Per People, she shared the event via Instagram stories — saying she “experienced stroke-like symptoms” and calling it “one of the scariest moments” of her life. She also revealed what may have gone wrong: “They found I had suffered a very small blood clot to my brain, which caused a small lack of oxygen, but my body had passed it on its own and I recovered completely within a few hours.” The health scare comes just weeks after husband and singer Justin Bieber tested positive for COVID-19 and, according to Twitter, was forced to cancel his world tour — leaving many to wonder whether the two are related.
What Young People Need to Know About Stroke
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 a stroke. It’s true that your stroke risk increases with age, but stroke in young people — even infants, children, and adolescents — does happen. In fact, between 10 and 15 percent of strokes occur in people ages 18 to 50, according to a study published in February 2020 in the journal Stroke. In general, most experts consider a young stroke age to be under 45. Even though the overall rate of stroke is decreasing, especially in people over age 65, it’s actually increasing among young and middle-aged people. A county-by-county analysis, published in November 2019 in the journal Stroke, found that between 2010 and 2016, strokes among middle-aged people increased in 3 times as many U.S. counties as strokes in people over age 64. These statistics were also no longer confined to what epidemiologists call the “Stroke Belt,” a swath of the southeastern United States in which stroke rates are between 2 and 4 times the national average.
How Strokes in Young People Can Be Different
The type of strokes that are seen in younger people are typically different from what doctors see in older patients. “There are certain heart-related problems that seem to be the causes of stroke in young people that seem to be less of a cause as we get older,” says Andrew Russman, DO, a neurologist and the medical director of the Comprehensive Stroke Center at the Cleveland Clinic in Ohio, adding that many young people are unaware they have an underlying condition that contributes to stroke until they have one. The factors that contribute to stroke in young people, which are typically different from what doctors see in older people who have a stroke, include the following: Patent Foramen Ovale About 1 in 4 people have small holes in the two atria of the heart, which are present at birth but typically not screened for, so most people don’t know they have it, says Dr. Russman. Arterial Dissection Up to 25 percent of stroke in people under age 45 is caused by a dissecting blood vessel in the neck. According to Russman, this can occur for a number of reasons, including whiplash or sports-related trauma, although most dissections occur spontaneously without trauma, he says. Blood vessels are made of three layers: a thin inner layer of cells, a muscular layer, and a fibrous layer. “The thin surface layer can tear, and then the blood can get into that vessel wall. This causes narrowing in the blood vessel and can be the cause of stroke,” says Russman. According to the Cleveland Clinic, symptoms of an arterial dissection can include the following:
HeadacheNeck and face pain, especially pain around the eyesDouble vision or a droopy eyelidA sudden decrease in sense of taste
Clotting Disorders Some conditions, including sickle cell disease, cause the blood to form clumps that can turn into clots and cause strokes in young people, says Russman. “Oftentimes a stroke may be the first indication that they had a clotting disorder,” says Russman. Substance Abuse Specifically, doing cocaine constricts blood vessels while increasing the clumping of blood cells that causes clotting, explains Russman, which is how the drug contributes to stroke in young people. Refraining from drug use and heavy alcohol consumption will reduce your risk of having a stroke at any age.
