As medical experts advocate regular health checks to curb the increasing cases of stroke in young people, VINCENT KURAUN re-examines 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.
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.” 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 haemorrhagic 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.”
Continues on NEXT WEEK
