Brian, a healthy 46-year-old man, had just returned from a snowboarding trip with family. It was an enjoyable trip, though he did have a few falls and noted some intermittent vision changes and neck discomfort. He simply thought of it as a muscle strain, until he noticed his left pupil was smaller than his right and some drooping of his left eyelid. A visit to an ophthalmologist lead to an immediate trip to the emergency room. There, CT images showed bilateral carotid artery dissections, or tears of the artery walls, which had occurred due to minor trauma to the neck while snowboarding. Brian was placed on medications with close follow-up scheduled.
Evolving symptoms
Two days later, though Brian’s prior symptoms had improved, he suddenly began dropping objects from his left hand. He went to the emergency room, where he learned that his carotid dissections had worsened. With medical treatment, he again improved.
The next night while still in the hospital, Brian developed sudden, disabling left-sided weakness and numbness, loss of vision, slurred speech and inability to recognize the left side of his body. He was immediately sent to the operating room, where he had two stents placed into his right carotid artery. Blood flow was restored with immediate improvement, and Brian went home three days later with no stroke deficits. He has had repeat CT scans showing that his arteries are healing with ongoing medical therapy.
Early warning signs of stroke
Brian’s experience highlights how early recognition of stroke warning signs is important in prevention of further worsening or disability, even in younger people. Stroke is a leading cause of preventable disability across all demographics, and it is affecting more of our younger population than ever before.
Stroke risk factors such as high blood pressure, high cholesterol, diabetes, illicit drug use and smoking all contribute to stroke in the younger population. In addition to these risk factors, younger patients can have strokes due to arterial dissections (as in Brian’s case), heart conditions, genetic disorders and situations where the blood is more prone to forming clots, such as with pregnancy and cancer.
Recognize the signs of stroke
Regardless of age, it is important to recognize signs and symptoms of stroke and act immediately. If you or someone you witness is having signs or symptoms of stroke, call 911 immediately. Stroke treatment options are time sensitive.
One acronym to highlight stroke warning signs is BE FAST:
- Balance: sudden loss of balance or coordination
- Eyes: sudden vision loss in one or both eyes or double vision
- Face: drooping of one side of the face
- Arms: sudden weakness in one arm or leg
- Speech: slurring of words and difficulty speaking or understanding
- Time: time to call 911 immediately
As a general rule, it is best to be evaluated for any sudden or new symptoms, as not all strokes present the same.
Blake Buletko, MD,Vascular Neurologist, Cleveland Clinic Cerebrovascular Center, [email protected]
