Strokes are increasingly common in people under 55 years of age.

The Servet Stroke Unit, which treats nearly half of the cases in the region, speaks of the importance of prevention and detecting symptoms. The Neuroscience research group at the Aragón Health Research Institute, with Dr. Javier Marta as coordinator, focuses on cognitive impairment in young patients after stroke.

Stroke is not a disease that only affects older people.. In recent years, at least since 2017, cases have increased in people under 55, something that worries experts, who call for greater awareness to adopt healthy lifestylesPoor diet, smoking, and high blood pressure are the factors that increase the risk the most. Recognizing the symptoms is vital: for every minute that passes after the onset, two million neurons are lost, so reaction time is key.

Providing prompt and appropriate patient care clearly influences mortality. And, if the patient survives, it affects the severity of the after-effects, such as disability or dementia. Prevention efforts, early detection, and rapid care have managed to reduce mortality, although cerebrovascular diseases still account for 8% of deaths, according to the Spanish Society of Neurology (SEN). Each year, approximately 2.200 strokes are admitted to Aragon, around a thousand of which are in the Servet (Health Service). It is the leading cause of death in women and the third in men in the region.

In Aragon, with more than 1,3 million inhabitants and 47.000 square kilometers of area, the dispersion of the population and its aging make care difficult, so In 2009, the Stroke Plan was launched, updated in 2024., whose main objective is to ensure that any citizen anywhere has access to rapid, quality healthcare, which has allowed mortality to be reduced by 40% in 15 years.

This is explained by neurologist Javier Marta, head of the Servet Stroke Unit and clinical coordinator of the Aragon Stroke Plan. In 2016, another turning point in stroke care occurred with the approval at Servet of thrombectomies, a neurointerventional technique, Very efficient but highly complex, it allows the extraction of the thrombus that blocks blood circulation.

The stroke unit at the Miguel Servet University Hospital in Zaragoza has a common room for semi-critical patients with six beds, as well as three rooms—one double and two single—for less severely ill patients, where they can be accompanied by family members. The service is committed to a more personalized approach to care: "It's important to humanize care, giving patients what they need while taking their comfort and well-being into account."There's a small room for rehabilitation therapies, as it's important to develop a recovery plan from the first few days. Patients then move to the Neurology ward.

"Time is brain"

«Every 15 minutes of delay increases the probability of becoming dependent for life or dying by 4%."Hence the importance of the message 'time is brain,'" he explains. "Strokes are almost never painful, so you have to know how to recognize what's happening so you don't make the mistake, as many people did before, of lying down at home for a while to see if it goes away," Dr. Marta summarizes. "That's the worst part, because what's really happening is that the patient is suffering a brain injury due to a lack of blood flow, and we only have a few minutes to avoid a heart attack, in other words, an irreversible injury, large or small." "Stroke means sudden," he specifies. "It's a brain problem due to a vascular problem, either because an artery has become blocked, which is a cerebral infarction, or because an artery has ruptured, which is a cerebral hemorrhage." That's why "recognizing the symptoms and receiving prompt care is so important."

The circuit starts with a call 061 Aragón, whose professionals ask a series of questions to detect the problem and activate the stroke code. Through a three-way call with healthcare professionals and the family, the severity of the problem is assessed and a decision is made as to which hospital to refer the patient to.

Among the causes, 75% are cerebral infarcts, 10% are transient ischemic attacks and 15% are cerebral hemorrhages.. For the first two reasons, approximately 20% of patients die during the first three months, 9% of them during admission. "Cerebral hemorrhages," says the clinical coordinator of the Aragon Stroke Plan, "are less common but more fatal." Approximately 45% of patients die in the first three months, 30% of them during admission.

The average age at stroke is 75 years: "But we have a specific category of patients that we call young stroke, which is under 50 years of age, and proportionally, there are more and more of them. Vascular health at age 50 is worse than it was two decades ago, due to lifestyle. And that worries us. "The profile is changing: Among the elderly, the age of the first stroke is delayed, but we are increasingly seeing more patients under 55 years of age.", she explains. Cases in this age group represent 15% of the total and are increasing: "In young women, cases of subarachnoid hemorrhage are increasing, and in men, ischemic stroke." Among the female population of this age, approximately three in ten die upon admission. As for ischemic stroke (a heart attack due to lack of blood flow), "mortality is low, so the concern is not so much saving lives as preventing further episodes." This trend experts link to "lifestyle, diet, sedentary lifestyle, smoking..." Drug use also contributes to these events among the population, especially cocaine.

Hence, reiterates Dr. Javier Marta, the importance of insisting on the health education from school And at every opportunity, including hospital admission, where nursing plays a key role: "There's a WHO campaign that goes by the slogan: 'The brain is for life, take care of it,' and brain health strategies should be implemented at every age. In children, avoid childhood obesity; in adolescents, stop normalizing alcohol and tobacco; in middle age, take care of blood pressure and avoid stress. You can reach 50 with the same arteries you had at 35 or as they would have been at 70: What you sow before 50, you reap at 70.

From the Neuroscience research group at the Aragón Health Research Institute, with Dr. Javier Marta as coordinator, one of its core areas (Ictus-cog) focuses on cognitive impairment in young patients after a stroke. Many patients are left with cognitive aftereffects, which are not as visible but can be significant.

A coordinated response

Within the Stroke Plan, they are monitored every six months The response times of the healthcare system to a stroke in Aragon and an annual report is prepared. From the moment a patient experiences the event until they report it and are evaluated by a neurologist, an average of 180 minutes elapses. "The idea would be to shorten this timeframe as much as possible, and that depends on the general population being aware of the symptoms and seeking help at 061, at their health center, or by going to an emergency room," he explains.

Once in the hospital, he continues, there are between 45 and 60 minutes to start treatment, "which can be catheterization or fibrinolysis (a drug-induced process that involves dissolving blood clots or thrombi through the degradation of fibrin). Once in the catheterization room, we manage to open the artery... in 80% of cases and in less than 35 minutes on average," he adds.

Source: Heraldo de Aragón

Photograph: Part of the stroke unit team at the Miguel Servet University Hospital in Zaragoza. Marcos Cebrián