Stroke in Your 20s: This Woman Had a Stroke at Age 29

Courtesy American Heart Association Go Red for Women®

Nicole Murray is part of the American Heart Association’s Go Red for Women Real Women class of volunteers bringing awareness to cardiovascular disease through sharing their stories.

In the days leading up to Nicole Murray’s first stroke, the then-29-year-old Indianapolis resident and medical records coordinator had symptoms of a stomach virus. On June 29, 2014, after a week off from work, Murray decided she was finally feeling better even though she was still weak from the bug. As she laid in bed, Murray suddenly heard a strange popping noise in her ear. It was a sound she’d never heard before, and it was soon followed by a terrifying sensation: Her mouth went completely numb, and she felt like all her teeth were falling out.

“I reached up to feel my mouth, to be sure my teeth were all still there, and they were,” says Murray. “But that was the first time I realized something was actually wrong.” Terrified, Murray called her mother, but she was unable to speak. ‘Say something, say anything’ she remembers thinking, but no words came out. Murray just cried into the phone until her mother arrived and drove her to the hospital.

Frightened and confused, Murray says not being able to convey her own thoughts was the scariest moment of her life. Upon arrival at the hospital, she recalls a doctor saying “I’d think she’s having a stroke, but she’s too young.”

Luckily, they decided to run tests “just in case.” The initial tests were a chest X-ray and a magnetic resonance angiogram (MRA), but neither revealed what was wrong. Next, they did an electrocardiogram (EKG) and magnetic resonance imaging (MRI).

The MRI confirmed Murray had a hemorrhagic stroke; a vessel had burst and blood was leaking into the left side of her brain, affecting the right side of her body. “Now I know that slurring of speech or not being able to talk is one of the symptoms of a stroke,” says Murray. (Here are the signs of stroke you may be ignoring.)

Strokes can occur at any age

The risk of stroke increases as people get older, and the conditions we associate with an increased risk of stroke—high blood pressure, diabetes, high cholesterol, and heart disease—also increase with age, but that doesn’t mean young adults can’t have a stroke. (This 24 year old had a massive stroke two days after giving birth.)

“The truth is, strokes can occur at any age,” says Carolyn Brockington, MD, a vascular neurologist and director of the stroke center at Mount Sinai West and Mount Sinai Morningside Hospitals in New York City. “We look at all risk factors. In people under 45, that falls into three main categories: We look at their blood vessels for a specific injury, their heart for structural abnormality, and their blood [to see] whether they have underlying blood clotting issues.”

Know your individual and family risk factors for stroke

One important risk factor that Murray was unaware of before her stroke is that she had a family history of the cerebrovascular events. Murray never knew her maternal grandfather, but discovered her mom had lost her own father to a stroke.

“My mom doesn’t show emotions well, so she just asked me a lot of questions even though all I could do was shake my head yes or no. It was like déjà vu for her when she found out about my stroke. It was scary for her,” says Murray.

“I think that’s partially the reason why I didn’t know [about my grandfather]. I’ve noticed in the African American community that we don’t talk about death a lot, we talk about how they lived,” she says. “So to associate the way someone died and to wonder how it could affect my life medically, that never crossed my mind. It probably never came across my family members’ minds either. But now they know. Seven people in my family, including my brother, have had strokes.”

Dr. Brockington underscores the importance of knowing genetic and individual risk factors. “We can’t change our family, but we can change some of the conditions that we have and control them better. We can eat better and be more active. We know those things promote a healthy body, as well as a healthy mind,” says Dr. Brockington. “People can take charge of their own lives and really reduce the risk of [stroke] happening at all.”

Women and stroke risk

The American Heart Association (AHA) reports that cardiovascular disease, or CVD, (including coronary heart disease, heart failure, hypertension, and stroke) affected 48% of adults, or 121.5 million people, over the age of 20 in the U.S. in 2016.

Each year, about 600,000 more females than males have a stroke, according to the AHA 2020 Heart Disease and Stroke Statistical Update, and approximately one in three black female deaths are from cardiovascular disease. (More than half, or 57%, of black women have CVD.)

Dr. Brockington explains that women have unique stroke risk factors beyond the traditional risk factors, including an increased risk of blood clot formation. “There’s a predominance of blood clotting abnormalities in women that may have a hormonal influence,” says Dr. Brockington. A slightly increased risk of stroke and heart attacks can affect women at certain points in their lives, including during pregnancy, and when taking supplemental hormones, either oral contraceptives or during menopause.

Another unique risk factor for women is migraine with aura. Although men get migraines too, it’s more common in women. Dr. Brockington says there may be an association between stroke and migraine with aura, as both have a vascular component. “It’s important to discuss risk factors with your doctor. Up to 80% of strokes can be prevented,” says Dr. Brockington. “That’s a pretty big number. If you know your own risk factors, you’re able to identify, modify, or control them long term.” (Make sure you know the stroke symptoms women are likely to ignore.)

