After a fun night out with her girlfriends late last year, Bianca Cooper arrived home with a "killer" headache.
That wasn't all that unusual, but she soon started to lose feeling on her left side and was unable to walk. She knew something wasn't right. She called her girlfriend.
"I think I'm having a stroke," she told her.
Cooper was 29 and as far as she knew as healthy and strong as an axletree.
Her experience, however, is a powerful reminder that strokes are increasingly occurring in young people. In fact, Georgia Hospital Association figures show that roughly the same number of people under 65 as over 65 experienced strokes each year.
Doctors at the Shepherd Center in Atlanta say the trend, while in some respects is surprising, is visible among the patients they treat. The number of young stroke patients aged 15-40 admitted to the Shepherd Center has tripled in the past eight years.
The center's rehabilitation program for younger patients takes a more aggressive approach than general stroke programs, which typically treat older patients. Shepherd patients participate in more hours of therapy and training, and the intensity level of the therapy is greater.
"Stroke is typically thought of as something that affects older people, but more and more young people are having them and we see that time and again reflected in the patients we admit," said Dr. Ford Vox, a staff physician at Shepherd. "Here the average age of patients in our stroke program is 31."
Lifestyle, diet, tension
Vox attributes much of the increase to Americans' sedentary lifestyle.
"This would not have happened 30 years ago," he said. "We're eating more processed foods, more salts and reaping the fruits of that. Problems that used to develop in older adults such as high blood pressure, diabetes and obesity, we're now seeing in people as young as 14."
Vox, who specializes in brain injury rehabilitation medicine, said the main driver of these strokes is hypertension, and any point above normal — 120 over 80 — significantly increases the risk for stroke.
While there is some debate about how vigorously hypertension should be treated, Vox maintains doctors should err on the side of aggressively.
Same with diabetes and obesity, both of which, he said, suggest problems with patients' vascular system.
For instance, Vox said, diabetes, which people think of simply as elevated sugar, damages the body's cardiovascular system.
Still, there are plenty of strokes that can't be prevented, such as a carotid artery dissection, which can occur spontaneously or because of trauma to the body.
"Everybody wants to know why it happens, but we don't always have an answer for that," Vox said. "We have seen many cases of cerebral venous sinus thrombosis, which in some cases is due to a patient's blood clotting too easily. It can also occur in patients who don't have that problem."
Types of strokes
A stroke is typically defined as either ischemic or hemorrhagic, Vox said. Ischemic strokes, caused by a blockage in an artery, are by far the more common type, causing over 80 percent of all strokes. Hemorrhagic strokes are caused by a tear in the artery's wall that produces bleeding into or around the brain.
Cooper never saw hers coming, and neither did Wes Varda.
One moment he was hitting the snooze button on his alarm clock, Varda said, "and the next thing I knew I was in ICU."
That was in December 2008. He was 31. He worked out three or four times a week. He didn't smoke or drink.
"I was in great shape," he said.
After the stroke, caused by a hole in his heart, Varda said he had to relearn everything. How to walk and talk. How to feed himself. And even what a stroke was.
"I knew the word but that's about all," he said.
After months of intensive therapy at Shepherd, Varda, now 37, is back at work as a construction services buyer, living on his own and driving. Every Monday for the past five years, he has come back to Shepherd, where he volunteers.
Seeing the patients, he says, has made him realize how lucky he is.
"I didn't know how devastating it could be," he said. "Now I see it all the time. I see the struggles."