Stroke in Young Adults with Holyoke Medical Center | Connecting Point | Aug. 6, 2019


>>>IN EARLY JULY, TEDY BRUSCHI,
FORMER PATRIOTS LINEBACKER, SUFFERED A STROKE. BRUSCHI HAD SUFFERED HIS FIRST
STROKE BACK IN 2005 WHEN HE WAS JUST 31. I SAT DOWN WITH DR. ZUBAIR
KAREEM, A NEUROLOGIST AND DIRECTOR OF THE STROKE SERVICE
AT HOLYOKE MEDICAL CENTER AND ANGELA SMITH, A REGISTERED NURSE
AND MANAGER OF STROKE SERVICE TO LEARN MORE ABOUT THE FREQUENCY
OF STROKES IN YOUNGER ADULTS.>>STROKE IN YOUNG, TECHNICALLY,
WE TAKE 55 AND YOUNGER, MEDICALLY SPEAKING WHEN WE TALK
ABOUT YOUNG PEOPLE. 55 AND YOUNGER. ABOUT 10% TO 15% OF STROKES
HAPPEN IN THAT POPULATION. NOW, OVERALL IN THE U.S., STROKE
INCIDENCE HAS BEEN PLATEAUED OR DECLINING, BUT THE STROKE IN
YOUNG UNFORTUNATELY HAS BEEN INCREASING SLIGHTLY. DURING THE LAST MANY YEARS.>>WHAT IS THE CAUSE OF THAT?>>WELL, TYPICALLY, STROKE, AS
YOU KNOW, IS A PLUMBING DISORDER. AS WE GROW OLDER, PLUMBING GETS
WEAK. YOUNG PEOPLE HAVE UNIQUE PROBLEM
WITH THEIR PLUMBING. SO BASICALLY THREE THINGS. ONE IS HIGH BLOOD PRESSURE. MANY YOUNG PEOPLE HAVE HIGH
BLOOD PRESSURE AND THAT IS ONE OF THE MAIN CAUSES OF STROKE. BOTH IN YOUNG AND ELDERLY. ESPECIALLY YOUNG PEOPLE WHO
DON’T WANT TO TAKE A MEDICINE, WHO DON’T WANT TO BELIEVE THEY
HAVE HIGH BLOOD PRESSURE. THAT IS THE FIRST CAUSE. THE SECOND ONE IS DRUGS. DRUG ABUSE. SO ALCOHOL, COCAINE, METH, THESE
DRUGS. NOW, YOUNG BODY, I WAS JUST
THINKING TODAY, HOW TO GIVE AN EXAMPLE THAT PEOPLE WILL
REMEMBER. YOUNG BODIES LIKE FORD 150. YOU LOOK AT IT, VERY MUSCULAR,
CAN DO ANYTHING. BUT IT IS NOT DESIGNED FOR
RACING. SO WHEN YOU PUT DRUGS IN YOUR
SYSTEM, YOU ARE TAKING YOUR BODY TO LIKE A RACING, LIKE A CAR
RACE. WHAT HAPPENS, THERE IS SUDDEN
SURGE AND INCREASE IN BLOOD PRESSURE AND YOUR VASCULAR
SYSTEM IS STRESSED. EVERY TIME YOU DO THAT, THERE IS
A VASCULAR FATIGUE, A CONCEPT CALLED VASCULAR FATIGUE, AFTER
SOME TIME YOU INJURE YOUR SMALL BLOOD VESSELS. THAT IS THE SECOND CAUSE. THE THIRD CAUSE IN YOUNG PATIENT
IS SOMETHING THEY ARE GENETICALLY INCLINED TO. SOME OF THOSE YOUNG PEOPLE HAVE
PROBLEM WITH PLUMBING, BLOOD VESSELS OR SOMETIMES THEIR BLOOD
IS TOO THICK. MAINLY THESE THREE CAUSES, HIGH
BLOOD PRESSURE, DRUG ABUSE AND GENETIC CAUSES.>>CERTAINLY WHEN YOU ARE
TALKING ABOUT YOUNGER PATIENTS, THEIR FOCUS IS NOT GOING TO THE
DOCTOR ALL THE TIME. YOU ARE BUSY AND HEALTHY IN YOUR
20s AND 30s. PEOPLE HEAR ABOUT SOMEONE WHO IS
YOUNG WHO HAS A STROKE THINK WHAT? THAT CAN’T POSSIBLY HAPPEN.>>THE STROKE IS SHOCKING FOR
EVERY AGE, BUT ESPECIALLY FOR YOUNG AGE. FOR ALMOST DECADES NOW, WE KNOW
THAT HIGH BLOOD PRESSURE, WE NEED TO TREAT. HIGH BLOOD PRESSURE IS NOT THE
