Strokes Striking People at Younger Ages

It was like any other weekday morning for Amanda Francis, a first grade teacher living in Gaffney, S.C. She woke up and quickly jumped in the shower to get ready for work. But from there, things took a turn for the worse. Amanda passed out. When she came to, she frantically tried calling out to her fiancé, Derek, who found Amanda and called 9-1-1.

At Spartanburg Regional Medical Center, emergency physicians ran a battery of tests and soon discovered the cause of her fainting spell. Contrary to a paramedic’s suspicion that she might be pregnant, Amanda – who was 24 at the time – had experienced a stroke, which left her unable to speak or use the right side of her body.

“The scariest part was not knowing what was going on with my body,” Amanda says, recalling that she had a heavy feeling on the right side of her body in the days leading up to the stroke.

She eventually transferred to Shepherd Center where she received a month of intensive rehabilitation and another eight weeks at Shepherd Pathways, Shepherd’s post-acute rehabilitation program in nearby Decatur, Ga., for people recovering from brain injury.

“I remember being scared to talk when I first got to Shepherd; I just couldn’t put the words together right,” Amanda explains. But the support and encouragement she received from her therapists was unparalleled, she adds. “They were so excited to see how quickly I was progressing, and they gave me so much motivation.”

She also credits the care she received at Shepherd Center with helping her “get back to walking and talking” so that she could walk down the aisle on June 22, 2013 – her wedding day.

Amanda has made a remarkable recovery. “I’m slower than I used to be,” she says. “But I’m working hard and staying positive.” In August, she hopes to return to her classroom as a full-time teacher.

Amanda is not alone. Strokes don’t only affect older people, and, in fact, they appear to be on the rise in young people.

“We now see more than 150 young stroke cases a year in our inpatient and post-acute programs,” says Susan Johnson, MA, CCC-SLP, CCM, director of brain injury services at Shepherd Center.

Nearly one in three strokes occurs in people ages 20 to 64, according to national research. Many experts speculate this trend might be due to risk factors – including diabetes, obesity and high blood pressure – now seen in younger generations.

“Stroke is not something that immediately comes to mind with younger patients,” says Owen B. Samuels, M.D., associate professor of neurology and neurosurgery, Emory University School of Medicine and of the Emory MBNA Stroke Center. “If you see a young college student who is complaining of unsteadiness, numbness, dizziness and headache, these can be seen as fairly benign symptoms with no significant risk. However, sometimes they can be signs of stroke.” 

Dr. Samuels was the physician who referred Robert Pritchard-Worthy of Sugar Hill, Ga., to Shepherd Center. Like Amanda, Robert was in his 20s when he experienced a stroke.

When his stroke occurred, Robert and his cousin decided to venture out into downtown Atlanta one night. But something felt “off,” he says. “It was really hard for me to talk.”  He tried to put it out of his mind, but while behind the wheel driving to a hotel to meet friends who were in town, he noticed the car kept drifting into the right lane. When Robert opened the driver-side door, he says he practically fell out of the car, sliding and landing face down on the pavement. He continued on, lifting and dragging his left leg behind him for more than two blocks. But a strange sensation would soon overcome him and trigger a seizure. Then, his cousins called emergency services.  

“It’s kind of crazy,” he says. “You go from being completely healthy – I didn’t have any of the typical risk factors – and all of a sudden, you’re completely debilitated and dependent on others. I couldn’t do anything.”

Through Shepherd Center’s intensive young stroke rehabilitation program, Robert quickly progressed from being in a wheelchair to using a walker and then only needing a brace on his left leg. He has regained full movement in his arm, but admits it does not function quite like it used to. Still, he is making improvements all the time – so much so that he has been able to pursue one of his dreams – to study for his master’s degree in criminal justice at the University of Central Florida in Orlando.

Never Too Young for a Stroke

“Our young stroke patients are people who have so much life left in them,” says Anna Elmers, M.D., a staff physiatrist who treats brain and spinal cord injuries at Shepherd Center. “Our goal is to help them regain function and take what lemons that life has given them and make lemonade.”

