Amanda Wilde (Host): When we think of strokes, we tend to think of them striking older adults, and historically, that's been true. The incidence of strokes is higher in older people, but recently a disturbing trend has emerged. Strokes are on the rise in young people. We'll find out why that is and what to watch for with Neurologist Dr. Christopher Southwood. Dr. Southwood specializes in Stroke and Interventional Neurology at Infirmary Health. Welcome to LifeCast, a podcast from Infirmary Health. I'm Amanda Wilde. Dr. Southwood, thank you for being here.

Chris Southwood, MD (Guest): Thank you for having me.

Host: A stroke happens when there is a problem with blood flow to part of the brain. Can you explain why this is increasingly happening in young adults?

Chris Southwood, MD (Guest): So what we're finding is that these classic risk factors that we knew about that affected patients who were more elderly; that we're finding that these are starting to crop up at a younger and younger age. Things that we think about like diabetes and poorly controlled diabetes, high blood pressure is starting to become a problem in younger patients. Obesity plays a role in this as well. And then, of course, high cholesterol. And that also goes into the diets that we eat and processed foods. And those are all big risk factors that affect any risk of especially large or small strokes in any patient population, but especially as we are having patients develop these risk factors at younger ages, that increases their risk of stroke.

Host: Are there some common symptoms of strokes in younger individuals to be aware of?

Chris Southwood, MD (Guest): I was just having this conversation today. Strokes don't necessarily present with a common sort of cookbook set of symptoms. The stroke symptoms that we classically look for, and certainly the ones that should trigger a call for an ambulance and call for 911, really include what we throw under the BE FAST mnemonic, B-E F-A-S-T.

 So B stands for balance. So if your balance is off and it doesn't get better, dizziness, that doesn't get better. The E stands for eye movement problems, which would lead to double vision or extremely blurred vision. The F stands for facial droop. So you'll notice if someone has a asymmetric or a droopy face. The A stands for arm weakness, or clumsiness, often described as heaviness by someone who is having a stroke.

The S stands for speech, again that can go to slurred speech, or speech difficulties meaning word finding or understanding speech. And then T stands for time, meaning we have to be as quick as possible to diagnose the stroke because nearly 2 million neurons die every five minutes from every amount of time once the clot has blocked blood flow to the brain.

Sometimes people also throw in a T for terrible headache if it is a hemorrhagic or a bleeding type stroke. Again, another warning sign to immediately go to the hospital.

Host: Do the symptoms of strokes in young people differ from those in older adults?

Chris Southwood, MD (Guest): That's a great question. So because of where the clot affects the brain, it will often leave patients with symptoms regardless of age. We know that strokes that are more devastating in patients who are younger, and that's because, of course, patients who are younger are often more functional and more active. Also patients who, while they've unfortunately suffered a devastating stroke, their chances at recovery, are often better just because their brain is able to recover from that injury, better than someone who is much, much later in their life.

Host: As a corollary question, are there potential long term effects or complications of experiencing a stroke at a younger age?

Chris Southwood, MD (Guest): Yes, and what we worry about are the loss of functional years, specifically the ability to live independently, the ability to drive, the ability to be at home rather than to be dependent on other people for things that we take for granted, like preparing our own meals or getting ready in the morning in the shower or going to the bathroom without help.

And that of course is especially profound in a patient who is 30 year old or a 40 year old that is just such a stark difference and such a stark contrast than what we would expect. But at the same time, the chance for recovery after those strokes can be much more profound as well with more time and more rehab.

Host: Now you talked about some of these risk factors like diabetes and high blood pressure, obesity and high cholesterol being factors at a younger age. And I guess that relates to this question about lifestyle. Do specific lifestyle choices or habits increase the likelihood of experiencing a stroke at a younger age?

Chris Southwood, MD (Guest): Absolutely. And we always try to preach moderation to our patients. So everything in moderation, including, and we're learning the saying used to be that one drink a day was okay for alcohol. Well, the data goes back and forth on if that's even really okay. The thought is that's certainly excessive drinking leads to more blood vessel inflammation and can certainly increase stroke risk. The data certainly does point to cigarette smoking leading to significantly higher stroke risks and that's one lifestyle modification that should certainly be addressed as soon as possible. The jury is still really out on vaping and it's harder to fall on a straight line if it directly does.

I personally believe that it does have effects on the blood vessels and stroke risk and then as with anything, lifestyle. So we always, even patients who have diabetes, while their stroke risk is high, if someone who has diabetes can keep their diabetes numbers under control, we normally try to target an A1c level of less than 7.0 percent; their risk of stroke will drop. come down to meet that of the normal population. Same with patients who have elevated cholesterol. Again, we can affect this with medications either by pill or by injection, that can reduce the chance of someone having elevated cholesterol, which will inflame the blood vessels.

However, again, primary diet is probably the one best way to prevent elevated cholesterol. And we will either preach the DASH diet, D-A-S-H, diet, or the Mediterranean diet. And that, the Mediterranean diet is the one that I really like to look towards as trying to use olive oil instead of butter for cooking, trying to use lean meats like chicken or fish rather than red meat.

Of course, high in protein from legumes or chickpeas rather than again, red meat and again, everything trying to avoid excess sweets or other trans fats.

Host: So diet is a big factor. And next to what you've just described, are there any other preventive measures or strategies that young individuals can take to reduce their risk of having a a stroke?

Chris Southwood, MD (Guest): Well, one thing that's on the horizon, which again, we're still learning and we're still grasping, which I think is of course a hot button topic anywhere you read nowadays, is these GLP 1 inhibitor injectables that are associated with weight loss. Not only are patients seeing the benefit of weight loss, but we're also seeing cardiovascular risk reduction. And even to the point where the cardiovascular risk reduction, it may outweigh even the weight loss benefit. So that's something that, of course, we're still learning for stroke prevention, but I know that that's something that a lot of patients are interested in, that's something that I'm having conversations with my patients weekly, at least multiple times per week about.

Host: Well Dr. Southwood, thank you for sharing this timely information. I appreciate you sharing your expertise.

Chris Southwood, MD (Guest): Yeah, thank you again for having me.

Host: That was Dr. Christopher Southwood, Neurologist at Infirmary Health. For more information, visit infirmaryhealth.org/services/stroke. If you found this podcast helpful, please share it on your social media. And thanks for listening to LifeCast, a podcast from Infirmary Health.