ONLY THING. MANY YOUNG PEOPLE ARE DIABETIC,
HAVE HIGH CHOLESTEROL. TO BELIEVE YOU HAVE A CONDITION
FOR WHICH YOU HAVE TO TAKE A MEDICINE EVERY DAY. WHO WANTS TO TAKE IT?>>YOU ARE INVINCIBLE IN THE
YOUNGER AGE.>>BASICALLY THAT LEADS TO
STROKES.>>ANGELA, I KNOW YOU BOTH HAVE
WORKED TOGETHER FOR MANY YEARS AT THE STROKE SERVICE AT
HOLYOKE. HAVE YOU TREATED YOUNGE
PATIENTS IN YOUR EXPERIENCE?>>YES. WE HAVE, AS HE SAID, AN ABSOLUTE
INCREASE IN THE YOUNGER PEOPLE THAT COME IN WITH THE STROKES. AGAIN, IT IS SOME OF THE
TRENDING WITH ALL THE DRUGS OF ABUSE, BUT THERE ARE THE GENETIC
FACTORS, AS HE SAID. SO WE REALLY HAVE THE PATIENT
COME IN AND WE RECOGNIZE THEY HAVE HAD THE STROKE. THAT IS THE BIGGEST PART OF OUR
JOB AND NOT TO MINIMIZE OR DISCOUNT IT AS SOMETHING ELSE
AND THEN GET TO THE BOTTOM OF IT AND SAY, WHY DID YOU HAVE A
STROKE? DO YOU HAVE A CLOTTING DISORDER? ARE YOU OBESE? ARE THERE THINGS WE CAN WORK ON
TO IMPROVE THOSE RISK FACFACTOR. THAT IS WHERE OUR ENERGY. WE ARE COMMITTED TO THOSE
PATIENTS.>>TEDDY BRUSCHI JUST HAD A
SECOND STROKE, PATRIOTS GREAT, LINEBACKER. HE HAD HIS FIRST STROKE EARLY
30s, 2005, HE WENT ON TO PLAY FOOTBALL. SO HE SORT OF BRINGS TO LIGHT
THIS FACT THAT YOUNGER PEOPLE, YOU KNOW, CAN SUFFER FROM THESE.>>THE THING ABOUT STROKE IS,
STROKES WHICH ARE NOT KNOWN TO US, OR STROKES WHICH ARE
EXTREMELY MILD, THEY ARE MUCH MORE COMMON THAN STROKE WHICH
REALLY ARE OBVIOUS. SOMEBODY WHO HAS HIGH BLOOD
PRESSURE MIGHT HAVE A STROKE, YOU WOULD NOT KNOW IT. OR HAVE A VERY SMALL EVENT AND
HE OR SHE MIGHT GO BACK TO WHATEVER THEY ARE DOING. WHEN WE IMAGE THEM, DO AN
M.R.I., WE SEE MULTIPLE EVENTS. I DON’T KNOW THIS CASE IN
SPECIFICS, BUT I WOULD SAY MOST LIKELY POSSIBILITY FOR A YOUNG
PATIENT IS HAVING HIGH BLOOD PRESSURE, HAVING A MINOR EVENT,
GOING BACK TO WHAT YOU DO. IF YOU DON’T TAKE CARE OF THAT,
IT CAN HAPPEN AGAIN.>>DO THE MINOR EVENTS, SAY TWO
OR THREE MINOR EVENTS THAT WERE NEVER CAUGHT. IS THAT THE PRECURSOR TO A BIG
EVENT? IS THAT TYPICALLY HOW IT WORKS?>>THE ONSET I GIVE TO MY
PATIENT. THIS IS A VERY COMMON QUESTION. IF YOU GET A TRAFFIC TICKET
CHANCES ARE YOU ARE GOING TO GET ANOTHER ONE. THAT IS SOMETHING ABOUT YOU. SO, YES, THAT IS TRUE. THE MAIN THING IS THERE IS A
PARTICULAR REASON THESE PEOPLE HAVE AND THEY NEED TO FIND OUT
WHY AND TAKE CARE OF THAT PARTICULAR REASON. MOST OF THE TIME IT IS SOMETHING
THEY COULD MANAGE LIKE HIGH BLOOD PRESSURE OR NOT PUTTING
SOMETHING IN THEIR BODY THEY SHOULDN’T BE PUTTING IN. AS FAR AS THE THIRD CAUSE IS
CONCERNED, JUST BECAUSE WE ARE TALKING ABOUT A MAN, IT IS
IMPORTANT TO TALK ABOUT WOMEN, TOO. YOUNG WOMEN ARE PARTICULARLY AT
