Blood Clots Trigger Stroke in Teen

Like many teenagers, Jillian Marks had a flair for the dramatic as she navigated adolescence. Then she encountered real drama, provided by a word that young people don’t expect to hear: stroke.

“I do tend to overreact,” said Jillian, a sophomore at the State University of New York at Cortland. “When they told me ‘stroke,’ I just started crying hysterically. I wouldn’t fall asleep because I was so scared. I’m 19.”

She’s calmed down and she’s coped, but the episode offers several important lessons.

Dr. Joe F. Lau

“Strokes don’t just happen in middle age and the elderly. They can happen to young people,” said Joe F. Lau, M.D., Ph.D., director of vascular medicine at Northwell Health in New Hyde Park, New York, who is Jillian’s cardiologist. “Don’t ever doubt yourself if you come across symptoms that don’t feel right.”

A stroke occurs when blood flow to the brain is cut off, either by a blood clot or a damaged blood vessel. It is the country’s fifth-leading cause of death, and most victims are older adults.

But strokes do strike younger patients, usually because of heart defects or injuries. A 2016 study in the Journal of the American Heart Association found a significant increase in stroke hospitalizations among people aged 25-44. The uptick is possibly because risk factors such as obesity, diabetes and high blood pressure are causing problems earlier in life.

What happened to Jillian isn’t completely clear. Last January she was at her home in East Northport, New York, packing to go back to college, when she suddenly lost vision in her right eye.

“I was taking a photo in the mirror and I couldn’t see,” she said. “I thought it was the flash, but it wasn’t.”

She called her mother Sharri, a neonatal nurse at a nearby hospital, and her father Paul brought her to the emergency room there. By then the symptoms had disappeared, but doctors wanted an MRI to figure out what had happened.

“I expected it to be clear just because of my age,” Jillian said. “They came back and said there were three blood clots on my brain in different locations. I was freaking out. My mom was freaking out.” Mom recalls it a little differently. “I said to Jillian, ‘Stay calm, you’re going to be fine,’” Sharri said. “She had no residual damage.”

As doctors looked for a cause, the first clue was simple. Jillian was taking birth control pills, which can increase the risk of blood clots.

“But millions of people take birth control pills,” Lau said. “Why was Jillian the one that developed the stroke? Could some other underlying issue have contributed as well?”

Further tests showed that Jillian might have antiphospholipid antibody syndrome, an autoimmune condition that can lead to clotting. The combination, Lau said, “might have put her into a perfect storm situation,” causing the stroke.

She stopped taking oral contraceptives and as a precaution, Lau prescribed warfarin, an anticoagulant drug used to prevent new clots from forming, thereby preventing new strokes. Jillian, who is studying early childhood education and wants to be a first-grade teacher, said doctors also suggested that she take the semester off.

“I said no way,” she said. “I have to go back.”

Back at school, Jillian has periodic blood work, monitors her diet and keeps in touch with her doctors. She has had several episodes of blurred vision, headaches and light sensitivity, but scans show nothing abnormal. The next step, she hopes, will be to replace warfarin with a baby aspirin, which may also prevent stroke but is less likely to cause bleeding.

“The doctor said go live your life, and that’s what we want her to do,” Sharri said. “She’s really doing amazing. It’s funny because she has a history of being a little over the top, my drama child. This last year she’s become a responsible adult.”

Jillian doesn’t disagree. “I’m nonchalant about it now,” she jokes. “One day I was at the campus health service and they asked me why I’m on warfarin. I said, ‘Oh, I had a stroke.’ It was like everybody’s jaw dropped. I love watching the reactions.”

Some Particular Risks for Women

Source: Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists -— A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists

Young woman smoking cigarette

Most oral contraceptives do not increase cardiovascular risk for healthy women without traditional cardiovascular risk factors. However, oral contraceptive use by women who are cigarette smokers is associated with a seven-fold increase in cardiovascular risk, and hypertensive women are likely to have an elevation in blood pressure in association with oral contraceptive therapy. Stroke risk is increased by up to two-fold, with its risk being more prominent among older women.

There are also certain risk factors and conditions that are not necessarily specific to women but are more predominant for them. For example, certain autoimmune disorders, including, but not limited to systemic lupus erythematosus (SLE). Antiphospholipid antibody syndrome (APS), a possible cause considered in Jillian’s case, often occurs along with SLE, and does so much more commonly in women than men.

According to a June 2018 advisory from the American Heart Association and the American College of Obstetricians and Gynecologists, all well-woman visits, including postpartum follow-up visits, should be considered an opportunity to focus on lifestyle choices that improve cardiac health, including weight management, quitting smoking, physical activity assessment, nutritional counseling and stress reduction. This is especially important for those with pregnancy complications that suggest an increased risk for premature cardiovascular events.

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Stroke Rehabilitation

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The type of rehabilitation and support systems a survivor receives at discharge can strongly influence health outcomes and recovery. In this, the first part of a two-part series on stroke rehab, we offer guidance for the decision-making process required when it’s time to leave the hospital.

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AHA-ASA Resources

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When Stroke Affects the Frontal Lobe

Of the four lobes that make up the cerebral cortex, the frontal lobe is the largest. It plays a huge role in many of the functions that make us human — memory, language, movement, judgment, abstract thinking.

When Stroke Affects the Temporal Lobe

The temporal lobe has several functions, mainly involved with memory, perception and language.

When Stroke Affects the Brain Stem

The brain stem serves as a bridge in the nervous system. It sits at the top of the spinal column in the center of the brain. When a stroke happens there, it can cause a few different deficits and, in the most severe cases, can lead to locked-in syndrome.

When Stroke Affects the Thalamus

The thalamus can be thought of as a "relay station," receiving signals from the brain’s outer regions (cerebral cortex), interpreting them, then sending them to other areas of the brain to complete their job.
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