As medical experts advocate regular health checks to curb the increasing cases of stroke in young people, VINCENT KURAUN re-examine the neurological disease that is said to be the leading cause of disability and the second leading cause of death globally and how it can be contained.
Abimbola, a secondary student, was writing the secondary Certificate Examination (SSCE) when he suddenly slumped in the examination hall. Little did he know that substance abuse which was introduced to him by his peers at a very young age, could lead to devastating consequences.
It was at the hospital that he was diagnosed with a stroke. Though he was able to recover after weeks of intensive treatment at the hospital, the condition left him with a permanent disability.
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“Things were already difficult with two legs and two hands; they are even more difficult now when I cannot use one side of my body,” Abimbola told Sunday Tribune while recounting his ordeal.
His case is similar to those of many young people who have now been diagnosed with stroke.
According to medical practitioners, the stroke in young people tends to result in a greater loss of self-worth and socioeconomic productivity than in older individuals and this is the case in Nigeria as many young people are now coming down with stroke more frequently nowadays than before.
In recent systematic analyses by the Global Burden Of Neurological Diseases investigators, stroke was foremost along with migraine and meningitis in terms of Disability Adjusted Life Years (DALYs) in Africa and, as of today, Africa has some of the highest indices of stroke burden in the world.
The World Stroke Organisation (WSO) described stroke as the leading cause of disability worldwide and the second leading cause of death. Corroborating this, the Global Stroke Fact Sheet released in 2022 revealed that lifetime risk of developing a stroke has increased by 50 per cent over the last 17 years and more alarming is the fact that one in four persons is estimated to have a stroke in their lifetime.
Medical experts in Nigeria have also confirmed that the increase in stroke among the youthful population is disturbing as it is being driven by multiple factors, particularly hypertension –which experts identified as the major modifiable risk factor– age, obesity, diabetes mellitus, stress, substance abuse, smoking, excessive alcohol consumption, unhealthy diet, physical inactivity, viral infections, heart conditions among others.
Confirming the recent increase of stroke in the young, a consultant physician/neurologist at Lagos State University Teaching Hospital (LASUTH), Dr Rashidat Olanigan, told Sunday Tribune that stroke in young adults is not something new but has become more pronounced in recent times.
According to her: “Stroke is a global health problem and the second commonest cause of death worldwide after Ischemic heart disease. The burden of stroke is enormous and still increasing especially in individuals in their most productive years.”
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Dr Olanigan further explained that “stroke in the young constitute between five and 20 per cent of all stroke admissions. When we say stroke in the young, there is an age cut-off for this group of patients which varies among geographical locations. In some countries, the age cut-off of 18-45 years is used; some would say 13-45 years while some other climes use an age bracket of below 50 years.”
A consultant radiologist at the Department of Radiology, Lagos State University Teaching Hospital, Dr Abiola Ayodele, also confirmed the recent increase in the number of younger people coming down with stroke in Nigeria
According to her, the radiology department receives a lot of younger people with stroke coming in for their CT (Computed Tomography) scan and MRI (Magnetic Resonance Imaging) investigations.
“We see them in their 20s and 30s coming down with strokes, these days and that was not the pattern before now.
“Before, you would expect someone older than 50 years of age to come down with stroke because age is also a risk factor. But these days, we are seeing young people with stroke and the pattern that I have seen in recent times on the CT scan, which is the first line of imaging for a stroke patient, is haemorrhagic stroke.
“Usually, we do a plain CT scan for them and what I can say is that, in a day, there is always one young person that, has a stroke when you are reporting and most of the time it is a haemorrhagic stroke,” Dr Ayodele explained.
‘Adoption of Western lifestyle contributing factor for stroke in Nigeria’
Speaking on the same issue, a senior resident doctor at R Jolad Hospital, Gbagada, Lagos State, Dr James Aniedi Idang, further confirmed that stroke in the young is becoming endemic globally, attributing the main reason for the surge to the adoption of the Western lifestyle.
Dr Idang noted that “westernisation has increased the risk factors that are associated with stroke and these include high consumption of processed food, decrease in adequate physical activities, obesity, increase in diabetes, increase in hypertension and all of these are risk factors of stroke.
“People don’t exercise any longer and the dependence on machines to carry out normal daily activities has increased in recent times. Because of this, people, especially the younger population, tend to come down with the risk factors that are associated with stroke.”
Contributing to this, a consultant physician/cardiologist at the University College Hospital Ibadan, Dr Abiodun Adeoye, said though stroke can affect all age groups, young people below 50 years are being affected lately.
“It can affect children. It can affect young adults and once we have people less than 45 to 50 years of age coming down with it, we would say it is a stroke in the young.
“Stroke in young people is disturbing because at their productive age, that will be the time they will not be able to do anything and it has a kind of negative impact on the economy of any country.
“Worldwide, the range varies, depending on where the study is being done. Some people say between 10 and 15 per cent of young people have a stroke. But what has been shown is that stroke generally, irrespective of age, is worse among blacks.