RISK IF THEY HAVE COMBINATION OF THINGS. SOME WOMEN HAVE, THEY USE
HORMONES AND IF THEY ALSO HAVE COMPLICATED MIGRAINES. MIGRAINE ALONE OR HORMONE TAKING
ALONE DOES NOT GIVE YOU TOO MUCH RISK FACTOR FOR STROKE. BUT COMBINATION OF THINGS CAN. IF YOU TAKE HORMONES, YOU HAVE
MIGRAINE AND YOU SMOKE, YOU ARE PUTTING YOURSELF AT TREMENDOUS
RISK>>WHAT DO YOU SEE, ANGELA,
PEOPLE IN REHAB, COULD THEY GO ON TO THE ACTIVITY THEY ARE USED
TO. A YOUNGER PATIENT UNDER 55. SAY THEY ARE A RUNNER OR PLAYS
TENNIS, CAN THEY GO BACK TO THAT LIFESTYLE IF THEY CHANGE OTHER
THINGS?>>YEAH. WE’VE SEEN GREAT PROGRESS IN
PEOPLE. YOUNG, YOU DO HAVE THAT TO YOUR
ADVANTAGE. YOU ARE YOUNG AND PLIABLE AND
YOU CAN GET THINGS BACK, EVEN IF IT IS A DEVASTATING STROKE. WE HAVE SEEN YOUNG PEOPLE COME
BACK FROM THAT EVENT AND THAT IS BECAUSE THEY HAVE YOUTH ON THEIR
SIDE. THAT IS JUST IMPORTANT FOR THEM
TO KNOW, BUT IT REALLY HAS TO BE RECOGNIZING THAT YOU REALLY DID
HAVE SOMETHING AND MAKING SOME KIND OF LIFESTYLE CHANGES WITH
YOUR SELF, YOUR MEDS AND JUST PAYING ATTENTION TO THAT.>>OBVIOUSLY, EXERCISE IS
PROBABLY A COMPONENT. BUT PEOPLE WORRY, DO I DO TOO
MUCH EXERCISE? COULD THAT LEAD TO
COMPLICATIONS?>>PHYSICAL ACTIVITY IN GENERAL
DOES NOT, REALLY. SOME ODD TYPE OF PHYSICAL
ACTIVITIES HAVE SOME UNIQUE RISKS ATTACHED TO THEM. IF YOU JERK YOUR NECK FOR SOME
REASON, I’LL GIVE YOU A REAL EXAMPLE. HEAVY KITE FLYING IN NEW
HAMPSHIRE, YOUNG PERSON. THAT WAS THE REASON, INJURED HIS
BLOOD VESSELS AND GOT STROKE. TRUCK DRIVERS. I WORKED IN MISSOURI FOR A YEAR
AND I HAVEN’T SEEN THAT MANY CAROTID DISSECTIONS WHICH IS
INJURY TO CAROTID IN THAT AREA BECAUSE THERE ARE TOO MANY TRUCK
DRIVERS PASSING BY. THERE ARE MULTIPLE FACTORS. JOGGING, RUNNING, BIKING, THAT
IS REALLY NOT A SIGNIFICANT RISK FACTOR.>>THAT IS NOT A SIGNIFICANT
RISK. THE BOTTOM LINE, PEOPLE HAVE TO
CHECK IN WITH THEIR PHYSICIAN AND LOOK FOR THE SYMPTOMS WHICH
ARE, AGAIN, IF YOU COULD SPELL THEM OUT, ANGELA.>>IT IS A SUDDEN ONSET, IT IS
WEAKNESS ON ONE SIDE OF THE BODY, USUAL THE FACE, THE ARM,
THE LEG. YOU CAN HAVE PROBLEMS WITH YOUR
SPEECH, BEING ABLE TO SAY A CERTAIN WORD OR RECALL A WORD OR
PRONOUNCING A WORD. YOU CAN HAVE DIFFICULTY WITH
YOUR GAIT, BALANCE, YOU COULD BE OFF AND YOU COULD HAVE ISSUES
WITH, IF IS IT HEMORRHAGIC TYPE STROKE, YOU COULD HAVE A REALLY
SEVERE HEADACHE, WHICH ACCOMPANIES HIGH BLOOD PRESSURE
LIKE AN ICE CREAM TYPE OF HEADACHE. IT IS GRIPPING. THOSE TYPE OF SYMPTOMS AND THE
EYES, YOU CAN HAVE PROBLEMS WITH YOUR EYES AS WELL. YOU CAN HAVE VISUAL FIELD LOSS
OR THINGS LIKE THAT. YOU JUST HAVE TO PAY REALLY
ATTENTION. IT IS CALLED B FAST, BALANCE,
ARMS, TIME.

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