Young, active and healthy: Why stroke can strike before 40; signs not to ignore

New Delhi: Being young, physically active and seemingly healthy does not make someone immune to having a brain attack. Although stroke is more common in older adults with conventional risk factors, it can also affect people in their 20s and 30s, sometimes without obvious warning signs.

The key reason: stroke is not just a disease of ageing. It is a problem involving blood flow to the brain, and several underlying conditions can disrupt that flow even in young, otherwise fit people.

Causes of stroke before 40

Blood clot blocking artery

An ischaemic stroke occurs when a clot blocks blood supply to part of the brain. The clot may form in a blood vessel or travel from elsewhere, sometimes because of an underlying heart condition.

Blood vessel rupturing

A haemorrhagic stroke happens when a blood vessel bursts and bleeds into or around the brain. Causes can include uncontrolled high blood pressure, an aneurysm or an arteriovenous malformation (AVM).

Tear in artery

A condition called arterial dissection can develop when the inner lining of an artery tears, allowing blood to collect within its wall. It may occur after neck trauma or sudden neck movement, and sometimes without a clear trigger.

Hidden heart conditions or clotting disorders

Certain heart rhythm problems, structural heart defects and inherited or acquired clotting disorders can increase stroke risk, even in people who exercise regularly and have no obvious symptoms.

Why fit person can still have stroke?

Fitness and vascular health are not the same thing. Someone may run daily, maintain a healthy weight and look athletic, yet have high blood pressure, elevated cholesterol or an undiagnosed heart or blood vessel condition. High blood pressure is particularly important because it often causes no noticeable symptoms.

Other factors that may matter in younger adults include:

• Smoking and vaping: Tobacco use increases cardiovascular risk; nicotine can raise blood pressure.
• Sleep deprivation and sleep apnoea: Poor sleep and sleep-related breathing disorders can contribute to vascular risk.
• Migraine, especially with aura: Associated with a higher risk of ischaemic stroke, although the absolute risk for most people with migraine remains low.
• Hormonal factors: Pregnancy, the postpartum period and some oestrogen-containing contraceptives can increase risk in certain women.
• Stimulants and recreational drugs: Cocaine and amphetamines, for example, can trigger dangerous changes in blood pressure and blood vessels.
• Genetics and clotting disorders: Some inherited conditions can increase risk despite an otherwise healthy lifestyle.

Warning signs you must never ignore

• Sudden loss of balance or inability to stand or walk.
• Double vision or loss of sight.
• One side of the face suddenly becoming weak or uneven.
• Sudden weakness or numbness, especially on one side of the body.
• Sudden slurred speech, confusion or difficulty understanding words.
• It is time to act immediately and rush to the nearest hospital.

Steps to take before a stroke happens

1. You do not need to wait until middle age to take prevention seriously; it can start early.
2. Check your blood pressure regularly, even if you feel completely healthy.
3. Get your blood sugar and cholesterol checked, and an ultrasound of the neck vessels (carotid Doppler) done, according to your individual risk and your clinician’s advice.
4. Avoid smoking, alcohol and recreational stimulants.
5. Maintain regular physical activity, adequate sleep and a balanced diet.
6. Discuss a strong family history of early stroke, unexplained blood clots or inherited heart conditions with a neurologist.
7. If you experience a suspected transient ischaemic attack (TIA), seek emergency care even if the symptoms resolve.

Being young and fit reduces some risks, but it does not eliminate them. A stroke before 40 may result from an unnoticed conventional risk factor, an underlying heart or blood vessel problem, or a less common condition affecting clotting. The most useful approach is not to live in fear, but to know your numbers (BP, sugar and cholesterol), recognise the warning signs and act without delay.

(Dr Amit Batra, Director, Neurology, Max Hospital, Delhi)

Disclaimer: This article is written by the doctor mentioned above and is intended for informational purposes only. The findings should not be considered medical advice or used for self-diagnosis or treatment. Consult a qualified healthcare professional for personalised guidance.