more stroke in young adults. Another cause to watch out for in young people is drug use, especially intravenous drugs,” says Dr. Azizi. Cardiogenic causes may include rheumatic heart disease, heart valve abnormalities, and being born with a hole between the right and left side of the heart, called a patent foramen ovale.

“Up to 25 percent of stroke under age 45 is caused by a dissecting blood vessel in the neck. This is a small tear in a big blood vessel that causes a clot to form and travel to the brain. Other stroke causes that have been linked to younger stroke age include migraine, pregnancy, birth control pills, and smoking,” says Andrew Russman, DO, a neurologist and the medical director of the Comprehensive Stroke Center at the Cleveland Clinic in Ohio.

Stroke Prevention and Recovery in Younger People

“If you accept that stroke is increasing in people under age 45, one big reason is probably obesity,” says Dr. Russman. “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.”

It’s never a bad time to employ these stroke prevention strategies:

  • Work with your doctor to identify underlying diseases.
  • Exercise regularly and maintain a healthy weight.
  • Eat a diet low in saturated fat and high in fruits, vegetables, and whole grains.
  • Start controlling high blood pressure and high cholesterol at an early age.
  • Recognize and control diabetes.
  • Avoid alcohol, drugs, and smoking.

One of the big differences between stroke in older people and younger people is recovery. Stroke in young people can mean a lifetime of recovery and a loss of many productive years. “About 15 to 30 percent of people who have a stroke have some long-term disability. 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,” the brain’s ability to adjust and learn new skills, says Russman.

A review article on ischemic stroke recovery in young adults, published in the journal Stroke Research and Treatment, found that recovery is much better for younger people than for older adults.

Here are some findings from research reviewed in the article:

  • Survival is more than 90 percent at five years compared with 40 percent for old age stroke.
  • Ninety percent are able to live independently compared with about 40 percent of old-age stroke.
  • 50 to 70 percent are able to return to work after a stroke.
  • Five-year stroke recurrence rates are half what they are for the elderly (15 percent vs. 30 percent).

“The key to managing stroke in young people is to identify and treat the underlying causes. Reducing risk factors, just as in older stroke, is the key to preventing a first stroke or a recurrent stroke,” says Russman.

While having a stroke in your 20s or 30s is rare, Russman says there is good reason for even young women to be aware of their potential risk. “It’s enough of an issue that women should be thinking about these things.”

Here are seven things that increase stroke risk in women:

1. Being on the Pill

Oral contraceptives increase the risk of blood clots, which can cause strokes. Women who smoke are advised not to take birth control pills, and those who have a family history of stroke should also avoid the Pill. Hormone replacement therapy after menopause also raises clot risk.

2. Pregnancy

High levels of estrogen, as seen in pregnancy, increase blood-clotting factors, which in turn increase stroke risk—especially a type caused by a clot in a vein that drains blood from the head. Russman advises women who are or want to become pregnant to find out whether there is a history of cerebral venous thrombosis in their family. “It’s important for family planning,” he says. Knowing there’s a higher risk means you can go on blood thinners preemptively when you get pregnant, or be ready to act fast if the need arises.

3. Migraine with aura

Women are three times more likely than men to have migraines. And though migraines with aura (a particular type of migraine headache that is accompanied by visual or other sensory disturbances) are associated with a higher risk of stroke in both men and women, that association is stronger among women. That doesn’t mean if you have migraine with aura you’re going to have a stroke. But you should definitely be aware of the connection.

4. High blood pressure

Again, high blood pressure is a classic risk factor that affects both men and women. However, the effect is stronger in women—a fact that is all the more concerning when you add in birth control pills. Russman points out that women can start to see high blood pressure in their 20s, and if that happens it’s crucial to get checked out, review your family history, and keep on top of it.

5. Preeclampsia

Preeclampsia is a condition marked by high blood pressure that sets in after 20 weeks of pregnancy. In addition to its effect on stroke risk (amplified by increased clotting during pregnancy), it can be life threatening for both mother and baby. Preeclampsia is sometimes brought on by gestational diabetes, a form of the disease that can come on suddenly in the middle of pregnancy.

6. Atrial fibrillation

This erratic fluttering of the top chambers of the heart impedes movement of blood into the lower chambers, which pump it to the rest of the body. The blood can collect in the atria, and still blood can clot. It is a strong risk factor for stroke that effects both sexes, but is more concerning in women.