Diet and stroke risk

Ileana L. Piña, MD, a heart failure and cardiac transplantation cardiologist who serves as a senior staff fellow and medical reviewer to the U.S. Food and Drug Administration’s Center for Devices and Radiological Health, notes that there’s a link between diet and stroke risk.

“About 45 percent of U.S. deaths caused by heart disease, stroke, and type 2 diabetes are because of poor dietary habits, such as high sodium intake, high sugary drink consumption and low intake of fruits and vegetables,” she says, according to a 2017 JAMA study.

Before the stroke, Murray says she exercised but her diet was not as healthy as it could have been. Now she sees a neurologist who has given her advice on how to eat better to prevent stroke.

“You can reduce your chances of stroke by 80% just by eating right and working out. It’s preventable. I used to eat whatever I wanted, now I’m more conscious. I think about carbs and my sugar intake,” says Murray, who also works with a trainer and has a more consistent exercise routine. “I lost about 30 lbs. at one point, but I’m still working on it. It would be nice to see a nutritionist, but strokes aren’t cheap. It took me a long time to recover budget-wise from medical bills and expenses.”

Dr. Piña says the reasons are not clear why African Americans have an increased risk of stroke, but “over two-thirds of black Americans have at least one risk factor for stroke: High blood pressure, overweight and obesity, diabetes, high cholesterol, sickle cell anemia—this common genetic disorder in African Americans is a risk factor for stroke and smoking.”

How she recovered from a stroke

After having a stroke, Murray was told to see a neurologist who gave her a prescription for Lipitor, a cholesterol medication, among other treatments. She was also told to get a lot of rest, because sleeping encourages brain health and helps the brain heal. Murray says she felt tired and weak for a long time, and she stayed at her mother’s house for about two months. Her family was worried about her living alone.

To treat her speech difficulties post-stroke, Murray began seeing a speech therapist three times a week for six months. “She literally taught me how to talk again,” says Murray. “She would give me assignments, such as talking for one hour on the phone every day. I have a huge family, and they’d call me back-to-back. So instead of talking for one hour, I’d talk about five hours each day. That really helped. If I hadn’t had that conversation and repetition, I definitely wouldn’t have recovered as fast as I did.”

A second stroke and a wave of depression

About three months after the first stroke, Murray recalls the therapist saying “Hey, I think you were pretty close to normal, and now it seems like you’re going backwards.” There were syllables Murray had been able to say previously, but suddenly couldn’t again. The therapist recommended she see a doctor and have another MRI. Sure enough, it confirmed that Murray had had another stroke; this time it was an ischemic stroke. “It was a blood clot, constricting the blood from reaching vessels in my brain,” she explains.

“I always felt tired and weak after the initial stroke,” Murray recalls, “so I didn’t see a difference when I had the second. I still didn’t know the signs or symptoms at the time. I didn’t know you’re more likely to have another stroke after your first one,” says Murray.

After the strokes, Murray went through a severe depression. “I thought it’d be better to be dead. That’s another symptom; people tend to get depressed after a stroke,” she says. “I needed help. I was not myself. There was me before the stroke and me after the stroke. I had to get used to a new normal. It took about four years after the stroke until I felt I could speak and the words came out the way I was trying to say them.”

Murray says that depression is an ongoing battle. “After the second stroke, that depression lasted about a year. I didn’t know I was depressed for a long time, until I started to think about ways to kill myself. I would think I was a burden to my family, to my friends,” recalls Murray. “I didn’t have much of a life because I was scared to go outside and scared to talk to people.”

“There was this feeling that I was no longer intelligent, that I was no longer this person who could hold a conversation. Once I started having those thoughts, I knew I needed help, but I was scared to tell anybody.” she says. “So I went to church. And it was so odd, my pastor talked about depression for a whole week. A lot of people talked about what they were going through, and hearing them talk really helped me.”

If you or someone you know has had thoughts of self-harm or suicide, contact the National Suicide Prevention Lifeline (1-800-273-8255), which provides 24/7, free, confidential support for people in distress.

Exercise and therapy helped her depression

Murray decided to see a therapist and asked him for ways to work through depression without having to take medication. He suggested beneficial activities like reading books, working out, going outside, going on bike rides. She began to do each thing on the list regularly.

“I would listen to documentaries and books on YouTube to keep my mind occupied, to keep me thinking. Then came a craving to learn more, to do more, just to be more, and that helped me get out of the depression,” she says.

Murray credits one book, The Obstacle Is the Way: The Timeless Art of Turning Trials into Triumph by Ryan Holiday, as particularly helpful.

Challenges and rehabilitation

Many stroke patients also have residual weakness in the muscles on one side of their body. Murray has arm weakness, so she concentrates on strength training at the gym. “Opening water bottles was hard for me post-stroke,” she recalls. “Now I can do it no problem, but something simple like that was hard.” A patient’s face may look different after a stroke, as well.

“I had this crooked smile. I still do sometimes,” says Murray, whose speech therapist assigned her tongue muscle exercises and to watch herself talking in a mirror.

