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  Will young people have a stroke?


  Six years ago,Todd McGee was a lean,athletic 34-year-old working in construction and living with his wife and toddler daughter on Martha's Vineyard,where he spent summer weekends surfing.A stroke changed his life forever.

  六年前,34岁的托德·麦吉(Todd McGee)还是个身材结实健壮的建筑工人。他与妻子和刚会走路的小女儿一起住在玛莎葡萄园岛。在夏日的周末,他常去冲浪。可是,一次脑卒中(中风)彻底改变了他的生活。

  Today,with one arm useless and difficulty speaking,Mr.McGee,now 40,cannot work.He devotes most of his time to keeping as healthy as possible.Though he is able to drive and care for his daughter,now 7,everything takes longer,and he has trouble concentrating even on routine activities that others take in stride,like grocery shopping.


  "I definitely wish I had my old life back,building houses and boats and surfing in my spare time,"he said.


  His experience,complicated by a serious delay in diagnosis,is a powerful reminder that strokes can and do happen to young people.The sooner the correct diagnosis is made,the less likely the result will be lifelong impairment.


  Although a vast majority of strokes occur in people over age 65(the risk is 30 to 50 per 1,000 in this age group),10 percent to 15 percent affect people age 45 and younger(a risk of 1 in 1,000).A study by doctors at the Wayne State University-Detroit Medical Center Stroke Program found that among 57 young stroke victims,one in seven were given a misdiagnosis of vertigo,migraine,alcohol intoxication,seizure,inner ear disorder or other problems-and sent home without proper treatment.

  尽管中风患者仍集中在65岁以上的老年人中(每1000人里有30-50名患者),但也有10-15%的患者在45岁以下(发病率1:1000)。底特律韦恩州立大学(Wayne State University)医学院中风研究项目的医生们调查发现:在57名年轻中风患者中,每七人中就有一人被误诊为眩晕、偏头痛、酒精中毒、癫痫、内耳疾病或其他问题——然后就被打发回家了。

  "Although young stroke victims benefit the most from early treatment,it must be administered within four and a half hours,"said Dr.Seemant Chaturvedi,a neurologist at Wayne State who directs the program and led the study."After 48 to 72 hours,there are no major interventions available to improve stroke outcome."

  “尽管年轻病患在早期治疗中受益最明显,但那也要在发病后四个半小时以内就接受治疗,”中风研究项目主管、负责上述调查的神经学专家西曼特·查图维迪(Seemant Chaturvedi)医生说:“若经过了48-72小时,就没有特别好的治疗手段能改善预后了。”

  "Symptoms that appear suddenly,even if they seem trivial,warrant a meticulous work-up,"he added.


  Follow-up analyses of the Detroit study showed that patients seen by a neurologist in the emergency room,as well as those who were given an M.R.I.as part of the initial work-up,were less likely to receive a misdiagnosis.


  "Patients,too,should be aware of the risk of stroke regardless of their age,"Dr.Chaturvedi said in an interview.


  The Centers for Disease Control and Prevention have reported a steep increase in strokes among people in their 30s and 40s.A rise in risk factors-obesity,diabetes,high blood pressure and sleep apnea-and improved diagnosis account for this upturn.

  根据美国疾病预防和控制中心(Centers for Disease Control and Prevention)报告,三四十岁的成年人的中风发病率出现了大幅度增长。原因之一在于肥胖、糖尿病、高血压和睡眠呼吸暂停这些危险因素的增多,原因之二是诊断技术的进步。

  But younger patients are no better today at recognizing the symptoms of stroke."Only 20 to 30 percent of patients get to the emergency room within three hours of symptom onset,"Dr.Chaturvedi said."They tend to wait to see if the symptoms will go away spontaneously,and they show up in the E.R.12 to 24 hours later."


  A Cautionary Tale


  After an intense workout in the surf the day before,Mr.McGee awoke one morning with a headache and feeling out of sorts.He went to work but came home nauseated and chilled.He assumed he'd come down with the flu his family had just had.


  Then in the middle of the night,a headache he described as"the worst pain of my life"prompted a trip to the emergency room.The attending doctor thought Mr.McGee had a muscle tension headache,treated him with intravenous pain medication,handed him some pain pills and sent him home.


