Young Adult Stroke Program

Overview

The Mass General Hospital Young Adult Stroke Program is designed to address the holistic needs of patients who suffer a stroke at a relatively young age. There is no specific age cut-off, but the program caters to adults who are in the workforce. Most patients are between ages 18-55 years.

We coordinate our work with both the main Mass General Stroke Service and the Pediatric Stroke and Cerebrovascular Service to ensure continuity of care for patients of all ages throughout their lives.

Young Stroke Patients Need More Than Just Medications

Compared to stroke in the elderly, stroke at young age leaves victims disabled in, or prior to, their most productive years. They need vocational counseling: more than half are unable to resume work and a quarter require changes in their jobs in order to resume work. Their stroke-induced cognitive, psychosocial, and personality changes need to be addressed. Stroke can impact their financial stability, family life, ability to cook, drive, participate in recreational activities, or how they care for their children. Having a stroke at young age can result in social stigma, anxiety, depression, and even divorce.

Program Goals

The goal of this program is to provide the highest quality of multidisciplinary care for patients and family/caregivers impacted by a stroke event, whether ischemic or hemorrhagic, or from cerebral venous sinus thrombosis. Our holistic approach is specifically designed to address the following issues:

• Appropriate diagnosis including referrals to medical specialists
• Evidence-based medical treatment
• Advise about rehabilitation
• Post-stroke depression, fatigue, anxiety, and personality changes
• Vocational guidance
• Genetic counseling if warranted
• Health insurance
• Admission to local and national stroke support groups

Our Approach

Our specialized team is comprised of stroke neurologists, headache specialists, vascular neurosurgeons, neuro-interventionalists, stroke nurses, stroke geneticists, rehabilitation specialists, and experts in cardiology, rheumatology, infectious diseases, psychiatry, and other fields of medicine. We provide vocational guidance and social support. In addition to these outpatient-focused activities, we have expertise in acute stroke management, neurocritical care, inpatient stroke management, and brain imaging. We collaborate with colleagues in the Mass General Brain Aneurysm Center and at Spaulding Rehabilitation Hospital.

About Young Stroke

Stroke is common in young individuals. Studies show that one-fourth to one-sixth of all strokes occur in adults below age 45 years. Stroke is slightly more common in men in this age group. Unfortunately the diagnosis is often delayed or missed because many people, including doctors, still considered stroke to be an ‘old person’ disease. Moreover, young individuals often present with less common stroke symptoms such as vomiting, headache, or sudden behavioral change. In young adults, approximately 50% of strokes are ischemic (i.e. blockage of a brain artery), 20% are intracerebral hemorrhages (i.e. from rupture of a brain artery into the brain), and 30% are subarachnoid hemorrhages (i.e. result from a rupture of a brain aneurysm), i ii iii. Cerebral venous sinus thrombosis (CSVT) can also cause ischemic and intracerebral stroke.

Ischemic strokes can result from a wide range of causes. Common causes include cerebral artery dissection, heart conditions such as Patent Foramen Ovale (PFO), the reversible cerebral vasoconstriction syndromes, infections like HIV and TB, genetic conditions, drug abuse, blood disorders, and cancers.

Hemorrhagic strokes also have a wide range of causes. Common causes include the rupture of brain aneurysms, subarachnoid hemorrhage, arterial malformations, blood disorders, the reversible cerebral vasoconstriction syndromes, and drug abuse.

Recent studies show that young stroke patients have a significant risk of getting a recurrent stroke, heart attack and mortality over the next 20 years. New strokes can be prevented by accurately diagnosing the cause of the first stroke and offering appropriate evidence-based treatment.

Regardless of the cause, certain lifestyle changes can reduce the risk of another stroke.

References

i Singhal AB, Biller J, Elkind MS, Fullerton HJ, Jauch EC, Kittner SJ, Levine DA, Levine SR. Recognition and management of stroke in young adults and adolescents. Neurology. 2013 Sep 17;81(12):1089-97. 

ii Jacobs BS, Boden-Albala B, Lin IF, Sacco RL. Stroke in the young in the northern Manhattan stroke study. Stroke 2002;33:2789–2793

iii Kissela BM, Khoury JC, Alwell K, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology 2012;79:1781–1787

Your Journey to Recovery

Stroke can be a devastating life event. You and your family members may be experiencing a variety of emotions and looking for answers concerning your prognosis, treatment, recovery and rehabilitation into the workforce. Our Young Adult Stroke service is here to help you, to offer hope, and to provide information and resources that will be useful to you and/or family members.

• Diagnosis –As stated accurate diagnosis is essential for appropriate management and to prevent new strokes... We can direct you to world-class experts, including cardiologists, rheumatologists, infectious disease specialists, and genetics experts if warranted.
• Treatment – Our specialists will prescribe guideline and evidence-based treatment
• Referrals to Experts – After your visit, our team will refer you to a recommended specialist
• Ancillary Needs – We will connect you with the appropriate resources based on your assessment such as driving and Social Work
• Rehabilitation – Spaulding Rehabilitation affiliation and Mass General therapists

All patients with symptoms of stroke, regardless of age, need to be assessed immediately by health care professionals. Please make an appointment. Your primary care physician can request a consultation with the Young Adult Stroke Service.

We offer second opinion services. Please note that no formal neuropsychological testing will be performed during your exam in the neurology clinic.

Your First Visit with Us

New patient Registration

New patients should contact the Mass General Registration and Referral Center at 866-211-6588 to receive a patient number and a Medical Record Number (MRN). Please have the following information available:

• Name
• Address
• Date of Birth
• Social security number
• Insurance information
• Emergency contact information

After you have registered as a new patient, call 617-726-8459. Service coordinator to make an appointment. The Young Adult Stroke Service is a multidisciplinary clinic, meaning that you may be scheduled to see up to three specialists at your appointment. For this reason, please anticipate that your clinic visit time may extend up to two hours.

Paperwork needed for your appointment

Be prepared to pay any insurance copayments and/or deductibles

Bring the following information with you to help you fill out any necessary paperwork:

• Insurance card, including your policy number and/or Medicare or Medicaid card
• Your referral from your PCP if required
• Name, address and phone number of your referring or primary care physician
• Health care proxy form

Patients treated at another facility

If treated at another facility, please bring copies your past medical records and scans must be received prior to your scheduled appointment. Please note that not all patients seen in the Stroke Clinic will have had all of these tests performed. Examples of prior medical records and tests necessary for this consult are:

• MRI or CT imaging
• Discharge summaries from any recent hospital admissions
• Reports from past neurologists
• Lab Results, especially Pro-clotting Studies (“hypercoagulation studies”) on child and/or parent
• Cardiology Reports or Echocardiogram Reports
• Neuropsychological testing
• Early intervention or school based developmental testing
• EEG reports
• Results from metabolic or biochemical testing

Unless otherwise specified, no other preparation is needed for your appointment.

Quick highlights of your visit with us

Pre-visit:

• Make an appointment and proved us with your medical paper in advance
• Arrive 15 minutes prior to your apt and anticipate a 1.5-2 hours for your first visit

During your Visit:

• Receive evaluation from our experts - may see up to three doctors during your appointment
• Neurological examination will be needed, depending on diagnosis
• Experts will discuss your findings and Plan of Care will be discussed with you
• Review and agree to a treatment plan
• Patient resources and referrals will be provided