Monthly Archives: October 2025

On this world stroke day 29th October 2025; let us bring stroke advocacy and awareness together to aim to drive action by imparting education to the public on STROKE signs; imparting emergency care immediately for those experiencing symptoms; and mobilising communities to ask for better stroke prevention; treatment and rehabilitation.

Key actions include:

1. Awareness and immediate action: Recognising STROKE signs: learn B.E.F.A.S.T: balance problem; eye symptoms and signs; face dropping; arm weakness; speech difficulty; Time to call emergency services.
2. ACT FAST: Time lost is brain lost. Recognise early symptoms and signs and call emergency services immediately to get quick treatment to significantly improve outcomes.
3. Use of right resources like ambulance service: recognise that going to hospital via an ambulance allows for quicker diagnosis and treatment in comparison to driving yourself or someone else drive you.

Advocacy and systemic change

1. Advocate for better care: improving access to quality stroke treatment and rehabilitation in your community and globally.
2. ⁠support policy changes: prioritising stroke prevention like taxation on unhealthy products like smoking; better supervision systems to monitor stroke and its risks factors like hypertension; diabetes mellitus and dyslipidaemia.
3. ⁠focus on prevention: awareness drive about major risk factors for stroke like high blood pressure; diabetes mellitus; high cholesterol and smoking.

Community involvement

1. Spread a message: sharing information about stroke symptoms and importance of quick action within the community like friends; family and society members.

2. ⁠getting involved: active participation in awareness events; support stroke organisation; sharing stories to empower others and highlighting the need for action in STROKE.

STROKE IN YOUNG

Introduction:Everyone from any age group can suffer a stroke which can lead to devastating lifelong disabilities. Though the risk of stroke increases with age, stroke in young especially under 45 years are becoming more common with a research showing a 14.6% increase among people aged 18 -44 years from 2020 to 2024. The increase in young stroke is to some extent attributed to rise in risk factors like hypertension; diabetes; bad cholesterol; obesity; smoking which are now more prevalent in younger age groups.

Factors causing increased stroke risk in young:

1. Traditional risk factors: hypertension; diabetes; bad cholesterol; coronary artery disease; obesity.
2. ⁠sedentary life style; poor dietary habits; smoking; alcoholism
3. ⁠cervical artery dissection (arterial tear in neck arteries)
4. ⁠patent foramen ovale (a heart defect).
5. ⁠substance abuse: heroin; alcohol; cocaine
6. ⁠air pollution; high temperatures 7. Hyper homocysteinemia; low vitamin B12; folic acid levels
8. ⁠abnormal sleep patterns; hormonal contraceptives
9. ⁠20-30% of stroke cases in young is unknown etiology. Effect of stroke in young is significant as it leads to higher mortality and disability which directly impacts quality of life and productivity. Increased burden leads to focus on prevention and treatment.

Management of stroke in young:

1. Prevention: life style changes like diet; exercise; yoga; smoking cessation). Early detection and treatment of diabetes; hypertension; bad cholesterol and obesity. Public awareness drive by various means to promote healthy life style and identification of stroke risk factors.
2. Treatment and secondary prevention: aggressive management as early as possible with all drugs and physical therapy can stop or reverse the disability caused by stroke. Identification of risk factors and rehabilitation helps to prevent future events. 80% of young stroke are ischemic and 20% are hemorrhagic.

Etiology subtypes: 1. Large artery atherosclerosis 2. Cardio embolism (atrial fibrillation; atrial flutter; cardiomyopathy). 3.Small vessel occlusion. 4. Stroke of other determined etiology( cerebral artery dissection; vasculitis; hematological diseases; malignancies; illicit drugs; thrombophilia; pregnancy and post partum). 5. Stroke of undetermined etiology ( cryptogenic).

Conclusion: With rise in stress and competition in way of life and other risk factors coming in play at a young age the risk of having a stroke before 50 years of age will increase in coming years. A alert society and alert government should focus on prevention of stroke and early identification and management to prevent mortality and disability in young. 15% of stroke occur in age group of 18-50 years; 1.5 million young adults worldwide suffer from stroke each year. The incidence of stroke in age group 20- 44 years has risen from 17 per 100000 in 1993 to 28 per 100000 in 2020.

Stroke symptoms in young adults similar to those in older adults

Sudden onset weakness or numbness in face; Arm or leg

Sudden change in speech

Sudden difficulty in walking or balance

Sudden severe headaches

Sudden change in vision

Types of stroke:

Ischemic stroke in which flow of blood and oxygen is disrupted causing damage to brain tissue. It represent 60% of strokes in patients younger than 50 years

Hemorrhagic stroke in which blood leaks out of blood vessels in or around brain result in damage of underlying tissue. It represents 40% of stroke in patients younger than 50 years. Overall stroke population 85% is ischemic stroke and 15% only hemorrhagic stroke.

Cervical arterial dissection results in 10-25% of stroke in young adults while only 2% of stroke above 65 years. Damage of the wall of large vessels in neck causes disruption of blood flow Spontaneously or intense physical pressure on neck with vigorous coughing; vomiting or weight lifting. Dissection can be seen in genetic disorders causing abnormal blood vessels. Dissection causes neck pain; headache; drooping eye lids before the onset of stroke symptoms.

Patent foramen ovale: it is a communication between the right and left side of the heart which enable clots from the leg to pass into blood vessels to the brain.

It is one of the rare cause of stroke in young

Underlying blood clot disorders can cause both ischemic and hemorrhagic stroke

Drug use like cocaine can cause stroke with a six fold increase in younger individuals when smoking was the method of use

Genetic disorders like Fabry disease or Moya moya disease can be associated with stroke

The recent increase in stroke frequency in young adults is due to increase in traditional cardiovascular risk factors in young individuals

Hypertension; type 2 diabetes mellitus; obesity; dyslipidaemia are seen with increasing frequency in young adults.

Additionally cigarettes smoking and sedentary life style are causing young strokes more

50% young stroke have hypertension; 14% have type 2 diabetes mellitus and 22% are obese

Modern imaging techniques like MRI detect stroke early and rapidly. It can detect the site of blood vessels blockage and accurate treatment

Age does not protect someone from stroke devastated effects. Unfortunately young adults reach ER late than older adults. Awareness about the disease should be spread so that they should reach ER like older adults as early as possible.

The modalities of treatment similar in older adults with all modalities of treatment equally effective

Prevention can be done by modifying modifiable risk factors like hypertension; dyslipidaemia; obesity and type 2 diabetes mellitus with control of cigarette smoking.

Early detection and aggressive treatment can modify the outcome and prevent stroke

Hypertension goes undetected and cause stroke; heart disease and kidney disease. Blood pressure assessment in young adults is a must.

Exercise and healthy eating help decrease the risk of stroke

Control of blood sugar; bad cholesterol; obesity; smoking and alcohol abuse can prevent 3/4 of stroke worldwide particularly in young patients.