Shortly after returning home following a fun family day out in August last year, Emma Rowley decided to make a cup of tea. But as soon as she walked into the kitchen, she developed an excruciating headache.
“It felt as if someone had hit me on the back of the head,” explains Emma, now 42, who lives in Manchester with her husband Andrew, 46, their daughter Amie, 14, and son Jack, 24.
“The pain made me jolt forward, and when I tried to speak, my speech was slow and slurred. My mouth dropped completely on the left side of my face, and the left side of my body felt numb. I knew I was having a stroke and was terrified.”
Emma is one of an increasing number of under-50s affected by stroke – a condition typically thought to impact older people, which affects around 100,000 people a year in the UK.
A recent study published in the journal Neurology found that stroke rates among adults aged 20 to 54 nearly doubled between the early 90s and 2020, particularly ischemic stroke, the type of stroke Emma had, when a clot stops the flow of blood to the brain. This makes up 85 per cent of stroke cases.
“We’ve seen a stark increase in the number of young people having strokes, particularly in the last five to 10 years,” says Professor Deb Lowe, medical director at the Stroke Association. “Recent studies have looked into what the causes of this might be, and for some young people, no obvious cause is identified (known as cryptogenic stroke), so we need more research and funding to understand why more under-55s are having strokes.”
“When I was a trainee, it would be unusual to see patients in their twenties and thirties with high blood pressure, type 2 diabetes, obesity and atrial fibrillation (irregular heart rhythm) but now it’s reasonably common,” adds Dr Joseph Mills, a consultant cardiologist at Spire Chester and Manchester hospitals. “If you have these risk factors in your twenties and early thirties then you’re more likely to have vascular events, such as stroke and heart attack, in your thirties and forties, which is what we’re seeing now.
“People of that age won’t tend to think that they’re going to have vascular disease, but if they’re making poor lifestyle choices, they’ll be more susceptible to these risk factors. However, they won’t know they have them without having health checks, which most young people won’t think to get, and which can be hard for them to access through a GP.”
The most common cause of all types of stroke is high blood pressure. Others include irregular heartbeat, high cholesterol, using recreational drugs and smoking, but some young people affected by stroke have a more unusual cause, explains Lowe. These include a tear in the wall of an artery supplying the brain, a condition called patent foramen ovale, when the hole in the heart we’re born with doesn’t close; clotting problems; genetic and autoimmune conditions; and pregnancy.
Symptoms of stroke vary, depending on which part of the brain is affected, and include loss of movement, sensation, speech, balance and vision, as well as facial drooping, arm weakness, severe headache and confusion. They usually come on without warning, although up to 20 per cent of people experience a transient ischemic attack, also known as a mini stroke, before an ischemic stroke.
Thankfully for Emma, Amie was nearby when her stroke started and quickly called an ambulance. “Mum had a stroke at 33 and my brother had one at 29, so I always worried I’d be affected too and taught the kids to look out for the signs,” says Emma, a critical care technician. By the time the ambulance arrived, 55 minutes later, she’d collapsed on her bed.
She was given clot-busting medicine (thrombolysis) in hospital and then a thrombectomy (surgical removal of the blood clot). Due to the delay in getting to hospital, she was about 10 minutes away from the cut-off point of being able to have it.
“Before I got wheeled into theatre, I heard doctors shouting that I’d lost all function on my left side – it was really scary,” she says. “When I woke up, I could talk, but I’d mix up my words and had to think carefully about what to say otherwise random words came out. I could use my left arm and hand again, but it was very wobbly, and I could only stand for short times.”
Emma worked hard with the hospital’s rehabilitation team to regain strength and started a phased return to work six months later.
“I still get very tired and suffer from bad headaches (thought to be due to a combination of the thrombectomy and the stroke itself), which I’m trying to get on top with medication, but so far nothing has worked well. I’ll have a headache most days and need to work from home when they’re bad.
“The pain makes it feel like my head will explode and I get pressure in my right ear, which affects my hearing and balance.”
She also feels traumatised by the event, and is constantly reminded of it because it happened at home.
The exact cause of Emma’s stroke was never determined – she has low blood pressure and no usual risk factors – but doctors believe there is a familial link. Her children will now have full health screening checks from an earlier age.
It’s not yet known if there are specific genes associated with risk of stroke. “There’s currently a lot of work being done on this subject and there are huge gaps in our knowledge,” explains Lowe.
Emma will now take antiplatelet medicine to prevent blood clots, and statins, to keep her cholesterol low, for life.
“I always knew I’d have a stroke because of my mum and brother, but I didn’t think it would come out of the blue from nowhere at my age,” says Emma. “As a patient, I was shocked to see so many young people, even in their twenties, on the stroke ward.
“People presume you’ll bounce back from something like that when you’re young, but you can’t without access to the right support.”
This is something that Dec, 21, knows only too well. Last November he was hit by a devastating haemorrhagic stroke – a stroke caused by bleeding in the brain from a blood vessel, which makes up 15 per cent of all strokes.
“I was talking to my girlfriend on the phone after finishing a shift and suddenly had a big headache, so I took paracetamol,” recalls Dec, who lives in Warrington with his mum and sister, and works for a fast-food chain. “I remember calling out to my mum and the next thing I know, I’d collapsed to the floor and was vomiting and foaming at the mouth.” Dec lost consciousness and had six seizures; his mother and sister could only watch on in horror while they waited for an ambulance to arrive.
He was rushed to hospital, where after an examination and CT scan, doctors explained that he’d had a cerebral haemorrhage caused by a collection of abnormal blood vessels in the brain. He needed emergency surgery to remove the abnormal vessels and as much of the bleed that they could reach. Dec was put into an induced coma, and his family were told it wouldn’t be clear if he had any lasting disabilities or if he’d speak again until he woke up.
After an agonising three-week wait, Dec woke up. When he started obeying commands, the surgeon examined him and said he was expected to make a good recovery. But initially he couldn’t speak, walk, eat or drink.
“I was very confused every day,” explains Dec.
It took four and a half months after waking up until he could talk fully again, following intensive rehabilitation in hospital, where he stayed until July this year. By the time he was discharged he could do most things again, but he still faces many challenges, including vision problems in both eyes and a loss of sensation in his right leg.
“My main other issue is getting overstimulated about everything – I get frustrated easily and I can’t read or write,” adds Dec, who is still waiting to go back to work. “My brain feels different now – it’s hard to explain because it’s still me, but at the same time it doesn’t feel like me. It’s a weird feeling.
“I didn’t think a stroke could happen to a young person,” says Dec, who is one of three young people featuring in the Channel 4 documentary, Trauma: My Broken Brain, at 10pm on Monday 26 October.
While haemorrhagic strokes have always occurred more in younger people, the numbers are increasing in the same way as ischemic stroke, explains Lowe. While the most common cause is high blood pressure, a small proportion of cases are caused by a ruptured brain aneurysm, known as a subarachnoid haemorrhage.
Lifestyle choices seem to be the main driver of the risk factors which contribute to increased cases of stroke in young people. “Since the pandemic, people are less active, there’s a higher proportion of people drinking more alcohol than the recommended limits and obesity is on the rise,” says Lowe.
If someone is showing signs of stroke – no matter how young they are – it’s vital to seek help quickly, he says. “The sooner someone can be assessed by specialists in hospital and given brain scans, the sooner they can access effective treatment and the better the outcome.”