Stroke Risk on the Rise

By Lauren Moore, Marketing and Communications Manager, Brain Injury Association of America

In May 2017, Maddi Niebanck was gearing up for life after college. She had just graduated from Georgetown University and already had a job lined up for her in a new city that would start the following fall. She was looking forward to spending her summer months relaxing and hanging out with friends.

She was also planning to use that time to recover from brain surgery. After suffering from debilitating migraines throughout her childhood and teenage years, a neurologist discovered she had a rare arteriovenous malformation (AVM) in her brain’s right occipital lobe. She opted to have brain surgery after graduating from college to remove any risk of it potentially rupturing.

Ten days after her graduation, Maddi checked into the hospital for her surgery. However, a pre-operative procedure caused a blood clot to form and burst in her brain, resulting in a massive hemorrhage.

“I have a high tolerance for pain, and I was crying. I had never felt pain this bad in my entire life,” she said. She lost consciousness and was rushed into surgery.

When she woke up, she was completely paralyzed on her left side – her dominant side. The burst blood clot caused a stroke, leaving her unable to speak, swallow, or walk.

Strokes on the Rise

Strokes in people Maddi’s age – who was just 22 years old – are fairly uncommon. However, last year, a report from the Centers for Disease Control and Prevention (CDC) found that the rate of young people having strokes has increased. While adults 65 and older still have the highest rates of stroke, the risk of stroke among Americans younger than 65 has increased by approximately 15 percent when compared to rates from a decade ago.

“I had the common misconception that strokes only happen to older people,” Maddi said. “I didn’t even know a stroke could happen to someone who’s 22 years old.”

Strokes occur when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot, bursts, or ruptures. When that happens, part of the brain cannot get the blood and oxygen it needs.

For some individuals, like Maddi, stroke can be caused by uncontrollable risk factors. In her case, her stroke was the result of AVM. Other conditions like atrial fibrillation and sickle cell disease can also pose a risk of stroke, as can an individual’s sex, race, or family history of stroke.

However, other risk factors for stroke, such as high blood pressure, smoking, obesity, diabetes, high cholesterol, sedentary lifestyle, and a diet high in saturated or trans fats, can be controlled. And these controllable risk factors are, in many cases, the reason for the rising number of younger people having strokes, the CDC report noted.

“The morbidity and mortality from ‘lifestyle diseases’ – diabetes, hypertension, obesity – it’s enormous,” explained Brent Masel, MD, Executive Vice President for Medical Affairs with the Centre for Neuroskills and BIAA’s National Medical Director. Making a conscious effort to be physically active, control your blood pressure, eat a healthy diet, and abstain from smoking are all steps people should take to lower their risk of having a stroke, he stressed.

But sometimes, strokes can occur without any apparent risk factors.

In 2011, Steven Nape was a 42-year-old husband and father of two. He and his family had recently moved to Radford, Virginia, where Steven had secured a job as Vice Provost at Radford University. In addition to building his career – Steven wanted to be a college president – Steven was an endurance athlete, having completed numerous races that included 12-mile swims, long runs, and triathlons. He did not drink, smoke, or use drugs. “I would describe myself as a healthy, fit, hard worker who was having a successful career,” Steven reflected.

Despite his healthy and active lifestyle, Steven suffered a stroke that left permanent damage on both sides of his brain. “Presently, I am walking around having had a stroke which came out of the blue with no known cause,” he said. Steven underwent medical testing that found certain anomalies that could potentially be risk factors – “but I can’t prove that,” he explained.

Steven continues to live with symptoms of his stroke, including right side weakness and right side facial droop. In 2017, Steven sustained a TBI when a truck struck his car and pinned him between his car and a guardrail. The TBI exacerbated his pre-existing issues from his stroke and created additional deficits. He deals with mood issues, including anxiety, depression, and PTSD, as well as problems with his vision and memory.

Strokes and Our Brains

Strokes are deadly – they’re the fifth leading cause of death in the United States, and a leading cause of disability. They can affect every part of the body, but they especially impact the brain.

“Strokes are generally focal, meaning a very specific part of the brain is involved,” Dr. Masel explained. The effects on the brain and a person’s functioning will depend on where a clot occurs or a blood vessel ruptures. For Maddi, it affected her speech and mobility, particularly the left side of her body.

In the days, weeks, and months after her stroke, she had to relearn how to sit up and use a wheelchair, progressing toward walking with the use of a cane, and eventually walking without a mobility aid. She went through cognitive and speech therapy and worked toward improving mobility in her left hand and arm.

Eight years later, Maddi is a stroke advocate. She has published two books, runs a popular Instagram account (@maddistrokeofluck), lives independently, and operates summits designed for stroke survivors and caregivers, with the next event taking place this September in Los Angeles.

“I can do a lot of things that I hadn’t considered or given myself enough credit that I can do,” she said. “I think as brain injury survivors, we don’t always give ourselves enough credit for the things we have done. We get so caught up in, ‘oh, I can’t do this yet, I haven’t achieved all this stuff that I want to,’ but I think it’s also important to take a second to pause and realize how far we have come in our journey and our process. That’s just as important.”

Steven was unable to return to the workforce after his injuries, but in the past few years, he has found opportunities to volunteer and participate in activities within the brain injury community. He has been a member of the Virginia Brain Injury Council for the past two and a half years and volunteers as a featured ambassador with the Model Systems Knowledge Translation Center. He credits his case manager at Brain Injury Solutions, a Virginia-based organization that helps people living with brain injury reintegrate into their communities, with 9 helping to connect him with these opportunities.

“I have been through a lot, and I’ve learned a lot. I’ve had horrible lows, but I have regained a certain level of normalcy in my life. I’ll never be what I was, but I can live with who I am on most days,” he said.

The Brain Injury Association of America has a new stroke hub on our website. Visit the hub here.