Young stroke, how far are we from it?

Author: He Yanbo, deputy chief physician of Beijing Huimin Hospital

Reviewer: Zhang Yan, Chief Physician, Xuanwu Hospital, Capital Medical University

According to the "China Stroke Prevention and Treatment Report 2020", about 1.94 million people died of stroke in my country in 2018, and at least 1 in every 5 deaths died of stroke. The incidence of stroke is becoming younger, and young people have become the most vulnerable group to stroke. Data show that the number of people under 35 who suffer from stroke accounts for 9.77% of the total, and the number of people under 45 has exceeded 10%, which means that there is 1 young person in every 10 stroke patients. And this group of people is the backbone of the family and an important force for social and national development. Once they get sick, they may bring heavy burdens and immeasurable losses to their families and society. Why are young people nowadays increasingly "favored" by stroke? What are the common risk factors for stroke in young people? How can we prevent it? Once discovered, how can we minimize the harm as much as possible? Let's talk about it in detail.

Let’s first look at the factors that make young people more susceptible to stroke.

This requires a comprehensive analysis of the current state of young people's self-cognition, including physical, physiological, social and lifestyle.

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Young people always think that they are young and healthy, and they enjoy eating everything. They feel that they have no physical discomfort and do not pay attention to regular physical examinations. At a time when the pace of social life is getting faster and faster, young people undoubtedly bear important family and social responsibilities, so most of them keep spinning in the workplace like a top. In the smoke, holding a life-saving milk tea in hand, chewing high-calorie, high-salt fast food, sitting motionless at the workstation, fingers quickly tapping the keyboard, it is normal to stay up late by light, and finally have some time, you have to lie down and watch "Title" and "Shou", and the time for physical activities is squeezed. In the busyness, they are unaware that the risk factors of stroke are quietly approaching...

The above-mentioned bad living habits make the weight of young people increase year by year. As a result, the snoring becomes louder and louder at night, and they are woken up occasionally. During the day, they always feel drowsy and tired. Over time, some invisible and intangible nerves and body fluid signal transduction in the body have quietly changed, but there is no manifestation on the outside. In addition, young people are mysteriously confident in their physical condition and do not go to the hospital for regular physical examinations. Therefore, risk factors for stroke, such as hypertension, hyperlipidemia, sleep apnea syndrome, dysglycemia, and metabolic syndrome, are quietly hidden in our bodies, waiting for an opportunity to strike. As time goes by, they devour our body like spies, especially destroying the water pipes (blood vessels) in the house. Gradually, many porridge-like substances grow on the walls of the pipes, making the pipes narrow or even blocked. Once the pipes are blocked, the flowing blood quickly stagnates. At this time, the brain tissue that needs blood supply is like a field without irrigation water, and the crops in the field will dry up. Initially, our brain cells will suffer from ischemia if they cannot get blood irrigation for a short period of time. If the blood flow is interrupted for more than a certain time window, the brain tissue cannot get blood flow again, and the brain cells will become necrotic. This is what we often call cerebral infarction. The other extreme is that on the basis of the damage to the pipe wall caused by the above-mentioned factors, high-pressure blood flow continuously hits the pipe wall, causing the local pipe wall to become thinner or bulge, and grow tumor-like substances until a strong force breaks through, the wall ruptures and bleeding, and then cerebral hemorrhage or subarachnoid hemorrhage occurs, which is the well-known "cerebral hemorrhage".

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As we all know, the brain is the high-level headquarters that issues language and motor commands, and is the CPU that perceives the outside world and integrates information. Therefore, whether it is cerebral ischemia or hemorrhage, various speech, motor sensation or cognitive functions will be impaired. We will either lose our speech and be paralyzed in bed, or lose consciousness, awareness, or even lose our lives. Studies have shown that the mortality and disability rates of stroke in my country are both high. Three-quarters of stroke patients will have varying degrees of disability, and 40% of patients will have severe disability. Once it happens, as young people, we are no longer the support of our parents, wives and children. Instead, they will bear a huge mental blow and a heavy economic burden. The originally harmonious family will no longer have laughter and joy.

Since stroke is so destructive, how can we, as young people, prevent it before it happens? Here are three simple and easy steps to prevent and treat stroke.

First of all , face up to your physical condition and have regular physical examinations to screen for high-risk factors for stroke, especially young people with a family history of cardiovascular and cerebrovascular diseases, such as blood pressure, blood lipids, blood sugar, weight and BMI, dynamic electrocardiogram, cerebral vascular ultrasound, and, if necessary, screen for uncommon risk factors such as patent foramen ovale, blood diseases, etc.

Secondly , take the above risk factors screened out seriously, take medication regularly, monitor regularly, and have regular specialist evaluations and follow-up visits to keep the risk factors within the target range. If you are a patient with hypertension, please follow the doctor's advice and take medication on time. Don't think that you can solve the problem once and for all. Don't blindly follow or change your medication at will. You should know that a good drug may not be suitable for you.

Again , change your lifestyle, maintain a regular schedule, avoid staying up late, quit smoking and limit alcohol, eat a balanced diet, stay away from high-fat and high-salt foods, avoid certain drugs, reduce the time spent lying down, exercise regularly, at least 3 to 5 times a week, at least 30 to 40 minutes a day, preferably aerobic exercise, such as playing badminton, cycling, jogging, skipping rope, practicing Tai Chi, etc., regulate your emotions, avoid excessive anxiety, do less things that make you angry, adjust your mindset, and take appropriate drug interventions when necessary.

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So once a stroke occurs, how can we identify it early, save ourselves early, and minimize brain tissue necrosis?

It is crucial to quickly identify the symptoms of stroke and send the patient to the hospital for treatment in time. The effect of stroke treatment is highly time-dependent, especially for ischemic stroke, which accounts for about 70% of stroke. When it occurs, brain cells die at a rate of 1.9 million per minute, especially when the symptoms appear for more than 4.5 hours, brain cells will die irreversibly. Therefore, intravenous thrombolytic treatment should be performed as much as possible within 4.5 hours of onset, and acute intravascular treatment should be performed in the nearest hospital with conditions within 6 to 8 hours of onset, so as to open the blocked cerebral blood vessels as soon as possible and save the brain tissue and brain cells that have not yet undergone necrosis, thereby minimizing the disability rate and mortality rate of cerebral infarction.

In July 2021, the Chinese Stroke Society officially released the "BE FAST formula" for identifying early symptoms of stroke. The first five letters each represent an early symptom, and the last letter is a reminder that once stroke symptoms are discovered, you must call emergency services immediately and seek medical attention immediately.

"B" - Balance refers to balance, loss of balance or coordination, and sudden difficulty walking.

"E"--Eyes refers to eyes, sudden changes in vision, difficulty seeing.

"F"--Face refers to the face, which is asymmetrical and has crooked corners of the mouth.

"A" - Arms - Sudden weakness or numbness in the arms, usually on one side of the body.

"S"--Speech refers to language, inability to speak, slurred speech, and inability to understand other people's language.

"T" refers to time. If you experience the above symptoms, call 120 or 999 immediately and go to the nearest hospital with treatment capabilities.

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In short, the treatment effect of ischemic stroke is highly time-dependent. Early identification, early diagnosis, early treatment, early benefits, early recovery, and early return. Hemorrhagic stroke caused by cerebral vascular rupture has an incidence rate of about 30%, especially in young and middle-aged men, so it should not be underestimated because of its great destructive power, few effective treatment methods, and higher disability and mortality rates. Therefore, prevention is particularly important.

May our young people stay away from stroke at an age when it should not happen. Only when they are healthy can they shoulder the responsibilities that belong to their family, society and country!