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The last thing Cara Zizzo remembers before waking up in the hospital was trying to fit her keys into her car trunk’s lock. She’d been shopping with a friend, and was about to stow her bags, but thought the key must be broken somehow. What seemed like a few seconds later, she was facedown on a gurney as doctors were testing her nerves with a pin roller.
“They told me I had a stroke, but I didn’t believe that,” she recalls. “I was 28 years old. Nobody has a stroke at 28. It just seemed impossible.”
That was three years ago, and Zizzo is still having some ripple effects from her stroke. She sometimes struggles to remember everyday words—like cupboard or pen—and has to describe them instead, like, “That thing you use to write with.”
What she does remember is to take her cholesterol medication every day, to help prevent another stroke. Her doctors hypothesized that the incident was related to a small hole in her heart that she’d had since birth without knowing it. Independently, that might not have become dangerous, but she also had high cholesterol—another factor she didn’t learn about until after her stroke—and that was what may have caused three blood clots to first form in her leg, then travel through her heart and into her brain.
“Before this happened, I didn’t know my cholesterol numbers, and honestly, I thought I was too young to worry about it,” Zizzo tells SELF. “I don’t smoke and my birth control doesn’t have hormones, so I thought I was free from any stroke risks. Screening for stuff like cholesterol and blood pressure never crossed my mind.”
Most young people, like Zizzo, aren’t aware of the very numbers that could put them at a higher risk of stroke.
That’s because most young adults are blowing off certain screening tests, believing that they don’t need to be done until you’re older, such as tests for cholesterol, blood pressure, and blood sugar. But those screening tests can give physicians a good idea about stroke risk, according to neurologist Diana Greene-Chandos, M.D., director of neurocritical care at The Ohio State University Wexner Medical Center.
“Compared to 20 years ago, incidence of stroke is rising in young adults to a significant degree,” she tells SELF. A recent study in JAMA Neurology found ischemic stroke hospitalization rates are increasing for both men and women under age 45. In women aged 18 to 34, the hospitalization rates for acute ischemic stroke rose 31.8 percent (from 4.4 per 10,000 hospitalizations in 2003-2004 to 5.8 per 10,000 hospitalizations in 2011-2012), while the rate in women aged 35 to 44 rose 30 percent (from 27.5 per 10,000 hospitalizations to 35.8 per 10,000 hospitalizations).
One factor for women might be contraceptive use. Hormonal birth control methods have been associated with a slightly increased risk of blood clots—and blood clots account for 87 percent of all strokes—though the absolute risk of blood clots while on birth control remains low. Some neurologists say that birth control isn’t the smoking gun it might seem. Oh, and speaking of smoking: that raises your risk of stroke, too, but it still isn’t the one big reason that’s driving up stroke numbers.
Instead, it’s likely because of large increases in the common stroke risk factors like hypertension, lipid disorders, diabetes, tobacco use, and obesity. The study in JAMA Neurology found that the range of absolute increase for each of these varies, but they’re all on the upswing. Lipid disorders—also known as high cholesterol—is increasing the most, from about 12 percent to 21 percent. And the prevalence of having three to five stroke risk factors more than doubled for women under 45.
“Clearly, something big is happening with stroke and young people,” Dr. Greene-Chandos notes. “When you talk to neurologists and ER physicians, what you’re hearing is that this is a growing problem, especially because many people still think that stroke just doesn’t happen to people under age 45.”
Ironically, stroke risk is actually decreasing for older adults, according to Koto Ishida, M.D., director of NYU Langone’s Comprehensive Stroke Center. According to the JAMA Neurology study, the rate of hospitalization for stroke in women aged 55 to 64 actually decreased 2.2 percent (from 173.4 per 10,0000 hospitalizations to 169.5 per 10,000 hospitalizations). That’s because the same risk factors that are booming in young people—things like cholesterol and blood pressure—are usually being managed in those over age 50, Dr. Ishida tells SELF.
“Older adults expect to have these kind of issues, so they get screened,” she says. “But someone in her twenties usually doesn’t think about something like blood pressure unless there’s a problem. She might only go to the doctor when she’s sick, and if she doesn’t get sick, she doesn’t get screened.”
Exacerbating the problem: Stroke signs may be different for young people.
There’s an acronym for spotting a stroke that’s taught to all emergency personnel, and it comes in handy for anyone who thinks a stroke is occurring: FAST. That stands for facial drooping, arm weakness, speech difficulties, and time to call 911.
Usually, one side of the body is affected as a stroke is happening in the brain, making someone’s face on that side sag, and leading to problems with raising that side’s arm. Slurred or confused speech is common as well, since a stroke may be affecting memory and verbal abilities.
At this point, time is crucial, because anti-stroke medication must be given within about four hours of stroke onset to prevent permanent disability or death.
But not all strokes look like a classic FAST incident, says Dr. Greene-Chandos. Older adults tend to be affected in larger blood vessels, she notes, making them more likely to have the “big stroke symptoms” like facial drooping and incomprehensible speech.
Younger adults, though, are more likely to have clots thrown from other areas of their bodies—the way that Zizzo did—and those clots travel through smaller blood vessels. Dr. Greene-Chandos says this difference often leads to stroke symptoms like numbness or headache.
“People tend to shake off these signs because we’ve all had numbness from sleeping in a funny position, or sitting on a leg wrong, leading to that sudden dead feeling,” she notes. In those kinds of moments, the nerves get compressed and when they’re released, the numbness should turn very quickly to that ouch-ouch-ouch tingle of your limb coming back online.
With stroke, though, there’s numbness without pain. Dr. Greene-Chandos adds that women having a stroke are also more likely to have debilitating headaches, and that people who suffer from regular migraines are actually at greater risk for strokes in general. Even hiccups that don’t resolve could be a stroke symptom, she notes.
Yes, you can have a stroke without knowing it happened. And that can raise your risk for future incidents.
Before she was in full-on stroke mode, Zizzo remembers smaller signs that something was wrong—her vision was narrowing, she recalls, and she felt weak. When she stood in line at checkout, she remembers everything feeling weird and just “off.” But she could still communicate in a way that didn’t raise any alarms, and she walked to her car without difficulty.
“It’s possible to have a small stroke and not realize it,” says Dr. Greene-Chandos. “You could even have multiple strokes and have no outward symptoms. But over time, the changes in your brain could affect your memory and speech significantly.”
Having one stroke significantly raises your risk for more, she notes, especially if the underlying factors for the stroke aren’t addressed. For example, if Zizzo didn’t get her high cholesterol under control, she would likely have been at higher risk for another stroke.
Of course, this isn’t meant to terrify you—just inform you. Dr. Greene-Chandos says that the message here isn’t to run to the ER whenever you have hiccups or a headache, but to know about these symptoms, especially if you have other stroke risk factors, like being a smoker, having a family history of strokes, taking hormonal birth control, having high cholesterol and/or high blood pressure, or being diabetic.
“Get a wellness check, even if you think you’re too young and you’re healthy,” Dr. Greene-Chandos advises. “Know your numbers. And most of all, don’t think that strokes are just for older people. That’s simply not the case.”