A stroke of bad luck: heart health is not age-specific

Five years ago, Marie Walsh, an orthopaedic co-ordinator at Tallaght hospital, left work after a busy shift. Four hours later, she was back in the hospital’s emergency department suffering from a stroke. She was 33 years old.

Like most people, Walsh believed stroke was a condition of old age, yet it is estimated that 5 per cent of all strokes occur in people under the age of 45.

A recent Irish study found that the assumption that stroke affects only the elderly can lead to the dismissal of symptoms in younger people, misdiagnosis, and even delayed medical intervention.

According to the study by researchers from NUI Maynooth, the University of Limerick and Tallaght hospital, there is a need to increase awareness of the incidence of stroke in younger patients among medical staff and the public .

"Stroke in Young Women: An Interpretative Phenomenological Analysis" was published recently in the Journal of Health Psychology and looked at the psychological impact of stroke from the perspectives of young women.

For the research, 12 women between the ages of 18 and 50 were interviewed up to six months after they suffered a stroke, and four themes were identified. These were: stroke as an illness of later life; post-stroke selves; a desire for peer support; and the impact of stroke on relationships.

According to the study, the stereotypical association between stroke and older age acted as a diagnostic barrier, with some participants reporting that they had difficulty being taken seriously when they sought medical advice.

“For most, although the seriousness of their symptoms was clear, neither the patients themselves nor, it seemed, the emergency room medical professionals interpreted the constellation of symptoms presented as stroke,” the study found.

Walsh remembers feeling giddy, and as if her tongue was too big for her mouth, when handing over to a colleague at the end of her shift that Friday in January 2009, but she simply put her symptoms down to being tired after a busy week at work.

Once home, Walsh fell asleep on the sofa and when her husband came in from work she remembers saying something to him and then “feeling like something burst”.

“It felt like a pop in my head and then I couldn’t see. It was a very weird feeling. It felt as if my speech was going from me, or somebody was literally turning the dial off, and I couldn’t say anything,” Walsh recalls.

While her sight returned almost immediately, Walsh still couldn’t speak and managed only to make what she describes as guttural sounds. She managed to get the word “stroke” out, and her husband phoned 999 immediately .

As a nurse, Walsh remembered taking care of older people with strokes and says she presumed “more was going to happen” and she would get weakness down one side. However, this did not occur.

While waiting for the ambulance, Walsh wrote her medication on a piece of paper. She was taking only one form of medication, the contraceptive pill, which was later linked to her stroke.

When the paramedics arrived, they saw a young woman with no major medical history struggling to speak. She didn’t have any other traditional symptoms associated with a stroke, such as weakness down one side or an inability to raise her arms above her head. Her face did not droop to one side, although this did happen the next day.

Walsh was obviously distressed and hyperventilating, and she says the paramedics initially thought she was having a panic attack. However, their reaction was not unusual. The Stroke in Young Women study found that one participant was initially sent home with the observation that it was “not possible” for her to have a stroke because of her age. Luckily for Walsh, however, the ambulance brought her immediately to Tallaght hospital in Dublin, which has one of the best stroke units in the State.

Dr Ronan Collins is director of stroke services at Tallaght hospital, a member of the Irish Heart Foundation (IHF) council on stroke and a co-author of the Stroke in Young Women study. According to Collins, the causes of stroke in people under the age of 55 are not the same as those in older people. While extremely rare, a number of conditions can cause stroke in children, and newborn babies can also be affected by stroke due to birth trauma.

A combination of lifestyle factors such as smoking and the contraceptive pill in a predisposed individual can lead to a stroke in young adulthood. Stroke can also occur in young people due to a variety of inherited disorders such as very high blood pressure, an undetected heart problem or as a result of neck trauma following a traffic accident.

“In at least 40 per cent of younger patients we don’t find the reason for the stroke,” he says. While there is no difference in terms of the possible severity of a stroke suffered by a younger or older person, in a younger, fitter patient the hope is that their recovery would be easier, he says.

“For many older people when they have a stroke, I think . . . they realise that they are older, it doesn’t come as such a bolt out of the blue,” Collins says. “Initially, very often, not always . . . there is probably a better psychological adjustment. After that, the initial phase of stroke presentation, acute stroke treatment, there is absolutely no difference,” he adds.

According to Collins, the majority of young people who have a stroke recover fully. While it took four weeks in hospital, months of recovery and intensive speech and language therapy, Walsh also made a full recovery and returned to work a few months later.

However, she is still affected by extreme tiredness if she tries to do too much and she likens the feeling to someone having taken out her batteries. From time to time, she can have difficulty recalling certain words, particularly if she is tired, and says it is important that people are patient when this happens.

“If you break your arm or your leg, you get a cast and people know there is something wrong with you. But I looked fine, so people presumed I was fine and then treated me full blast; people really do forget very quickly,” she says.

The tiredness is an obvious frustration for Walsh as it limits her activities considerably. She also takes blood-thinning medication, so some sports and social activities are out; if she were to fall and break a limb, she would bleed uncontrollably.

Walsh faces other issues that an older person in her situation may not have to think about. For example, before her stroke she bought a house with her husband, and a mortgage meant that returning to work was vital. She has also had to make decisions about whether or not to start a family, as pregnancy may increase her chances of having another stroke.

Walsh, who is now 38, is upbeat and positive about the future. “It has given me perspective; it has given me a confidence in my life in some ways. I really know who my good friends are . . . there are things I am grateful for that have come out of it. I am happier in my own skin . . . I don’t get wrapped up in small dramas,” she says with a smile. For stroke information and support, contact the Irish Heart Foundation at irishheart.ie, tel 01-6685001. Helpline: 1890-432787.