7. Loneliness and depression

Depression and “psychosocial stress,” such as social isolation, work stress, or discrimination, are associated with high blood pressure, one of the biggest risk factors for stroke—and they impact women’s risk more than men’s. (Research has also shown that figurative heartache can become a literal heart attack, especially among older women.) Though it can be difficult to address issues of mental health and loneliness, it’s crucial not just for your psychological well-being, but for your physical health as well.

If you think you may be having a stroke, call 911 immediately, even if the symptoms seem to go away. The acronym F.A.S.T. describes the three telltale signs of stroke: face drooping, arm weakness, and speech difficulty. The T stands for “Time to call 911.”

July 5, 2000 — Young people don’t typically have strokes, so when they do, it can be particularly frightening. We understand that older people have strokes more often than young people because the stroke risk factors, such as narrowing of the arteries, increase with age. But researchers are still trying to find out how to decrease the risk of stroke in people under 45 — a group that doesn’t typically have the risk factors of older people.

In a recent study, doctors found that stroke patients and healthy patients had similar levels of total cholesterol, but pinpointed low levels of the ‘good’ cholesterol, HDL, in stroke patients. HDL is believed to lower stroke risk.

The results suggest that having your HDL cholesterol measured may be a good indicator of whether you’re at risk for a stroke prematurely.

High cholesterol levels that lead to artery narrowing have often been associated with an increased stroke risk. However, in this study, which was published in a recent issue of the Journal of Neurology, Neurosurgery and Psychiatry, young stroke patients were different from the typical older stroke patient because they showed no signs of narrowing of their brain arteries. This suggested that another factor was the increasing the risk.

The study involved 94 stroke patients under 45. Doctors examined the patients, questioned them about their medical histories, and studied their brain arteries with imaging techniques. They also asked whether the patients had other known risk factors for stroke, such as cigarette smoking, high blood pressure, high blood cholesterol levels, diabetes, or oral contraceptive use. Blood samples were taken and their cholesterol levels were measured. The findings were compared to a group of 111 healthy subjects.

Unlike the typical older stroke patient, only a few showed any signs of atherosclerosis, which is fatty deposits on the walls of blood vessels that narrow them, according to J.F. Albucher and colleagues at the Purpan Hospital in Toulouse, France. So having “clean” blood vessels is no guarantee that a stroke won’t develop.

When the researchers measured levels of fat in the blood, they found that only a low level of HDL cholesterol was strongly associated with stroke risk. The study also confirmed that stroke risk was higher in these young patients if they had evidence of the other established risk factors for stroke, such as use of oral contraceptives (in women), smoking, and high blood pressure. Men were also more likely to have a stroke than women.

Dr. David Liebeskind is director of outpatient stroke and neurovascular programs and director of the Neurovascular Imaging Research Core at Ronald Reagan UCLA Medical Center. He contributed this article to Live Science’s Expert Voices: Op-Ed & Insights.

About every 40 seconds, someone has a stroke in the United States, according to the U.S. Center for Disease Control and Prevention — and from the moment the first symptoms occur, the clock is ticking.

Medical professionals refer to the first 3 hours after the onset of a stroke as the “golden window.” Those who receive medical treatment within those first 3 hours stand a much better chance of living and avoiding permanent injury from a stroke than those who don’t.

What you don’t know could kill you

During a stroke, blood supply to the brain is interrupted , either by blocked arteries or because a blood vessel within the brain ruptures. Without a continuous supply of oxygen and nutrients, brain cells begin to die rapidly, and without immediate medical attention, the damage can be extensive and permanent, and ultimately fatal.

While physicians know certain risk factors — like high blood pressure, smoking and high cholesterol — increase stroke risk, the truth is, we simply cannot predict exactly who will have one. According to the CDC, of the nearly 800,000 strokes that will occur this year, 3 out of 4 will be first-time strokes, meaning it will be a new, frightening experience for those patients.

Our best hope is that people know the early warning signs of a stroke and act immediately if they, or someone around them, is having one.

Unfortunately, this is a message many people, especially younger people, aren’t getting. A new national survey commissioned by my colleagues and I at Ronald Reagan UCLA Medical Center found that people under age 45 often underestimate the symptoms of a stroke and the urgency to seek medical help.

Dr. David Liebeskind examines young stroke victim Jennifer Reilly at Ronald Reagan UCLA Medical Center. Reilly had a stroke at age 27, one of a growing number of patients under the age of 45 in the United States to suffer a stroke. (Image credit: Ronald Reagan UCLA Medical Center)

Knowing what you don’t know

In our research, we asked more than a thousand people across the United States what they would be likely to do within the first 3 hours of experiencing numbness, weakness, or difficulty speaking or seeing, which are all common symptoms of a stroke.

