We usually think of stroke as afflicting older people, usually male, often with risk factors of smoking, high blood pressure, vascular disease and diabetes. Two patients from January 2011 remind us that stroke may occur across the age spectrum.
• Anna (a pseudonym) at age 36 was a healthy, active mother of two young children. She had recently begun a program of running for relaxation and fitness. One afternoon she developed a headache and a sense of tunnel vision. She noted difficulty in speaking clearly, and that evening she stumbled over words as she read a bedtime story to her children.
Her headache persisted into the next day. That afternoon, while in her car, she developed vertigo, could not speak and noted sudden weakness in her right arm and leg. She pulled into a parking area, opened her door and collapsed to the ground.
Emergency responders recognized a stroke and transported her to the Erlanger Stroke Center. The neurologist on call found her alert, unable to speak and paralyzed on her right side. Scans showed blockage of the main arterial supply to the left side of her brain. A clot extended from her neck throughout the course of the artery. A perfusion scan showed that much of her left brain was at risk of death.
Dye injected through a catheter further identified a tear or dissection in the lining of the affected artery. Prompt consultation with the stroke team and the patient's husband led to an immediate intervention to remove the clot and to place three stents to repair the damaged arterial lining.
Four days in the neuro-intensive care unit and in-patient and outpatient physical therapy followed. Fifteen months later, she continues to mend. She is fully active. She notes slight slowness in word selection and slight weakness in her right hand.
• Zoe (a pseudonym) at age 36 had no health problems. Soon after awakening from a normal night's sleep, she was suddenly aware of profound weakness in her left side. She fell to the floor. She called to her husband, who immediately summoned emergency responders. They transported her to ESC. The vascular neurologist confirmed her left-sided stroke. A sequence of scans and an arteriogram showed a clot that occluded the artery to the right side of her brain.
Immediately, the radiologist advanced a catheter into the blocked artery, retrieving the entire clot.
Zoe was aware of the rapid return of normal movement to her left arm and leg. She had returned to normal activity three days later when discharged from hospital. Sixteen months later, she has no symptoms from her ordeal.
Although more frequent as we age, stroke may occur at any age. Symptoms are typically sudden. They include weakness and/or numbness of one side of the face, arm and/or leg, difficulty speaking or understanding speech, impaired vision, imbalance and sudden headache, particularly if associated with other neurologic symptoms. In the event of a TIA, symptoms may wax and wane. Immediate evaluation is crucial.
Email Clif Cleaveland at firstname.lastname@example.org.