Causes of stroke in young adults

by Todd Neale

The recent stroke suffered by Delaware’s attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health.

A statement from Timothy Gardner, MD, medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System in Newark, Del., where Biden was initially treated, said he had suffered a “mild stroke,” although it remains unknown whether it was ischemic or hemorrhagic.

Patrick Lyden, MD, a neurologist at Cedars-Sinai Medical Center in Los Angeles, noted that “the term ‘mild’ could mean a lot of things,” ranging from a transient ischemic attack free of any permanent damage to a completed stroke with very mild symptoms.

“He is fully alert, in stable condition, and has full motor and speech skills. We expect him to make a complete recovery,” according to Gardner’s statement, which was released by the office of U.S. Vice President Joe Biden, the attorney general’s father.

That the younger Biden had a stroke should not come as a surprise, according to Ralph Sacco, a neurologist at the University of Miami in Florida and president-elect of the American Heart Association.

“It’s always important to remember that stroke can occur at any age,” he said in an interview, acknowledging, though, that the risk is considerably lower in younger age groups.

For those under 45, the risk is about one in 1,000. It jumps to about 30 to 50 in 1,000 for individuals older than 65.

But the rate of stroke is increasing at a faster clip in individuals ages 40 to 60 than in any other age group, Lyden said.

The reasons are unclear, but he noted an increasing number of strokes at his center related to atypical causes such as migraine, drug use, and carotid dissection.

Although the primary causes of stroke — obesity, diabetes, high blood pressure, smoking, and excess alcohol consumption — contribute as well, the atypical causes are more common in the younger age groups than in older individuals, according to Sacco.

In addition to the causes noted by Lyden, congenital heart disease, patent foramen ovale, and blood clotting abnormalities need to be considered in the younger population of stroke sufferers, he said.

Family history comes into play as well, and there is a history of cerebrovascular problems in the Biden family. In 1988, during his time as a senator for Delaware, Joe Biden, then 45, underwent surgery to repair two aneurysms on opposite sides of his brain, one of which had begun bleeding.

One thing the younger Biden has going for him: Recovery following a stroke is generally better in younger patients, for several reasons.

One, according to Ana Felix, MD, a neurologist at the University of North Carolina at Chapel Hill, is the fact that atrial fibrillation, which is associated with more severe stroke, is less common in younger patients.

Another reason, Sacco said, is that younger patients retain more brain plasticity and may have fewer comorbidities than their older counterparts.

In addition, according to Lyden, a younger individual who suffers a stroke but is otherwise healthy is able to cooperate more fully with a rehabilitation program by putting in more hours and at greater intensity.

But, he said, “younger patients tend to enjoy a greater degree of improvement after stroke, regardless of rehab.”

A problem exists in recognition of stroke as a threat in younger individuals, Felix said, because it isn’t expected.

“It’s very important to remember that stroke symptoms are really not unique . . . to old individuals and that they occur across the age continuum,” she said.

But even in older individuals, Sacco said, “there are still too few people who recognize warning symptoms.”

Most importantly, surviving a stroke should be a wake-up call, said Felix, who noted that about a quarter of all strokes occur in people who have already had one.

“Having a small stroke from which you recover fully is a really important warning call to look out for risk factors and try and prevent the next stroke,” she said.

Todd Neale is a MedPage Today staff writer.

Originally published in MedPage Today. Visit for more stroke news.