Time and Support Key for Younger Stroke Patients
June 1, 2023 — The morning of his stroke, Evan Parker woke up feeling ill at ease. He recalls he was drinking a cup of coffee at about 9 a.m. He had noticed a slight headache for the past few days, but now it was much worse. He sensed “a wave just washed over” him and went to get a glass of water.
When Parker arrived at his job for an agricultural retail firm in Lafayette, LA, his boss immediately noticed the telltale symptom of a stroke. “And she said, ‘Oh my God, Evan, your face is drooping.’” Parker dismissed her concern. He was only 27 at the time and having a stroke was just about the last thing on his mind.
“I didn’t have any idea because I had never known anyone my age to have something like that happen,” Parker said. “Older people that I had known that had strokes, it would happen in their sleep and things. A lot of older people I had known had died as a result of it.”
But Parker’s boss persisted and called an ambulance for him. The time from his onset of symptoms to the arrival at the hospital was only 1 hour, but it made a pivotal difference.
Intracerebral hemorrhage (ICH) stroke is on the rise, according to research published by American Heart Association. A study over 15 years found an overall increase of 11% nationwide, with a 38% increase in the 18 to 44 age group. Yet nearly 30% of U.S. adults younger than 45 are unaware of common stroke symptoms, according to a survey from the association.
“We are seeing a larger incidence of stroke in younger persons,” said Sheryl Martin-Schild, MD, stroke medical director for the Louisiana Emergency Response Network. “We think that it’s at least in part due to younger age at development of risk factors for stroke specifically: high blood pressure, high cholesterol, obesity, smoking. And those things over time can lead to stroke long before than the usual age.”
There are two types of stroke: ischemic stroke – blockage or blood clots in the blood vessels to the brain, or hemorrhagic stroke – an artery leak or rupture in the brain.
“It’s really hard to get people to think about stroke to be worried enough,” said Thabele “Bay” Leslie-Mazwi, MD, an American Stroke Association national volunteer expert. He said patients are sometimes dismissive of their symptoms as the time to get emergency help passes.
Intermountain Healthcare in Utah built on the American Stroke Association’s FAST model to create the acronym BE-FAST: Balance, Eye, Face, Arm, Speech, and Time for stroke symptoms and awareness:
- B: Balance – sudden dizziness or loss of balance or coordination
- E: Eyes – sudden trouble seeing in one or both eyes
- F: Face – sudden weakness of the face (Does one side of your face droop?)
- A: Arm – weakness of an arm or leg
- S: Speech – sudden difficulty speaking
- T: Time – time the symptoms started.
Leslie-Mazwi said that the most common signs of stroke are changes in speech and face. “Strokes that involve especially the blood vessels of the back of the brain can sometimes be missed. But face or speech involvement occurs in about 88% of patients that have a stroke, so it captures the bulk of them,” he said.
“BE-FAST now captures those vulnerable symptoms that have been underrepresented in social media, like the sudden problem with balance and the sudden problem with eyesight,” Martin-Schild said. “It improves the sensitivity of that screening tool to about 95% instead of 89%.”
Martin-Schild specializes in neurology at both Touro and New Orleans East Hospital and said the three often misjudged signs of stroke are sudden problems with balance, sudden problems with eyesight or a sudden, terrible headache.
A stroke can show itself as a visual disturbance, such as double vision caused by problems with eye muscles, an effect of nerve malfunction due to stroke.
She said people shouldn’t panic if they notice the symptoms but must seek immediate help if the onset is sudden.
When Parker arrived at the Rapids Regional Hospital in Lafayette, hospital staff rushed him to different tests. After a CT scan, they pinpointed the stroke in his basal ganglia, a region near the center of the brain controlling body movement.
“I think that’s one of the biggest things for my recovery; it was such quick action on behalf of everyone that was involved in it,” Parker said.
Since his stroke in 2019, Parker has recovered. He dieted for a period of time and lost about 70 pounds. He said he had stopped eating sugar to maintain his weight and takes a blood thinner daily. He also takes cholesterol medicine as an additional preventative measure.
“I tell people all the time to keep an eye on their cholesterol and blood pressure,” Parker said.
When Parker came to Touro Infirmary, Martin-Schild narrowed down his cause of stroke to protein S deficiency, a rare genetic disorder that can cause blood clots.
Parker said knowing the signs of stroke and acting fast are crucial to surviving a stroke.
“Time is everything: The faster you can get adequate treatment, the faster you can be on the road to recovery, and the better recovery you can have,” Parker said.
“It’s important to live life prepared and not scared,” Martin-Schild said. “And being prepared means that you do everything within your power to lower your risk.”
The preventative measures include taking medications prescribed by health providers and calling 911 if things worsen.
Meghan McKee, a physical therapist of 14 years living in North Carolina, also caught her symptoms early. McKee had patent foramen ovale (PFO), a hole between the left and right upper chambers of the heart. So she informed her husband of the possibility of stroke and the signs of BE-FAST symptoms she read on StrokeAwareness.com.
“I always knew the possibility, but I also I thought, you know, I’m young, I’m active, I’m healthy. I’m doing the right thing so that it can’t happen to me,” McKee said.
At the age of 31, the stroke came as a complete surprise. When McKee was watching a movie with her husband, she had difficulty reaching for a water bottle. Her left hand flapped the desk. McKee then grabbed the bottle with the right hand and choked on the water. Her husband noticed that her walk was strange when she got up and called 911.
“I actually couldn’t even recognize the symptoms in myself at that moment — that my entire left arm was flat, hanging down on my side,” she said. “I was not able to move my left leg. I was dragging it behind me.”
The hospital was only 4 miles away. McKee stayed in the hospital for 4 days and underwent surgery to close the hole in her heart. In her experience as a physical therapist, she had treated women who had a stroke after childbirth, and she knew treatments such as her surgery focused on avoiding a second stroke.
McKee also received speech therapy, occupational, and physical therapy. Within a week, her symptoms resolved.
“To this day, I do have deficits, I have strength impairments in my hand and my foot, and then my smile still is not fully symmetrical,” McKee said. “But other than that, you know, I was very, very lucky.”
Seven years after the stroke, McKee has two daughters. In sharing insights for surviving stroke, McKee said, “Time is brain. As with every passing minute, there could be potentially more damage that could occur to your brain; your entire body is controlled by your brain. And when I say that, I mean your ability to walk and stand and speak, and think, and have your cognition and memory.”
A delay, she said, can often lead to a disability.
Martin-Schild said early treatment and access to critical rehabilitation services result in good stroke recovery. However, she said disparities exist in patients’ access to both.
“Depending on your insurer, whether they fund your in-patient rehab, for example,” Martin-Schild said. “It depends on your hometown, whether there are any rehab facilities in your area, or whether you’re physically separated from your family by sometimes hundreds of miles while you’re in your key rehab phase.”
People who can rely on a team of support do best at any age when a stroke occurs, she said.
“We need more public health work and more resources devoted to that. That’s going to be where we have the biggest impact,” Leslie-Mazwi said. He recommended a diet minimizing salt and sugar intake, animal products, and avoid smoking.
