People typically think of stroke as an elderly person’s ailment. Stroke risk does increase by age, but young adults (ages 18-55) can have strokes, too. In fact, the proportion of strokes affecting young adults in the United States has been growing for the past few decades. 

At the Tufts Medical Center’s Stroke and Young Adults Program (SAYA), Lester Y. Leung, a vascular neurologist, stroke specialist, and associate professor at Tufts University School of Medicine, works to improve stroke recovery for younger patients. Each day he sees firsthand how young stroke patients face a unique challenge.

“Stroke in young people is actually not that rare, but young stroke patients often end up being kind of invisible,” Leung said. 

A Worrying Trend

Globally, stroke in younger adults now accounts for about 10% of new cases of stroke each year. In the United States, stroke rates increased by about 64% between 1993 and 2015, and one nationwide study found that rates of hemorrhagic stroke—the second-most common type of stroke—among people 18-44 years old jumped by 38% between 2004 and 2018. Notably, stroke is usually not a fatal disease, so young stroke survivors have to deal with the aftereffects of stroke for decades and likely represent a larger portion of stroke survivors than suggested by the 10% statistic. 

Scientists are still studying why strokes may be on the rise among young people. In general, the rise indicates that young Americans aren’t managing common stroke risk factors, like cardiovascular disease, high blood pressure, and diabetes, well. But some factors more specific to young people, such as oral contraceptive use, pregnancy, migraine, and recreational drug use, can also contribute to risk of stroke.

Helping Young People Cope

Overall, young adults tend to have less severe strokes, with less intense loss of function. “The main deficits of stroke may not be as severe,” Leung said, adding that outwardly, it may not seem like a young stroke patient is struggling as much as an elderly one with language or movement. But strokes can cause other disabilities in young people that may be misunderstood.

For example, seizures are a concerning complication of stroke that rarely arise in stroke patients over 70 years old. But for young adults, the risk of developing seizures within five years after a stroke is much higher, around 20%, Leung said. Fatigue, depression, anxiety, and chronic pain are also common but invisible late complications after stroke among young people.

And young adults often suffer these complications in the midst of demanding life roles—they may be at the peak of their career, raising children, attending school, or working towards athletic goals. That can make stroke recovery much more frustrating, especially if employers or schools are unwilling to grant accommodations. 

“The experience for a lot of young stroke survivors is very tough,” Leung said. “The goals are set higher—I have patients who are surgeons, or computer programmers, or have hobbies that are very important to them that involve physical ability.”

At the SAYA program, Leung tailors his care to the specific and sometimes ambitious goals of his young patients. He also checks in with them more frequently and over a longer time period than typical providers, who might see a patient just once after they leave the hospital. 

“It’s becoming increasingly evident that younger folks and middle-aged folks need more help over longer periods of time,” he said. “Besides preventing future strokes, we often focus on how to unlock more recovery potential and achieve their life goals that were interrupted by their strokes.”