Only about 1 in 3 respondents under age of 45 said they would be very likely to go to the hospital. A shocking 73 percent said they would instead be more likely to just wait to see if their symptoms improved.

That delay is not only disturbing; it could prove deadly.

Many younger people assume strokes occur only in the elderly, dismissing the telling stroke symptoms. While strokes may be more common as people age, people of all ages can experience them.

The risks are real

The truth is, anyone, even younger people, can be at risk for stroke, especially with obesity rates at an all-time high. Not only are Americans heavier, but we’re dealing with diseases like diabetes much earlier in life.

Moreover, people with diabetes are one and a half times more likely to have a stroke than those who don’t have the condition, and since 1990, the rate of diabetes in people younger than 44 has skyrocketed by 217 percent, according to the CDC.

High blood pressure, or hypertension, is another important risk factor for stroke, and today, it affects about 70 million people, including 1 in 4 men ages 35 to 44.

Given those numbers, it’s clear that many people under age 45 have risk factors for stroke, and according to a recent study published by the American Academy of Neurology, strokes in younger patients are on the rise. The study found that between 1995 and 2008, the number of strokes in people between the ages of 15 and 44 increased by as much as 53 percent.

Dr. David Liebeskind, professor of neurology and director of outpatient stroke and neurovascular programs and director of the neurovascular imaging research core at Ronald Reagan UCLA Medical Center, says the number of strokes in younger patients is on the rise, but their awareness of the urgency for treatment is lagging. (Image credit: Ronald Reagan UCLA Medical Center)

Most strokes can be treated

Regardless of a patient’s age, most strokes (about 85 percent) are ischemic strokes, in which an artery that carries blood to the brain becomes blocked, usually by a clot. Without normal blood flow, the brain is robbed of oxygen — and the longer it goes without oxygen, the more it’s damaged.

If patients arrive at the hospital soon enough, doctors can give them drugs called tissue plasminogen activators (tPA) to break up the clots and restore blood flow. In some cases, surgery is necessary. If the clot is in a carotid artery — the large arteries on the sides of the neck — we may need to perform a carotid endarterectomy to remove plaque from the artery, or angioplasty, in which we use a balloon to widen the artery (and often insert a stent to keep it open and restore unrestricted blood flow).

We also perform surgery for hemorrhagic strokes, which occur when an artery in the brain ruptures or leaks blood directly into the brain.

If you’re a topical expert — researcher, business leader, author or innovator — and would like to contribute an op-ed piece, email us here.

The good news is, there are treatment options for stroke. The bad news is, unless you know what to look for and get medical attention immediately, doctors may never have the chance to help.

The American Heart Association has an easy way for you to remember the early warning signs of a stroke so that you can act “F.A.S.T.” Check for the following signs:

Face drooping. Ask the person to smile, and see if their smile seems crooked. Arm weakness. Ask if one arm is numb or weak, and have them raise both arms to check their strength. Speech difficulty. Is the person slurring their speech or speaking incoherently? Time to call 9-1-1. Call immediately, and note the time you first noticed the symptoms.

It’s natural for younger people to be inclined to think that symptoms of a stroke are likely due to something else. Unfortunately, those cardinal signs of stroke are the only trigger or alert that we have to implement prompt diagnosis, and importantly, effective treatments.

Given the results of this survey, it’s clear we need to do a better job of making all patients aware of the signs of a stroke and the urgency to seek treatment before it’s too late.

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google+. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.

Photo Credit Yvetta Fedorova

Personal Health

Jane Brody on health and aging.

Six years ago, Todd McGee was a lean, athletic 34-year-old working in construction and living with his wife and toddler daughter on Martha’s Vineyard, where he spent summer weekends surfing. A stroke changed his life forever.

Today, with one arm useless and difficulty speaking, Mr. McGee, now 40, cannot work. He devotes most of his time to keeping as healthy as possible. Though he is able to drive and care for his daughter, now 7, everything takes longer, and he has trouble concentrating even on routine activities that others take in stride, like grocery shopping.

“I definitely wish I had my old life back, building houses and boats and surfing in my spare time,” he said.

His experience, complicated by a serious delay in diagnosis, is a powerful reminder that strokes can and do happen to young people. The sooner the correct diagnosis is made, the less likely the result will be lifelong impairment.

