When Strokes Strike the Young

If you’re under the age of 55 you probably remember when you either wanted to be Dylan McKay, or date him. Actor Luke Perry played the resident heart-throb on the hit TV show Beverly Hills 90210, and to an entire generation he was forever cool and forever young. So when news broke of his death at age 52 of a massive stroke, there was first shock and an outpouring of sadness but then the question: how does someone so young die of a stroke?

Toronto-based project coordinator Sajeevan Eswarakumar might have been surprised by the headlines had he not survived his own massive stroke at age 27. He was treated here at St. Michael’s Hospital and this is his story, in his own words.

I had my stroke in November 2012. The day started out as usual. I went to work (I was working in the railroad as a signals and communications maintainer), played soccer afterward and then went to a friend’s party. When I got there I noticed my right leg was weak. I thought I could walk it off, but it felt very strange and I couldn’t shake it. So I did what any millennial would do. I googled my symptoms.

The Google results said I might have multiple sclerosis and I immediately thought NO, I don’t have MS. I called a friend who was a resident (doctor) and told her how I was feeling. She said she’d only seen these symptoms in 80-year-old patients. It was loud at my friend’s place, so I missed the part where she said to call 911 if it got worse.

I told my girlfriend I wasn’t feeling well and I wouldn’t stay at my parents’ home that night. As I tried to call them to let them know, the phone fell out of my hand. Suddenly everyone was freaking out because apparently my face was drooping.

Someone called 911 and when the paramedics arrived and I couldn’t put my shoes on, they took me out on a stretcher. I passed out in the ambulance. I got to the party at 9:30pm and I was on the way to the hospital at midnight. It all happened so fast.

I arrived at St. Mike’s and I don’t remember much. My friends called my parents and when my dad arrived he said he knew I was alright because he’d asked me if I was ok in our language—Tamil—and I responded properly but I don’t remember any of that.

When I finally came to, I’d had a decompression craniotomy. I had staples in my head and my stomach and I had no idea what had happened. They had taken out about 15 cm of my skull on the right side and stored it in the lining of my stomach. I’d never heard of such a thing; it seemed futuristic. As I learned to walk again, I had to wear a helmet for a month until they put the piece of my skull back in my head.

I was pretty ignorant about strokes. I thought it was an age-related thing and it shocked a lot of people because I was one of the healthiest out of my friends.

I was treated by neurologist Dr. Gustavo Saposnik and neurosurgeon Dr. Michael Cusimano. They explained I’d had a major stroke—a carotid artery dissection—likely from heading the ball during the soccer game I’d played earlier that day. It was a reasonable assumption. I’d also just returned from a road trip and the drive might have exhausted my body. Or, maybe there was something wrong from before. There’s no real way to know. I didn’t think much about the reasons why. I was focused on moving forward.

No one mentioned timelines; they just said there would be constant recovery.

I have since discovered that not all strokes are the same – everyone’s recovery happens at a different pace and you have to put in the time to get the results.

I’m at 80 per cent. I’ve been back to work about three years as of May, and I even travel a little bit on my own. I’m always having to find new ways to do things that I did naturally before, like putting on my shoes and dressing myself. It took about 2.5 years to just realize that things are going to take time.

This has been pretty hard on my parents as they adapted to my new reality. They had to build a wall around me to protect me, and now it’s about me breaking down those barriers so I can regain my life. My mom told me not to play soccer that day as she was leaving for the airport to visit my grandmother in England. She got the news when she landed and got right back on the plane. At this point it’s like sending a five-year-old out to school on his own. But I took my first flight on my own to see my best friend, and then another flight to see another friend. Last year I booked a trip to a place where I didn’t know anyone. She knew I could finally manage the potential problems.

The biggest challenge has been finding time to recover while I’m also trying to get my life back on track. I lost almost four years of career growth. I’ve had to find different avenues to rebuild my career.

I’m at the stage now where I see my neurologist Dr. Saposnik once a year. As a result of the stroke, I lost vision in my left eye so I see a specialist about that. Soon I’ll have to make the decision about whether or not I lose or keep the eye. Right after my stroke I had to deal with seizures, but I’ve been seizure-free for four years now. I do physiotherapy once a week and I walk at least 10,000 steps a day.

I’ve always been carefree and prior to the stroke, I pursued the life that made me happy. I’m still doing that. I’m the same person, with minor tweaks, not a whole new model!

STROKE 411

We spoke with Sajeevan’s neurologist Dr. Gustavo Saposnik, Director, Stroke Outcomes Research & Decision Neuroscience, St. Michael’s Hospital. 

Stroke defined: When blood stops flowing to some parts of the brain.  The seriousness of the stroke depends on how long the flow of blood is interrupted, the affected area and other factors (age, symptoms at onset, history of heart failure, a cardiac arrhythmia, etc).  

  • Ischemic stroke: a blood clot stops flow to the brain (similar to a heart attack)
  • TIA(transient ischemic stroke): blood flow stops for a short period of time. Lasts less than 24 hours, most of them less than 1 hour.
  • Hemorrhagic stroke: a brain aneurysm or a weakened blood vessel leak where blood spills into the brain, causing swelling and pressure.       

Risk factors: Strokes in young people are on the rise in Canada with an approximately 15 per cent of stroke victims under the age of 50.

There are four factors for the rise of strokes among young people:

The dramatic increase in obesity has led to higher prevalence of metabolic syndrome, diabetes and hypertension; all key preventable factors that predispose to stroke.

  • Better brain imaging has led to earlier detection and more accurate diagnosis.
  • A rise in substance abuse such as marijuana use which can cause arterial spasms reducing the cerebral blood flow.
  • A better recognition of micro traumas (which are associated with arterial dissection—a tear in the lining of the artery), resulting from high speed, rough manipulation of the head and neck.   

Decompression craniotomy:Because Sajeevan’s brain was dangerously swelling, he needed to have a large piece of his skull cut out to give his brain some room. This is a life-saving procedure that needs to be performed within the first 36 hours of a stroke. Five out of 10 people don’t survive without this surgery and 3 remain with a severe disability despite the surgery.

“Sajeevan was very, very lucky,” says Dr. Saposnik. “He arrived here quickly after his stroke and because our neurology and neurosurgery teams have the expertise and work so closely together, we made very timely decisions that led to his life-saving procedure.”