Factors Young People Can Control to Reduce Stroke Risk
Although having an underlying heart condition is out of your control, several studies have shown that many of the risk factors that make someone susceptible to stroke later in life, such as high blood pressure, high cholesterol, diabetes, and obesity, are becoming more common in younger people. According to the Centers for Disease Control and Prevention (CDC), more than 42 percent of U.S. adults and more than 18 percent of U.S. children are obese. “If you accept that stroke is increasing in people under age 45, one big reason is probably obesity,” says 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.” Eating healthy, fresh, and unprocessed foods and not drinking sugary beverages are both associated with a lower risk of cardiovascular disease. But according to Russman, the most important dietary modification to take into account is limiting salt intake. “If you are predisposed to high blood pressure and you take in a lot of salt, you’ll have a difficult time controlling high blood pressure, which is the leading cause of stroke,” he says. According to the CDC, 90 percent of American children eat too much salt, averaging an extra 1,000 milligrams (mg) more than the recommended daily limit of 2,300 mg. “Fast food and prepared foods are notoriously high in sodium and are best to avoid,” says Russman. “If you struggle with access to food other than fast food, you can modify your order, such as asking them to not add salt to your fries.” Cutting back on smoking cigarettes, even if you choose not to quit smoking all together, can also lower your risk of stroke in young adulthood. A study published in May 2018 in the journal Stroke found a strong correlation between the number of cigarettes that men under 50 smoked and their ischemic stroke risk. The researchers concluded that although quitting smoking should be the goal, even cutting back can be an effective way to reduce stroke in men under age 50. The 2021 stroke prevention guidelines from the American Heart Association (AHA) back these claims. While experiencing a blood clot doesn’t necessarily mean you’ll have a stroke, blood clots that are damaging enough to cause ischemic strokes — like the one Bieber experienced — are caused by a few predisposing factors, according to Melissa Tracy, MD, Systems Medical Director at the Cardiac Rehabilitation Center at Rush University in Oak Brook, Illinois. Hormonal birth control and smoking are two potentially comorbid factors. Dr. Tracy mentions that hormonal birth control medications can increase the risk of blood clots. Tracy adds, “If a women smokes, she significantly increases her risk for the development of both cerebrovascular (stroke) and cardiovascular events.” A study published in February 2019 in MedLink Neurology confirms that hormonal contraceptives are linked to an increase of stroke, but that risk is minor unless the patient has other stroke risk factors — such as smoking.
COVID-19 and Stroke
Research also shows that stroke — and specifically blood clots — are connected with COVID-19. In a study published by the American Stroke Association (ASA) in February 2022 in Stroke, researchers found that adults diagnosed with COVID-19 were more likely to develop blood clots than those who had not been infected. “I am not sure of all of the details of Hailey’s case,” says Jean M. Connors, MD, a World Thrombosis Day steering committee member and associate professor of medicine at Harvard Medical School in Boston, “but we do know that moderate to severe COVID-19 cases can cause a higher risk for stroke.” “The two have been linked in recent studies, but it’s unlikely that they are comorbid,” Tracy adds. “Most patients who have had a stroke during the COVID-19 pandemic have other risk factors than COVID alone.” “The important message that we are reminded of with Hailey’s recent scare is that yes, younger people can develop strokes,” says Dr. Connors, adding that she wants young people to know how to recognize the signs and symptoms of both stroke and blood clots.
Signs and What Should You Do if You’re Having a Stroke
To detect stroke symptoms, the ASA suggests that you remember the acronym FAST: F: Face drooping A: Arm weakness S: Speech difficulty T: Time to call 911
If you think you’re having a stroke, call 911. “With a stroke, time lost is brain lost, so getting to the ER as quickly as possible is the best thing to do,” explains Rosen. “Don’t even think about driving yourself, an ambulance will get you there quicker.”
The Road to Recovery
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. A small study from researchers in the United Kingdom, published in September 2019 in the journal Stroke, estimated that as many as 44 percent of people under age 65 who experience a stroke will not be able to return to work, most commonly due to having permanent trouble walking. “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,” says Russman, referring to the brain’s ability to adjust and learn new skills. According to the AHA, many factors determine how well a person will recover from a stroke, including how the brain was affected, caregiver support, the quality of a person’s health before they had a stroke, quality of rehabilitation assistance, and the patient’s motivation. The AHA also points out that depression will sink in for as many as half of all stroke survivors within the first few months, so make sure to keep an eye on your mental health as much as your physical health. Joining a stroke support group could help. “Every stroke center should screen patients for depression, both by asking them questions in person as well as asking them to fill out a questionnaire that can further screen for depression,” says Russman, who adds that having preexisting depression is a huge risk factor in having depression after stroke. “Depression can cause some significant impairment in recovery — not just the physical recovery but also how a stroke survivor perceives their recovery,” says Russman. “It’s really an expectation that all centers screen stroke patients for depression because it’s so prevalent.” Additional reporting by Katie Robinson.
