Rising number of stroke cases among youngsters and children, a growing concern in India

A stroke is said to be the 4th common cause for mortality in India and it can strike any age group. When we talk about a stroke, as a health menace, we always relate it with the elderly, how it affects and causes disability as well as mortality in this group of the population.

Statistics tell us that stroke incidents in rural areas are less compared to the urban areas, possibly due to stress and other life events. It’s about 84-262 per 100,000 population in rural areas compared to 334-424 cases per 100,000 in urban areas. About 80% of the strokes are ischemic, due to reduced blood supply to the brain and 20% of them are because of hemorrhage.

It is crucial to note that a stroke can also affect children as well as young adults below 40 years, which is considered as ‘young stroke’. Nearly 2 lakh stroke cases are reported every year in India. According to a report by Global Burden of Diseases (GBD), India represented the biggest share of the total stroke cases with an incidence of 68.6%, 70.9% stroke deaths and 77.7% of Disability Adjusted Life Years (DALYs) lost. GBD also stated that in India 31% of the stroke cases were witnessed in children, aged less than 20 years.

Causes of Young Stroke
Cardiac causes: Most important causes for young stroke in India are the cardiac causes. Any cardiological illness affecting the heart can lead to a stroke. The embolic phenomenon, in which a small blood clot gets discharged (Thrombus) from the heart, which gets dislodged and blocks a blood vessel which may be supplying blood to a particular part of the brain, can result in a stroke. Since cardiac cases can occur in young individuals too, be it a valvular disease of the heart or a myocardial infarction, an embolism to the brain can produce a stroke.

Trauma: Trauma can be a head injury due to different reasons. There are some unusual causes like bone projection inside the spine which can result in the dissection of arteries, leading to damages to the wall of blood vessels producing a stroke. A bony spur or bony growth inside the neck that is rubbing against the blood vessel during movement, can result in tearing of the blood vessel wall. This is an unusual cause but we need to be aware of this to identify it, as early diagnosis will help in complete recovery.

Hemorrhagic stroke: Hemorrhagic stroke normally constitutes about 1/4 of the whole stroke population and can occur at any age. Hemorrhagic stroke includes Aneurysm in which walls of blood vessels become thin and weak. This weak area can burst at any time resulting in Aneurysmal bleeding. This can happen in small children and young adults. Since birth, they may have Aneurysms or a malformation of the artery and the vein, which can bleed at any time. Sometimes due to high blood pressure or a sudden stress, rupture of these vessels can happen which leads to bleeding inside the brain resulting in a Hemorrhagic stroke.

Postpartum Venous Thrombosis: This is another important common cause seen in young ladies in India. In some situations, during the postpartum period, (four to six weeks after the delivery) the mother suddenly develop a headache followed by vomiting and they may start exhibiting convulsions. This is a different type of hemorrhage called the venous stroke. This can lead to unconsciousness followed by Hemiplegia, resulting in one side of the body becoming weak. These are acute emergencies which needs immediate intervention. The good thing is Postpartum Venous Thrombosis, if recognized early can be treated effectively and the patient can lead a normal life and can even have the next child without any complication.

Infections: Infections are another cause. TB of the brain can result in arteritis, producing a stroke. Other conditions that cause stroke in the young people are autoimmune disorder, vasculitis, neuro cysticercosis-tapeworm infection etc.

Stroke in Children
Stroke can occur in children even during the first year, known as Infantile Stroke Syndrome. We have already discussed the common causes of Young Stroke, but when it comes to children there is a slight difference. Apart from trauma, infections and vasculitis as in the young, there is another important cause in children, called Metabolic disorders. These are rare disorders that can cause stroke in children. Conditions like Homocystinuria, Fabry’s disease, aminoaciduria etc. are metabolic disorders which can produce stroke in children as well as in young adults.

Golden hour
Stroke is a treatable disorder if attended during the Golden Hour. Moving the patient immediately to a stroke ready hospital having all the facilities under one roof where neurologists, neurosurgeons, cardiologists and interventionists are available along with MRI and CT scan, is crucial. The closest nursing home/clinic may not have all the facilities and the golden hour period will be over by the time you reach a stroke ready hospital. So, do not waste precious time trying to check into a nearby clinic which may not have all the key facilities.
To detect a stroke, please refer to BE-FAST (Balance Issues, Eye Sight Changes, Face Drooping, Arm Weakness, Speech Difficulty, Time to call Emergency).

Dr. P. Satish Chandra, Senior Consultant in Neurology & Adviser- Apollo Hospitals, Jayanagar, Bangalore