Memory loss is another side effect for many people after a stroke, says the American Stroke Association. Murray says a combination of both short and long term memory loss is her number one side effect. “People would tell me places I’ve been and I didn’t remember,” says Murray. “Or I might leave the stove or oven on, and I’d leave or go to sleep and not think anything of it until I smelled something burning.”

Since Murray lives by herself, she says her family often checks in on her, especially her mother. Sometimes she has memory loss related to directions and driving routes, even just getting home from work, so she uses GPS more frequently now.

She also experiences anxiety. “If I’m driving down the street and have a stroke and can’t speak, my fear is not being able to tell people what’s happening to me,” she says. “Or if I don’t know where I am, I’m scared I won’t be able to explain that I need help.”

How to recognize stroke symptoms using F.A.S.T.

Murray’s fears are also motivating factors for her to help others learn the signs of stroke, especially minorities and people with family histories similar to her own. “It’s a good feeling, being able to teach people what the signs are and tell them my story. With the depression, I felt I was wasting my life away. But if I can help one person, that’s fulfilling,” she says.

Both Murray and Dr. Brockington stress the importance of knowing the signs of a stroke via the acronym F.A.S.T.: “F” for face drooping,. “A” for arm weakness, “S” for slurred speech, and “T” means time, as in time to call 911. (And also that time is of the essence—the quicker the treatment, the less likely the chances of brain injury.)

Courtesy Dwayne Murray

A special trip to Hawaii

In 2016, two years after surviving the strokes, Murray planned a special trip to Hawaii. She was going to visit her brother who was in the military and stationed in Oahu. Unfortunately, Murray lost her job right before the trip and was worried about expenses, but her brother convinced her to come anyway. He said there was a mountain they needed to climb together.

She was still weak with low energy, but Murray prepared for the trek by working out for weeks in advance.

“We climbed the Kuliouou mountain my second day. It took about two and a half hours to get to the top. Granted I walked a bit slow, but I set a goal for myself and knew I had to just keep going,” says Murray. “I made it to the top and burst into tears. One, it was beautiful. Two, I was so happy I made it. I would’ve missed out on such a beautiful view had I decided to end my own life. And getting to the top made me realize I had succeeded, and there were so many more mountains I could climb. I had already gotten over the ‘stroke mountain.'”

Stroke and feelings of depression during Covid-19

Currently, Murray worries about slipping back into depression. “The Covid-19 pandemic almost takes you back there because you’re stuck in the house, and you can’t really do much or go out,” says Murray. “I’m still working to process my feelings of uncertainty and fear. I made a point to work closely with my amazing health care team to understand my risk for Covid-19 as a woman of color and stroke survivor. What I am coming to find,” she says, “is our doctors need to know more about how Covid-19 affects women like me—women of color, women who are survivors.”

In light of a recent article in the New England Journal of Medicine (NEJM) that linked Covid-19 to strokes in younger adults, it’s more important than ever to know your family history, vitals, risk factors and symptoms related to stroke and heart disease, says Dr. Brockington

Not only has there been a spike in the number of strokes and heart attacks nationwide since the pandemic, but there’s also been a spike in the sub-group of young adults with no traditional risk factors who are having strokes, says Dr. Brockington.

“Within this Covid crisis, patients are coming in at ages 25-49 with no traditional risk factors, but having very large strokes. The research is early, but there’s some suggestion that maybe this virus produces an exaggerated inflammatory or immune response in some people, and that causes blood clotting, and the blood clots can go to the brain causing a stroke, to the heart causing a heart attack, or to the lungs causing respiratory compromise,” Dr. Brockington explains.

Although much of the Covid-19 research is preliminary and focused on a small group of patients, Dr. Brockington thinks the take-home message is that these younger patients wouldn’t have normally been expected to have an increased risk of stroke.

Dr. Piña adds that while data on race, under-resourced communities, and the coronavirus is too limited to draw conclusions, “a disproportionately high rate of sickness—and death—seem to be emerging, particularly among people of color.” She stresses that members of under-resourced communities are less likely to have access to quality healthcare.

Have a plan in case of emergency

Murray stresses the importance of a positive patient-doctor relationship when it comes to getting good healthcare. “I realized going through this that it’s really hard to find a doctor that listens and talks to me without looking over or through me. I had to keep searching. I know people of color, especially women, have that issue,” she says. “I didn’t feel like I was getting the treatment I needed. It’s OK to switch and find someone else.”

Murray’s last piece of advice: Have a plan, and always have someone in your corner looking after you. “If you live alone, have somebody you can call or a neighbor in a case of an emergency. It’s a great benefit to get to the hospital as soon as possible.”

Dr. Piña concurs. “It’s important to remember that even during the pandemic, if you are having an emergency, such as heart attack or stroke, call 911,” she recommends. “Some hospitals may be crowded due to Covid-19, but emergency systems have plans to ensure appropriate treatment. Getting care as soon as possible improves the chances of survival, and first responders are well trained to avoid spreading germs.”