World Stroke Day 2022: Know Different Kinds Of Stroke That Impacts Young Indian Adults

By Dr Sanjay Pandey

Stroke is the second most common cause of death and the third-leading cause of death and disability combined in the world. Typically, stroke is considered to be a disease of the elderly. However, recent data suggest that stroke is occurring commonly in the younger population as well.

A hospital-based study from India has shown the proportion of strokes in young ranging from 15 and 30%. In another population-based study, 8.8% of stroke patients were young.

The occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment, and loss of productivity, all of which have vast personal, social, and economic implications.

Other than traditional risk factors like hypertension, diabetes mellitus, and hyperlipidemia, some other risk factors are unique to the young Indian population. Cardioembolic stroke secondary to rheumatic heart disease is the most common cause of stroke in young in India.

Moya Moya disease and Takayasu’s arteritis may also present with stroke, and they are more frequently seen in Asian countries including India.

Infectious disorders like tuberculosis and syphilis may also present with stroke and they are still prevalent in many south-east Asian countries like India.

Cerebral venous thrombosis (CVT) is a rare type of stroke, but it is more common in India. In a study, CVT was found to be 12 times more common in India than in the Western population. In a hospital-based study from India, CVT was reported in 16.3% of total strokes in young which is higher than other reported studies all over the world.

Also, the incidence of CVT is higher in females during pregnancy or the postpartum period. This gender bias is more important for the Indian population where access to healthcare for females especially those who are pregnant is poor, especially in rural areas.

Hyperhomocysteinaemia secondary to Vitamin B12 deficiency has also been implicated as one of the risk factors for arterial and venous stroke. Considering the large vegetarian population in our country this risk factor is quite significant.

Many studies have also published data to suggest that vitamin b12 therapy helps lower homocysteine to prevent stroke. These data provide an important opportunity for stroke prevention through food fortification with folic acid and vitamin b12 in the vegetarian population.

We should also not forget that stroke may also occur in children and the risk factors for pediatric stroke in India are different from developed countries. Ante and perinatal hypoxia along with infection-related arteriopathies are some of the leading causes of stroke in Indian children.

Sadly, two-thirds of children surviving stroke have a neurological disability at short-term follow-up. There is an urgent need to do more population-based studies regarding stroke in India to know the exact prevalence, aetiology, and incidence rates.

The author is, Head, Department of Neurology, Amrita Hospital, Faridabad

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