Although a vast majority of strokes occur in people over age 65 (the risk is 30 to 50 per 1,000 in this age group), 10 percent to 15 percent affect people age 45 and younger (a risk of 1 in 1,000). A study by doctors at the Wayne State University-Detroit Medical Center Stroke Program found that among 57 young stroke victims, one in seven were given a misdiagnosis of vertigo, migraine, alcohol intoxication, seizure, inner ear disorder or other problems — and sent home without proper treatment.

“Although young stroke victims benefit the most from early treatment, it must be administered within four and a half hours,” said Dr. Seemant Chaturvedi, a neurologist at Wayne State who directs the program and led the study. “After 48 to 72 hours, there are no major interventions available to improve stroke outcome.”

“Symptoms that appear suddenly, even if they seem trivial, warrant a meticulous work-up,” he added.

Follow-up analyses of the Detroit study showed that patients seen by a neurologist in the emergency room, as well as those who were given an M.R.I. as part of the initial work-up, were less likely to receive a misdiagnosis.

“Patients, too, should be aware of the risk of stroke regardless of their age,” Dr. Chaturvedi said in an interview.

The Centers for Disease Control and Prevention have reported a steep increase in strokes among people in their 30s and 40s. A rise in risk factors — obesity, diabetes, high blood pressure and sleep apnea — and improved diagnosis account for this upturn.

But younger patients are no better today at recognizing the symptoms of stroke. “Only 20 to 30 percent of patients get to the emergency room within three hours of symptom onset,” Dr. Chaturvedi said. “They tend to wait to see if the symptoms will go away spontaneously, and they show up in the E.R. 12 to 24 hours later.”

A Cautionary Tale

After an intense workout in the surf the day before, Mr. McGee awoke one morning with a headache and feeling out of sorts. He went to work but came home nauseated and chilled. He assumed he’d come down with the flu his family had just had.

Then in the middle of the night, a headache he described as “the worst pain of my life” prompted a trip to the emergency room. The attending doctor thought Mr. McGee had a muscle tension headache, treated him with intravenous pain medication, handed him some pain pills and sent him home.

Embarrassed that he’d gone to the hospital “for just a headache,” Mr. McGee took the pills when the pain returned the next afternoon. Soon after, he suffered what he thought were side effects from the medicine. Now he knows what it really was: a transient ischemic attack, a mini-stroke, that left him briefly unable to speak and numb on one side.

That night, he fell out of bed trying to get to the bathroom and lost bladder control en route. One arm, he found, had begun flapping uncontrollably. He returned to the E.R., where two doctors ordered a CT scan that suggested either a severe migraine or a stroke. At the time the hospital had no M.R.I. equipment, which could have revealed the real problem: a stroke resulting from a tear in the carotid artery, which feeds the brain.

By the time an ambulance and ferry got Mr. McGee to Boston, where the diagnosis of stroke was confirmed, it was much too late for the clot-busting drug tPA to ameliorate the stroke’s effects; the drug must be given intravenously within three or four hours. (Although some doctors are concerned that tPA can cause fatal bleeding in a person with a torn carotid, Dr. Chaturvedi said the drug is “safe and effective” in such patients.)

Repeated blows from surfing, possibly combined with an inherent arterial weakness, are believed responsible for Mr. McGee’s stroke. Other activities that can cause a carotid tear are those that involve sudden neck jerks, including scuba diving, golf and tennis, as well as chiropractic manipulation and bending the head sharply back (the so-called beauty parlor stroke).

But a majority of strokes that affect young adults result from clots precipitated by the usual cardiac risk factors: obesity, high blood pressure, high cholesterol and smoking. Abuse of alcohol and drugs are also contributing factors; among women, use of birth control pills can raise the risk of stroke. People prone to migraines also have a somewhat higher risk of stroke.

When to Act Fast

The distinguishing characteristic of stroke symptoms is their sudden onset. Thus, Dr. Chaturvedi said, no matter what a person’s age, the sudden appearance of any of the following symptoms should prompt a trip to the hospital as quickly as possible.

¶ Numbness or weakness of the face, arm or leg, especially on one side of the body.

¶ Confusion, trouble speaking or understanding speech.

¶ Trouble seeing in one or both eyes.

¶ Difficulty walking, dizziness or loss of balance or coordination.

¶ Sudden, severe headache with no known cause.

Unlike a heart attack, most strokes are painless. Even if the initial symptoms dissipate they must be taken seriously.

“A CT scan doesn’t show strokes very well in the first 24 hours,” Dr. Chaturvedi said. He recommended that if the diagnosis is uncertain, an M.R.I. should be done and a neurologist consulted in the emergency room.