Younger stroke patients undergo more aggressive treatment than older patients who may be undergoing rehabilitation in a facility that doesn’t specialize in brain injury, as Shepherd Center does, Dr. Elmers says. Because they are in the prime of their lives when they experience a stroke, it’s the training and educating of families that becomes so critical. Also, the peer support and visitor program at Shepherd Center, which matches patients with people who have also experienced a stroke at a similar life stage, helps provide reassurance, hope and insight, she adds. Reintegration activities help patients transition back to work, school, parenting and leisure activities.

Dr. Elmers, who helped care for Robert, is heartened to know he is now pursuing a master’s degree. “He was nowhere near there when we first saw him,” she recalls. “That’s what’s most satisfying about what we do. There is so much potential for functional recovery with our younger patients.”

Many of the challenges faced by younger and older patients are the same as they grapple to understand what has happened to them.

“The brain, in general, does have the ability to regenerate function,” Dr. Samuels says. “Early neurorehabilitation is where it starts and is enormously important for rehabilitation of the brain, both for motor deficits, including weakness and spasticity, and cognitive deficits like speech and memory.”

Facilities such as Shepherd Center are keenly aware of this and provide enormous benefits to those recovering, Dr. Samuels notes. Robert agrees.

“It was really cool to see other people recovering, coming back more like themselves and getting their lives back, and it’s all thanks to Shepherd Center,” Robert says.

Don’t Wait

While recovery is often expected to be better in younger people because their brains are more adaptable and prone to repair, life after a stroke can be quite different. A recent study found that one in three people who had a stroke before age 50 still has a related disability and loss of function within 10 years.

“If you think you are having symptoms, don’t wait to go to the doctor,” Amanda says. The school nurse had encouraged Amanda to see a neurologist because of the tingling she felt in her arm, thinking it might be a pinched nerve. “I might have been able to prevent it,” she adds.

While the prognosis is typically good for young people who experience a stroke, it can be an uphill road adjusting expectations to a “new normal.”

Amanda and Robert are both inspiring examples of what is possible.

Shepherd Center’s experts in rehabilitation medicine work one-on-one with people recovering from stroke to set goals to:

• Provide intensive, individualized rehabilitation
• Maximize each person’s functional abilities and level of independence
• Provide extensive training and education for the person and their family
• Rebuild the person’s quality of life
• Organize activities that facilitate a smooth transition back to their home, community, school or workplace

Most strokes occur when a clot blocks the blood supply to the brain. Swift diagnosis and treatment are critical to prevent long-term deficits, including speech and memory problems, disability or paralysis.  

The reasons for stroke in younger and older patients are often different, Dr. Samuels says. Strokes in older people are typically associated with the usual risk factors of heart disease, diabetes, high cholesterol, chronic smoking or family history. But younger people may have an injury to their artery (called dissection), allowing clots to form, or congenital birth defects that make stroke more likely.

Know the Signs and Symptoms

Experts and people recovering from stroke say the most important advice they can give is to know the signs and symptoms of stroke. Doing so will not only get urgent care more quickly to minimize brain damage, it may also save your life. Call 9-1-1 right away if you have sudden:

• Numbness or weakness in your face, arms or leg, especially on one side of the body
• Difficulty walking, feeling off balance/unsteady or dizzy
• Trouble seeing in one or both eyes
• Confusion, trouble speaking or understanding speech
• Severe headache

Robert says he didn’t know what a stroke was before he had one. “Maybe if I had known, I might have sought medical attention more quickly,” he adds, “Just having greater awareness can go a long way.”

A Word of Advice

“It’s a long process,” Amanda says of rehabilitation and recovery. “You’ve got to be patient and do your best at all times.”

Remaining positive and having a “can-do” attitude makes a huge difference, Johnson says. “It’s our clinicians’ role to help facilitate the recovery,” she adds. “But patience, perseverance and faith drive healing.”

More Information on Rehabilitation Services

For more information on Shepherd Center's young stroke rehabilitation program, see www.shepherd.org/stroke.

Written by Amanda Crowe, MA, MPH
Photos by Kristen Grace and Gary Meek