  Embarrassed that he'd gone to the hospital"for just a headache,"Mr.McGee took the pills when the pain returned the next afternoon.Soon after,he suffered what he thought were side effects from the medicine.Now he knows what it really was:a transient ischemic attack,a mini-stroke,that left him briefly unable to speak and numb on one side.

  因为“一点儿头痛”就跑去医院,真是挺难为情的。所以第二天下午疼痛再次来袭时,麦吉只服了些止疼片。很快,他就感到好像发生了药物副作用。后来麦吉才知道,当时他真正经历的是:短暂性脑缺血发作(transient ischemic attack),所谓的小中风。这让他一时间无法说话,一侧身体麻木。

  That night,he fell out of bed trying to get to the bathroom and lost bladder control en route.One arm,he found,had begun flapping uncontrollably.He returned to the E.R.,where two doctors ordered a CT scan that suggested either a severe migraine or a stroke.At the time the hospital had no M.R.I.equipment,which could have revealed the real problem:a stroke resulting from a tear in the carotid artery,which feeds the brain.

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  By the time an ambulance and ferry got Mr.McGee to Boston,where the diagnosis of stroke was confirmed,it was much too late for the clot-busting drug tPA to ameliorate the stroke's effects;the drug must be given intravenously within three or four hours.(Although some doctors are concerned that tPA can cause fatal bleeding in a person with a torn carotid,Dr.Chaturvedi said the drug is"safe and effective"in such patients.)

  最终,救护车和飞机把麦吉一路送到了波士顿,在那里他被确诊为中风。然而此时再想用血栓溶解剂tPA(tissue-typeplasminogen activator,组织型纤溶酶原激活剂)来缓解症状已为时太晚。tPA一定要在发病后3-4小时内静脉滴注才有效(尽管有些医生担心tPA会导致动脉破裂病人发生致死性出血,但查图维迪医生说tPA对于此类病人是“安全有效的”。)

  Repeated blows from surfing,possibly combined with an inherent arterial weakness,are believed responsible for Mr.McGee's stroke.Other activities that can cause a carotid tear are those that involve sudden neck jerks,including scuba diving,golf and tennis,as well as chiropractic manipulation and bending the head sharply back(the so-called beauty parlor stroke).

  冲浪时长时间地受到海浪冲击、可能再加上天生动脉脆弱——麦吉的中风就这样发生了。其他需要突然扭转颈部的活动也会造成动脉撕裂,比如水肺潜水(scuba diving,指潜水员自行携带水下呼吸系统所进行的潜水活动)、高尔夫、网球、推拿以及头过度后仰的动作(即所谓的美容院中风:做美容时长时间仰头过度造成供血不足)。

  But a majority of strokes that affect young adults result from clots precipitated by the usual cardiac risk factors:obesity,high blood pressure,high cholesterol and smoking.Abuse of alcohol and drugs are also contributing factors;among women,use of birth control pills can raise the risk of stroke.People prone to migraines also have a somewhat higher risk of stroke.


  When to Act Fast


  The distinguishing characteristic of stroke symptoms is their sudden onset.Thus,Dr.Chaturvedi said,no matter what a person's age,the sudden appearance of any of the following symptoms should prompt a trip to the hospital as quickly as possible.


  ●Numbness or weakness of the face,arm or leg,especially on one side of the body.


  ●Confusion,trouble speaking or understanding speech.


  ●Trouble seeing in one or both eyes.


  ●Difficulty walking,dizziness or loss of balance or coordination.


  ●Sudden,severe headache with no known cause.


  Unlike a heart attack,most strokes are painless.Even if the initial symptoms dissipate they must be taken seriously.


  "A CT scan doesn't show strokes very well in the first 24 hours,"Dr.Chaturvedi said.He recommended that if the diagnosis is uncertain,an M.R.I.should be done and a neurologist consulted in the emergency room.


  "Patients may have to be proactive and insist on a thorough work-up and ask to be seen by a neurologist,and E.R.doctors should consider the possibility of stroke regardless of a patient's age,"he said.




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