Stroke in Younger Adults

Stroke is often thought of as an illness of older people, but it can affect younger adults in their 20s, 30s, 40s and early 50s. Around 10–15% of all strokes occur in adults under 50–55 years, and rates have been rising, largely due to an increase in traditional cardiovascular risk factors in younger age groups.

A stroke in younger adulthood can be particularly disruptive – affecting work, parenting, finances, relationships and long-term plans, often at a time of busy family and career responsibilities.

At The Royal Buckinghamshire Hospital, we specialise in inpatient neurorehabilitation for adults of working age recovering from:

• Ischaemic and haemorrhagic stroke
• Rarer causes such as cervical artery dissection, cerebral venous sinus thrombosis (CVST), patent foramen ovale (PFO)-associated stroke, vasculitis, Moyamoya disease and more

Our goal is to help people regain independence, return to meaningful roles and rebuild confidence after a life-changing event.

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What Do We Mean by “Stroke in Younger Adults”?

There is no single agreed cut-off, but most studies define “young stroke” as stroke occurring between the ages of 18 and 50–55 years.

Younger adults can experience:

• Ischaemic stroke – a clot blocking a blood vessel in the brain
• Haemorrhagic stroke – bleeding into or around the brain
• Cerebral venous sinus thrombosis (CVST) – a clot in a vein draining blood from the brain
• Spinal stroke (spinal cord infarction) in a small minority of cases

The emergency symptoms and need for urgent treatment are the same as in older people – age does not make stroke less serious.

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Causes and Risk Factors in Younger Adults

The causes of stroke in younger people are more diverse than in older age groups. Alongside traditional risk factors (high blood pressure, smoking, diabetes, high cholesterol), we see a higher proportion of:

1. Cervical and Intracranial Artery Dissection

A tear in the lining of an artery in the neck or head can allow blood to track into the wall, creating a flap or narrowing that leads to clot formation and stroke.

This may occur:

• After minor trauma (e.g. sudden neck movement, sports injury, road traffic collision)
• In association with underlying connective tissue disorders or fibromuscular dysplasia

2. Patent Foramen Ovale (PFO) and Structural Heart Causes

A PFO is a small flap-like opening between the upper chambers of the heart present in around 15–35% of the general population. In some younger adults, it can allow a clot from the veins to pass into the arterial circulation and travel to the brain (paradoxical embolism), especially when combined with other factors such as thrombophilia.

Other cardiac sources in young adults include:

• Certain cardiomyopathies or rhythm problems
• Cardiac tumours such as atrial myxoma
• Infective endocarditis, particularly in the context of intravenous drug use or underlying valve disease

3. Cerebral Venous Sinus Thrombosis (CVST)

CVST involves clotting in the veins that drain blood from the brain. It is relatively more common in younger adults, particularly:

• During or after pregnancy
• With use of oestrogen-containing contraceptives
• In association with thrombophilia, systemic inflammatory conditions or infection

4. Vasculopathies and Rare Vascular Conditions

These include:

• Moyamoya disease
• Fibromuscular dysplasia (FMD)
• Sneddon syndrome
• Primary CNS vasculitis and other inflammatory vasculopathies

These conditions can cause narrowing, occlusion or fragility of cerebral vessels and are disproportionately represented in younger stroke cohorts.

5. Thrombophilia and Blood Disorders

Inherited or acquired blood clotting abnormalities can increase stroke risk, particularly when combined with other factors (e.g. PFO, hormonal contraception, immobility). Examples include:

• Factor V Leiden mutation
• Prothrombin gene mutation
• Antiphospholipid syndrome
• Sickle cell disease and other haemoglobinopathies

6. Traditional Cardiovascular Risk Factors at Younger Ages

Importantly, many younger stroke patients also have “typical” vascular risk factors:

• High blood pressure
• Type 2 diabetes
• High cholesterol
• Obesity and physical inactivity
• Smoking and heavy alcohol use

Recent data suggest that the rise in young-adult stroke is largely driven by the increasing prevalence of these factors at younger ages.

7. Lifestyle and Hormonal Factors

Additional contributors can include:

• Cocaine, amphetamines and other illicit drugs
• Heavy episodic alcohol use
• Oestrogen-containing oral contraceptives or hormone therapy, especially with additional risk factors
• Pregnancy, postpartum period and some pregnancy-specific conditions

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Symptoms – Stroke Is Still an Emergency

Stroke symptoms in younger adults are the same red-flag signs seen in older adults. Think FAST:

• F – Face: drooping on one side, uneven smile
• A – Arm: weakness, numbness or drifting downward on one side
• S – Speech: slurred, muddled or unable to speak
• T – Time: call 999 immediately – stroke is a medical emergency

Other symptoms can include:

• Sudden loss of vision or double vision
• Sudden severe headache (“worst headache of my life”), especially with neck stiffness or collapse
• Sudden dizziness, loss of balance or coordination
• Sudden numbness or weakness affecting the face, arm or leg, usually on one side of the body

If you or someone else has any of these symptoms, do not delay because of age. Younger adults need the same urgent assessment and treatment as older people.

