Brain haemorrhages, though often associated with older adults, are increasingly observed in younger, seemingly healthy individuals in India, with a significant percentage of strokes in those aged 18-44 being haemorrhagic. This trend is attributed to rising risk factors in younger populations, including uncontrolled high blood pressure often exacerbated by chronic stress, poor sleep, sedentary lifestyles, and high-sodium diets. Additionally, structural abnormalities like arteriovenous malformations and aneurysms, along with cerebral venous sinus thrombosis and recreational drug use, can trigger brain bleeds in younger people. Urgent medical attention is crucial for symptoms such as sudden, severe "thunderclap" headaches, unilateral weakness or numbness, speech or vision difficulties, loss of balance, vomiting with headache, and altered consciousness, as delayed diagnosis due to mistaking symptoms for less serious conditions can negatively impact outcomes, highlighting the importance of regular health check-ups and prompt evaluation of neurological symptoms.

Brain haemorrhages, though often associated with older adults, are increasingly observed in younger, seemingly healthy individuals in India, with a significant percentage of strokes in those aged 18-44 being haemorrhagic. This trend is attributed to rising risk factors in younger populations, including uncontrolled high blood pressure often exacerbated by chronic stress, poor sleep, sedentary lifestyles, and high-sodium diets. Additionally, structural abnormalities like arteriovenous malformations and aneurysms, along with cerebral venous sinus thrombosis and recreational drug use, can trigger brain bleeds in younger people. Urgent medical attention is crucial for symptoms such as sudden, severe "thunderclap" headaches, unilateral weakness or numbness, speech or vision difficulties, loss of balance, vomiting with headache, and altered consciousness, as delayed diagnosis due to mistaking symptoms for less serious conditions can negatively impact outcomes, highlighting the importance of regular health check-ups and prompt evaluation of neurological symptoms.

Brain haemorrhages, though often associated with older adults, are increasingly observed in younger, seemingly healthy individuals in India, with a significant percentage of strokes in those aged 18-44 being haemorrhagic. This trend is attributed to rising risk factors in younger populations, including uncontrolled high blood pressure often exacerbated by chronic stress, poor sleep, sedentary lifestyles, and high-sodium diets. Additionally, structural abnormalities like arteriovenous malformations and aneurysms, along with cerebral venous sinus thrombosis and recreational drug use, can trigger brain bleeds in younger people. Urgent medical attention is crucial for symptoms such as sudden, severe "thunderclap" headaches, unilateral weakness or numbness, speech or vision difficulties, loss of balance, vomiting with headache, and altered consciousness, as delayed diagnosis due to mistaking symptoms for less serious conditions can negatively impact outcomes, highlighting the importance of regular health check-ups and prompt evaluation of neurological symptoms.

Brain haemorrhages are often thought of as a condition of old age or of people with long-term health problems like high blood pressure. These are important risk factors, but brain haemorrhages can also happen in much younger adults, even those who seem otherwise healthy and active.

A brain haemorrhage is bleeding in or around the brain and needs urgent medical treatment. Although not as prevalent in younger individuals, increased awareness of the risk factors and warning signs can help ensure timely diagnosis and treatment.

A shifting tendency

Stroke is generally of 2 types: ischemic (brain damage as a result of sudden stoppage of blood supply to an area of the brain) and hemorrhagic (bleeding in the brain). Recent studies have shown an increasing incidence of stroke among younger adults in India. A review of more than 34,000 stroke cases found that about 13.8% of them were in people between the ages of 18 and 44. Some experts also point to a slow increase in stroke risk factors in younger groups (people in their 20s, 30s, and 40s).

Haemorrhagic strokes, which are caused by bleeding within the brain, continue to be a major contributor to the overall burden of stroke in the country.

Why do young people get brain haemorrhages?

The term “healthy” may not always be indicative of the underlying vascular health. Uncontrolled high blood pressure is a major risk factor for brain haemorrhage. It is often called a “silent” condition because it may have no obvious symptoms. Other things that can raise blood pressure over time include chronic stress, lack of sleep, sedentary lifestyle, and high-sodium diets.

Structural abnormalities of blood vessels, such as arteriovenous malformations - AVMs (abnormal connections between arteries and veins, present since birth but detected much later in adult life) or ANEURYSMS (small balloon-like dilatations of the blood vessel wall), may cause brain haemorrhage in younger patients. Aneurysm rupture usually leads to “subarachnoid haemorrhage”.

Another significant condition is cerebral venous sinus thrombosis, a particular type of clot in the veins that drain blood from the brain. It can be associated with bleeding. Its risk factors include dehydration, anaemia, alcohol abuse, the postpartum period and some clotting disorders.

The use of recreational drugs is also a recognised risk factor, especially in younger adults, and may predispose susceptible individuals to brain haemorrhage.

What are the symptoms? 

A classic sign of subarachnoid haemorrhage is a sudden, severe headache that reaches its peak within seconds. Physicians often refer to this as a “thunderclap headache” because of its abrupt onset. Headaches of this type should be evaluated promptly, particularly if they are different from previous headaches.

Other symptoms which require immediate medical attention are:

*Sudden weakness or numbness in one side of the body

*Difficulties with speech or understanding speech

*Vomiting associated with headache (not proven to be due to migraine)

*Sudden changes in vision

*Loss of balance or coordination

*Reduced level of consciousness or loss of consciousness

These symptoms are not always a warning of a brain haemorrhage, but should not be ignored.

Why is seeing a doctor early important?

Evaluation in time is an important factor towards improving outcomes for patients with stroke and brain haemorrhage. But many people delay seeking medical attention because symptoms are mistaken for stress, fatigue, migraine or other less serious conditions. Also, risk factors such as hypertension, diabetes, obesity, sedentary lifestyles and excessive alcohol consumption are on the rise in younger adults.

Brain haemorrhages are still relatively rare in young, otherwise healthy people, but knowledge is important. Keeping up with regular health check-ups, monitoring blood pressure, understanding your family health history and seeking prompt medical attention for sudden neurological symptoms are ways to promote better brain health and outcomes.

It makes a big difference to be aware and alert to warning signs.

The author is a senior consultant in neurosurgery at Manipal Hospital, Yeshwanthpur. 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or the views of THE WEEK. 

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