“Patients may have to be proactive and insist on a thorough work-up and ask to be seen by a neurologist, and E.R. doctors should consider the possibility of stroke regardless of a patient’s age,” he said.

I had a stroke at the age of 29

The following morning surgery was conducted to remove part of my skull and save my life. The stroke had caused my brain to swell.
The stroke left me unable to walk and to feed myself, but I was alive.
My speech was so slow my family couldn’t understand me at first. I spent the next seven months in rehabilitation fighting to be well and get my life back.
I was determined to not waste a day.
Nick and I had been planning to get married and found ourselves asking “what are we waiting for?”. We decided to go ahead with our wedding, but in a new location – the hospital gardens.
It was a magical day, we were surrounded by our loved ones. Our sons, Noah and Seth, carried the rings, which was incredibly special.
Afterwards everyone in the ward joined in the celebrations with platters of food and gifts. It was so much fun. It was the first ever wedding on the rehab ward!
Today, I am making the most of life after stroke. I am finally out of my wheelchair, although I walk with a limp. My speech is slow and slurred. But I am here.
My condition is constantly improving.I just got my driver’s licence back, which has been a huge achievement and I can now drive the boys to school. I have even started my own business making and selling flower crowns online.
In the lead up to National Stroke Week this September, I am determined to raise awareness of the signs of stroke so that nobody has to experience what I went through.
Stroke is one of the biggest killers in Australia and a leading cause of disability. It kills more women than breast cancer and more men than prostate cancer. Yet stroke is treatable.
I sometimes wonder what my outcome would have been if my stroke had been diagnosed earlier and whether I would have fewer ongoing issues. These days there are amazing treatments which can make an enormous difference if carried out early.
That’s why it’s so important to recognise the signs of stroke and act FAST. Every minute counts. The earlier treatment is delivered, the better the outcomes can be for patients like me.
My stroke may have put my life on a different course, but it hasn’t changed my personality or attitude. I stay positive, I love being a mum and I am fortunate to be alive.

“Clearly, something big is happening with stroke and young people,” Dr. Greene-Chandos notes. “When you talk to neurologists and ER physicians, what you’re hearing is that this is a growing problem, especially because many people still think that stroke just doesn’t happen to people under age 45.”

Ironically, stroke risk is actually decreasing for older adults, according to Koto Ishida, M.D., director of NYU Langone’s Comprehensive Stroke Center. According to the JAMA Neurology study, the rate of hospitalization for stroke in women aged 55 to 64 actually decreased 2.2 percent (from 173.4 per 10,0000 hospitalizations to 169.5 per 10,000 hospitalizations). 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, Dr. Ishida tells SELF.

“Older adults expect to have these kind of issues, so they get screened,” she says. “But someone in her twenties usually doesn’t think about something like blood pressure unless there’s a problem. She might only go to the doctor when she’s sick, and if she doesn’t get sick, she doesn’t get screened.”

Exacerbating the problem: Stroke signs may be different for young people.

There’s an acronym for spotting a stroke that’s taught to all emergency personnel, and it comes in handy for anyone who thinks a stroke is occurring: FAST. That stands for facial drooping, arm weakness, speech difficulties, and time to call 911.

Usually, one side of the body is affected as a stroke is happening in the brain, making someone’s face on that side sag, and leading to problems with raising that side’s arm. Slurred or confused speech is common as well, since a stroke may be affecting memory and verbal abilities.

At this point, time is crucial, because anti-stroke medication must be given within about four hours of stroke onset to prevent permanent disability or death.

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—the way that Zizzo did—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 ouch-ouch-ouch tingle 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.

Yes, you can have a stroke without knowing it happened. And that can raise your risk for future incidents.

Before she was in full-on stroke mode, Zizzo remembers smaller signs that something was wrong—her vision was narrowing, she recalls, and she felt 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.

Of course, this isn’t meant to terrify you—just inform you. Dr. Greene-Chandos says that the message here isn’t to run to the ER whenever you have hiccups or a headache, but to know about these symptoms, especially if you have other stroke risk factors, like being a smoker, having a family history of strokes, taking hormonal birth control, having high cholesterol and/or high blood pressure, or being diabetic.

“Get a wellness check, even if you think you’re too young and you’re healthy,” Dr. Greene-Chandos advises. “Know your numbers. And most of all, don’t think that strokes are just for older people. That’s simply not the case.”

Related:

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  • 8 Health Conditions That Disproportionately Affect Black Women

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