Stroke rates buck trends in young people amid missed signs and misdiagnosis

Strokes increasing in young people due to lack of tailored prevention efforts, experts say Ben Murphy's first stroke took more than three days to be identified as he was shuffled between hospitals. Aged 27 at the time, he puts the delayed diagnosis down to his age. "It happened during COVID, so they were trying to get people in and out," he said, adding he was deemed fit for discharge after just 10 days. Scans had also found a "hole" in Mr Murphy's heart, but doctors did not recommend he get it treated then. Five years later, he had another stroke. This time far more severe and lead to a three-month stay in south-east Queensland hospitals. "I completely lost my speech … and then I couldn't walk either because my right limbs, my hand, my leg, were just non-functional," the 33-year-old said. "My life isn't really the same again, because this time, I'm still recovering." The severity of the second stroke prompted a procedure to close the heart opening. Two years on, life back on his family farm in the Scenic Rim near the Gold Coast and a gradual return to activities like driving are helping him make strides towards independence. Young stroke rates bucking the trend Data from the Stroke Foundation shows more than 440,000 Australians were living with stroke as of 2023, with one in four strokes occurring in people of working age. According to a review published by the World Stroke Organization (WSO) in January, the incidence of strokes amongst people aged under 55 has increased globally since the early 2000s, despite decreasing at older ages. Stroke Foundation chief executive Lisa Murphy said it was a similar picture in Australia because prevention efforts still only targeted an older demographic. "We've known for a long time that risk factors such as high blood pressure, high cholesterol, diabetes and a thing called atrial fibrillation, which is an irregular heartbeat, all contribute to a risk factor of stroke," she said. "And we know what to do about those … [however] that hasn't translated into young people yet, and I think one of the reasons why is a lot of those risk factors are actually silent." Neurology professor Vincent Thijs from the Florey Institute of Neuroscience and Mental Health said the increased incidence in young people was limited to ischemic strokes, but the reasons as to why were not fully understood. Ischemic strokes occur when a blood clot blocks an artery supplying blood to the brain and account for 80 per cent of all stroke events in Australia. Many cases have no known cause Professor Thijs said there had also been an increase in young stroke cases with no identifiable cause, known as cryptogenic strokes, with links to increased drug use, air pollution, longer hours at work, and delayed pregnancies. A Patent Foramen Ovale (PFO), a type of opening in the heart as with Mr Murphy, is another factor that has been associated with cryptogenic strokes. Australian clinical trials suggest they are present in up to 50 per cent of cases in young people. However, Professor Thijs said PFOs were common in healthy young people too and there was often no need to get them closed until a first-time stroke. "More and better screening should occur after a stroke in the 18- to 60-year-olds as closure prevents a second stroke from happening if a PFO [with certain features] is identified," he said. Gold Coast woman Ash De Cotta was "totally fit and healthy" before she suffered a brain stem stroke at the age of 35 and, two years on, still does not know why. "I had severe neck pain leading up to it, just out of the blue … and I had migraine with aura, which is where your vision sort of goes fuzzy, and that was about a month leading up to my stroke," she said. "I did go to the doctors a few times, but I was just given painkillers and sent on my way." She ended up spending six months in hospital after suffering locked-in syndrome, a full-body paralysis caused by ischemic strokes. Ms De Cotta said it was crucial people listened to their body and questioned unusual symptoms. Different needs of young survivors The Florey's Young Stroke Service is the sole dedicated service for young people, aged 18 to 55, recovering from a stroke but is only available in Victoria and South Australia. Professor Thijs said there was a huge need for tailored support and funding to deliver such services Australia-wide. "Younger people have different goals. They want to get back to work, they want to return to driving,"he said. "Our health system isn't particularly catered towards the needs of these younger stroke survivors, so that's why the impact is different and bigger in many respects." Ms De Cotta agreed. "Typically, people think older people have strokes, and that's not the case, and services do need to catch up with that," she said.