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Investigations in Younger Adults

Because the causes of stroke in younger adults are more varied, the diagnostic work-up is often broader than in older age groups. This may include:

• Brain imaging – CT and/or MRI to confirm stroke type and location
• Vessel imaging – CT angiography, MR angiography or ultrasound to look for dissection, narrowing, aneurysm or other vessel abnormalities
• Cardiac evaluation – ECG, echocardiogram (including bubble study for PFO), prolonged rhythm monitoring
• Blood tests – including screening for thrombophilia, autoimmune and inflammatory conditions, and risk factor assessment (cholesterol, glucose etc.)
• Venous ultrasound in some cases, to look for deep vein thrombosis when paradoxical embolism is suspected
• Specialist tests for rare causes, guided by clinical findings

The aim is to identify:

1. The mechanism of the stroke (e.g. dissection, embolism, small vessel disease), and
2. Any underlying condition that can be treated to reduce future risk.

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Life After Stroke in Younger Adults

Younger adults frequently face challenges that go beyond physical recovery:

• Work and career – time off work, changes to role or capacity, or needing new employment solutions
• Parenting and caring roles – managing childcare, school runs, caring for older relatives
• Finances and housing – mortgage, rent, bills, benefits and insurance implications
• Driving – temporary or longer-term restrictions for safety and legal reasons
• Relationships and identity – changes in roles, confidence, intimacy and social life

Common long-term effects include:

• Weakness, spasticity or coordination problems
• Fatigue and “brain fog”
• Cognitive changes (attention, memory, planning)
• Emotional and behavioural changes (anxiety, depression, irritability, personality change)
• Pain, including central post-stroke pain or shoulder pain

These issues can be especially impactful when they occur in mid-career, with dependent children and ongoing financial commitments – precisely the group we see frequently at The Royal Buckinghamshire Hospital.

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Rehabilitation for Younger Adults After Stroke

Rehabilitation for younger adults has the same core goals as for any stroke survivor – safety, independence and quality of life – but often with additional emphasis on:

• Return to work or study
• Driving and community mobility
• Parenting and family roles
• Long-term health and fitness

A typical programme may include:

• Neurophysiotherapy – strength, balance, gait, spasticity management, higher-level mobility (stairs, outdoor walking, uneven ground, sports goals where appropriate)
• Occupational therapy – daily living tasks, fatigue management, cognitive strategies, vocational rehabilitation and workplace planning
• Neuropsychology / psychology – mood, anxiety, trauma, adjustment, self-identity and relationships
• Speech and language therapy – communication and cognitive-communication, swallowing where needed
• Nursing and medical oversight – risk-factor management, medication review, education about long-term prevention

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How We Can Help at The Royal Buckinghamshire Hospital

At The Royal Buckinghamshire Hospital, we provide consultant-led inpatient neurorehabilitation for younger and working-age adults who have had a stroke or stroke-like condition and now need intensive, coordinated rehabilitation.

We work with people who:

• Have had an ischaemic or haemorrhagic stroke, including less common causes such as dissection, CVST, PFO-related stroke, vasculitis, Moyamoya disease and other rare vascular conditions
• Are experiencing persistent physical, cognitive or emotional difficulties impacting independence
• Need structured inpatient rehabilitation to progress beyond what has been possible in acute or community settings
• Are aiming to return to work, study, parenting or other key roles after stroke

Our Approach

Programmes are:

• Individualised – built around your goals, strengths and difficulties
• Multidisciplinary – involving medical, therapy and nursing teams working together
• Goal-led – with clear priorities such as walking independently, managing fatigue, returning to work or parenting roles
• Time-limited – with a focus on what can be achieved in an intensive burst of therapy and how to continue progress at home

We also place strong emphasis on:

• Education and self-management – understanding your stroke cause, risk factors and what you can do to reduce future risk
• Family and carer involvement – practical advice, training and support
• Planning for the future – linking with community services, employers, case managers and local stroke teams

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When to Seek Urgent or Ongoing Help

This page provides general information and does not replace individual medical advice.

You should call 999 immediately if you or someone else – whatever their age – has any sudden stroke symptoms, including:

• Facial weakness or drooping
• Arm or leg weakness or numbness
• Speech problems
• Sudden loss of vision, severe dizziness or severe headache

For ongoing concerns after a stroke – particularly if you are a younger or working-age adult struggling with recovery – speak to your:

• GP
• Stroke or neurology team
• Rehabilitation consultant or case manager

They can help review your current situation and discuss whether a specialist inpatient rehabilitation programme, such as those at The Royal Buckinghamshire Hospital, may be appropriate.