“In my experience, we have been treating more young adults with strokes in recent years,” said Dr. Tiffany Brown, stroke medical director at Intermountain McKay-Dee Hospital. “This reflects a national trend of increasing rates of stroke amongst young people, particularly between the ages of 18-44, but also in people aged 45-65.”

According to the Centers of Disease Control and Prevention, stroke prevalence increased 14.6% among people ages 18-44 and 15.7% in those aged 45-65 between the periods of 2011-2013 and 2020-2022. While strokes are increasing in younger people, Brown said the national trend of stroke rates in older adults over the age of 75 has been going down, possibly due to progress in improving stroke prevention measures.

“The cause of the increase in strokes in young patients is not entirely clear, but many experts are working on figuring this out,” Brown said. “The increase likely has multiple causes, including unhealthy lifestyles such as poor diets high in processed foods, smoking — the use of e-cigarettes in particular has increased in young adults aged 18-24 — despite a global decline in tobacco use otherwise.”

Brown said any kind of tobacco product increases stroke risk, including vaping.

Heavy alcohol consumption, drug use and inadequate exercise could also be a contributing factor, Brown said.

In addition, the CDC estimates approximately 22% of people between the ages of 18-39 have high blood pressure, Brown said, which is likely also caused by unhealthy lifestyles being witnessed in the younger population. High blood pressure is one of the biggest, most modifiable, treatable risk factors for stroke, she said. However, many people don’t realize they have high blood pressure (hypertension) since it usually causes no symptoms.

“In medicine, we call hypertension ‘the silent killer’ because it is still causing significant damage to the arteries of the brain, heart and other organs, even if people have no symptoms,” Brown said.

In recent decades, there has been an increase in obesity in children and young adults, and obesity is a significant stroke risk factor, Brown said. The youngest patient she has treated for stroke was only 17 years old.

“I have worked at several different hospitals in Texas, Colorado and now Utah. Even though these different states all have different patient populations, with different types of stroke risk factors, I have seen a concerning number of young people with strokes across all hospitals I have worked out,” Brown said. “I estimate that I personally see approximately two to three stroke patients under the age of 50 each month. When I first began my neurology training at a large stroke center in Texas, it was quite unusual to see young people with strokes.”

In 2001, Dr. Steven Edgley, director of stroke rehabilitation at University of Utah Health, suffered a stroke at the age of 28. An avid marathon runner and triathlete who ate a healthy diet, Edgley had no risk factors. At the time of his stroke, he was an ophthalmology intern, but during his recovery, he made the decision to switch his specialty to stroke rehabilitation.

“It’s alarming to me,” Edgley said regarding the increase in strokes among young people. “My stroke was not based on any of the lifestyle factors. Especially in young people, the cause of stroke is not determined in about a third of cases.”

Edgley also said lifestyle is a big factor when it comes to stroke prevention. Blood pressure should be under 130/80, he said. Physical exercise should be part of your daily routine, and if you are overweight, a plan to lose weight should be discussed with your physician. Smoking and drinking should also be eliminated. However, Edgley said if you are going to drink, two drinks per day for men and one drink per day is recommended.

“No alcohol is probably better though,” he said.

Edgley also said the overall incidence of stroke is approximately 800,000 per year in the United States with 10% of those people being under the age of 50.

Additionally, Brown said, in recent decades, there has been an increase in rates of cancer in young adults, and cancer increases the risk of clotting events and ischemic strokes.

“Sometimes, a stroke or other clotting event is the first indication someone may be developing an underlying cancer,” she said. “It’s hard to know if there is any direct connection between these two terrifying trends at this point, and both of these trends are being closely investigated by experts.”

There are two main types of stroke, according to stroke.org. They are ischemic and hemorrhagic. An ischemic stroke is caused by a blood clot that blocks blood flow to the brain. A hemorrhagic stroke is caused by bleeding in or around the brain. Edgley said approximately 15% of all strokes are of the hemorrhagic kind.

A third type, transient ischemic attack, or TIA, causes temporary stroke-like symptoms which can be a warning sign for a full-blown stroke in the future.

Other types of strokes include cryptogenic strokes, in which the cause is undetermined; brain stem stroke, which can affect both sides of the body; thrombotic stroke, caused by a blood clot that develops in the brain’s blood vessels; embolic stroke, caused by a blood clot that travels to the brain from another part of the body; aneurysm, which occurs when a weakened blood vessel balloons outward and ruptures; and arteriovenous malformation, a structural problem usually present from birth.

“We use the acronym BE FAST to discuss common stroke symptoms,” Brown said.

The acronyms stand for balance problems, including imbalance with walking and sudden-onset vertigo; eye problems, such as vision loss and blurry or double vision; face drooping, weakness or numbness; arm weakness or numbness; speech problems; and time to act (the sooner a person seeks medical attention after a stroke, the sooner brain-saving treatments can be administered). Another important symptom is a sudden severe or unusual headache with no known cause.

Anyone experiencing these symptoms or witnessing these symptoms in someone else should immediately call 911, rather than trying to drive themselves to the emergency room, Brown said.

“Women may be more likely to have atypical stroke presentations compared to men. For example, women may be more likely to experience symptoms like slurred speech, nausea and confusion,” Brown said. “Women are also more likely to have migraines, and a history of migraine can increase risk of stroke; plus some of these stroke symptoms can appear to be migraine symptoms, which could lead to delays in diagnosis.”

Treatment of stroke varies, depending on the type of stroke, but Edgley and Brown both said it’s important to get help immediately so the right treatment can hopefully reduce the overall outcome.

“We have treatments that can potentially reduce the overall size and severity of an ischemic stroke, but only if we can deliver those treatments quickly after a stroke starts, ” Brown said. “Years ago, medical professionals weren’t jumping straight to the idea of a possible stroke in a young person presenting to the emergency room with neurologic symptoms, because stroke in those age groups was so rare. However, we now understand the trend of increasing stroke rates in young adults in recent years, and medical providers are recognizing stroke in young patients quickly so we can expedite their care and improve their overall outcomes.”

McKay-Dee Hospital also is in the process of adding an additional interventional radiology suite, which Brown said will vastly improve the ability to care for acute stroke patients. The IR suite is used for cases where someone has a clot in a large artery of the brain.

“Our interventional radiology colleagues can do a minimally invasive procedure (thrombectomy) to remove the clot and save brain tissue that would otherwise be permanently damaged by the lack of blood flow and oxygen,” she said.

Brown and Edgley said they strongly encourage young people to practice a healthy lifestyle. The American Heart Association recommends 150 minutes per week of moderate intensity of aerobic exercise. Also, avoid tobacco products and drug use and limit or forego alcohol intake.

“It’s also important to discuss any family history of stroke or other medical conditions with a primary care provider to ensure proper preventative testing and treatments are done,” Brown said. “No one is ever too young to start thinking about a healthy lifestyle for stroke prevention.”