“We did our studies under the Stroke Investigative Research and Educational Networks (siren) study –the largest stroke study in Africa for now– and looked at the prevalence of stroke in the young, and we were having a high percentage up to 24.3 falling below the age of 50, and it is disturbing because if it continues that way, then it is not good for the system at all.”
Factor responsible for stroke surge in young Nigerians
Providing more insight into the course(s) for the surge, a consultant Orthopaedics at Federal Medical Centre, Jabi, Abuja, Dr Ganiyi Aremu, said many factors could be responsible for the increase in stroke, also known as cerebrovascular accidents, in the young.
“Many cases that were initially managed in the primary health centres in the past are now getting to tertiary health institutions and many hospitals are now having an upsurge of cases that come to them.
“Also, many of our younger population are now living a sedentary lifestyle. Most of the house chores are now done by domestic staff coupled with the kind of food that they eat which is usually refined food products,” he explained.
These factors, according to Dr Aremu, tend to lead to an increased level of cholesterol in young people.
Speaking on the types of stroke, he said: “There is hemorrhagic stroke which is caused by uncontrolled high blood pressure, leading to the patient bleeding directly into the brain and if that happens on the left, the right side of the bodies will be paralysed and if it happens on the right, the left side will be paralysed.
“The other type which is thrombotic, we see them more with people who have high levels of cholesterol in their bodies. This happens when there is an inadequate blood flow (blood clot) to a part of the brain due to a blocked artery.”
Dr Aremu added: “Because of the sedentary lifestyle of some of our young chaps, nowadays, lack of body exercise, increase in body mass index that is obesity, they are prone to develop thrombotic stroke.
“Furthermore, many people are hypertensive and this is a silent killer disease and the first sign of hypertension is the development of stroke. You see a young man will just slump and when you ask a question they will tell you they never knew they were hypertensive.
“By and large, changes in our lifestyle and high consumption of refined foods are some of the factors that can account for the increase in the rate of stroke that we see among the young now. Many people die at home, and some of these cases are not reported.”
Giving more insight into major risk factors of stroke in the young, Dr Olanigan noted that in the past, stroke in the young was thought to be rare but recent evidence suggests that the traditional risk factors found in this age group are higher than previously thought. The most frequently reported risk factors are hypertension, high blood cholesterol and smoking.
“When we are talking about risk factors in general, some factors are non-modifiable and some are modifiable. When talking about non-modifiable risk factors of stroke we are referring to age, ethnicity and gender.
“For gender, it is shown that being a male is a risk factor for stroke. The risk of stroke doubles every 10 years after the age of 55. The race that is more prone to developing stroke is the black population; those three are the major non-modifiable risk factors,” she explained.
According to Dr Olanigan, the number one modifiable risk factor for stroke is hypertension. “This goes to say that what causes stroke in the older population is still the number one cause of stroke in the young.
“Other risk factors include high blood cholesterol, obesity, smoking, excessive alcohol consumption, diabetes and the use of illicit drugs. Substance abuse has been on the rise recently. The use of cocaine, amphetamines, heroin and so on, which may also be mixed in various combinations, has added to the recent surge of young individuals developing stroke.”
Explaining further, she said, “Apart from that, patients who have sickle cell disease (SCD) and other haematological conditions are prone to develop stroke, viral infections can also cause stroke like human deficiency virus (HIV) and Covid-19 infection. Generally, patients with varying heart conditions (congenital heart disease, valvular heart disease, Arrhythmias) and kidney diseases are also prone to develop stroke.”
Corroborating Dr Olanigan’s claims on why stroke is becoming endemic in the younger population in the society, Dr Ayodele reiterated that people should be wary of the risk factors.
“Stroke has different types; we have ischemic stroke and hemorrhagic stroke but the type that is more common now in the younger population is hemorrhagic stroke and we are thinking the risk factor is stress and this is more common in males. You know that most of the males are more stressed trying to make ends meet.
“Another thing that I have discovered is people not taking their health seriously. Most people in Nigeria don’t do annual checkups; people don’t check their BP (blood pressure). Hypertension is already endemic and by association, it is people that have hypertension that are predisposed to having a stroke, so I think stress generally is now causing the younger population to come down with stroke,” Dr Ayodele said.
Speaking in the same vein, Dr Abiodun warned that irrespective of one’s age, uncontrolled hypertension, uncontrolled diabetes, bad cholesterol, heavy drinking of alcohol, active and passive smoking can predispose one to stroke. There are some of these things that are inherited and there is nothing much anyone can do about it.
“Some of them have heart conditions –abnormalities in the formation of their heart commonly called holes in the heart. It can be atrial septal defect (ASD) or ventricular septal defect (VSD). Children with such inherited conditions will have aneurysms (an abnormal bulge or ballooning in the wall of a blood vessel) and this can cause stroke in the young.
“There is polycystic kidney disease, a kind of cysts in the kidney or in the liver that is not meant to be there. People like that are prone to having aneurysms.
“Sickle cell patients are also prone to having stroke because of the coagulation problem that they have. Some patients who have migraines can also develop stroke.
“Birth control drugs can also lead to stroke. It can be as the result of the drugs they are using to treat viral infections like HIV or as the result of the HIV organism itself,” he explained.
The outlook
Experts also posited that the survivor rate for stroke is dependent on several factors such as the severity of the stroke, clinical evaluation, and completion of medication, among others.
Speaking further on this, Dr Olanigan told Sunday Tribune that, “If a patient has a mild stroke, the outlook is fantastic. The outlook for moderate stroke depends on some other conditions that might develop while the patient is on admission. Most times, patients with moderate stroke do well but may be left with some limb disabilities and patients with severe stroke are prone to increased morbidity and mortality.”
She further explained that “Following discharge, the patients with disability have between six weeks and six months to regain functional recovery of the affected limb. Any deficit that is still present after six months of stroke is not likely to improve more than what it is. So maximum improvement is expected to occur within six months post-stroke.”
In his submission, Dr Idang pointed out that disability as a result of stroke reduces the quality of life of affected persons. “The best thing one can do is to prevent the modifiable risk factors,” she advised, adding that “the recovery rate is very low and that is the reason why emphasis should be more on prevention.”
While citing a study conducted at the University of Port Harcourt which discovered that more than 77 per cent of young people with stroke were hypertensive, Dr Idang said: “When one is hypertensive, one must take every necessary action to prevent stroke and this could be done by taking the anti-hypertensive medication regularly as prescribed by the doctor. If the youth can prevent hypertension, there is a high tendency that the incidence of stroke would go down.
“Some people make the mistake of taking these drugs when their blood pressure normalises, which is not correct. These medications should be taken judiciously and should be taken every day for life.”
Prevention measures
Speaking on prevention measures, Dr Olanigan said, Just a singular act of regular health check alone will go a very long way.
“Just walk into a hospital and do a routine check. It is very simple and important for every individual to pursue because when you do that, any health issue can easily be detected and treated on time.
“Those who are hypertensive should reduce their salt intake and use their anti-hypertensive drugs regularly and also keep their appointment with their doctors and not just decide to continue their medications without going for follow-up appointments.
“It is important to keep specific appointments with their doctors to check if there is any complication of hypertension and also see if the drugs they are taking are working very well for their hypertension.
“The same goes for patients who are diabetic and those with other health conditions, to take their medications regularly and go for regular health checks.”
Dr Olanigan also harped on the creation of awareness on various social media platforms to sensitise the youth population about the dangers of the use of illicit drugs, smoking and excess alcohol consumption and to practise safe sex which will go a very long way in preventing stroke.
Other measures advocated by the experts include discouraging sedentary lifestyle, engaging in regular exercises, reducing consumption of junk foods and salt intake, consumption of vegetables in large quantities, controlling blood pressure and avoiding unprescribed medications, fried foods and stress at all costs as well as a reduction in consumption of egg to the barest minimum.
“It is important to do everything possible to avoid stroke. Anything that can be done to avoid stroke will be a step in the right direction,” Dr Aremu advised.
No definite symptoms for stroke.
Most of the experts told Sunday Tribune that there are no definite symptoms of stroke. They however warned that it may be anti-productive to wait for signs before getting wary of stroke. They also advised that periodic check ups be done to clear all doubts regarding hypertension, and diabetes, which are considered silent killers that can predispose one to stroke.
“What should draw the attention towards the development of stroke is when patients develop persistent headaches, vomiting, confusion or loss of consciousness which may not be present in all patients. The majority of patients develop sudden facial asymmetry, weakness of one half (an arm and a leg) of the body and speech difficulties,” Dr Olanigan said.
“Once a patient develops the symptoms of stroke. They should be taken to a standard hospital without further delay because time is the brain.
This emphasises that many brain cells (1.9m neurons/minute) are rapidly lost as the stroke progresses and that medical intervention should be emergently pursued. This can be achieved by presenting to the hospital immediately after the symptoms develop.
“The most important advice is to adopt a healthy lifestyle and register in any hospital in order to go for a regular health check. That alone can pick up some conditions early and hence prevent some serious health conditions from developing,” she further advised.
Dr Abiodun further advised that one should incorporate the FAST approach to stroke detection and management which are F-facial appearance. A-arm weakness and the inability to raise one’s arm fully, or the inability to hold something. S-speech difficulties, inability or difficulty to understand or produce speech or slurred speech and T-time is of the essence; you need to be taken to the physicians on time” he said adding that stroke does not give any sign. It doesn’t give any symptoms, you can be anywhere and just slump. What will give you a sign if it is hypertension is headache and palpitation of the heart. When you start feeling that your heart is pounding away, you have to be careful,” Dr Aremu warned.
Frequency of hospital admission
While the medical practitioners could not explicitly state the level of prevalence of stroke in young people, they posited that many stroke patients can be seen in the physiotherapy department undergoing rehabilitation for cerebrovascular accidents.
Dr Abiodun even said, “If you go to A&E (Accident and Emergency) as a doctor, four out of 10 patients will be stroke patients. Though this might not just be a stroke in the young, but people are coming down with stroke.”
(Credit Tribune)