Having your hair done - or reversing a car. The number of young people getting strokes is on the rise A stroke occurs when blood flow to the brain is interrupted Obesity and other lifestyle factors are thought to be the primary cause In a quarter of cases in under-45s, the cause is a tear inside an artery This tear will be triggered by some form of trauma, often quite trivial By Lucy Elkins Nurse Cija Smith had always longed to try bungee jumping, so when she was travelling in New Zealand earlier this year, she took the plunge. The experience was every bit as exhilarating as she'd hoped. But immediately after, she started to have tunnel vision. 'I couldn't see at the side, just ahead. I thought I was maybe feeling a bit faint because of the jump,' recalls Cija, 32. Months of treatment: Cija Smith, a 31-year-old nurse, had intensive speech and language therapy at the hospital and at home Then a few hours later I developed a throbbing headache on the left side, but I had been travelling for a few months by then and thought I was just tired and ready to go home, so I took a paracetamol and went to bed. A week later, on April 1, she was back at home in Starston, Norfolk, with boyfriend Byron Trigg, 43, a scaffolder, when she woke up in the night feeling unwell. 'I just didn't feel right and went to get out of bed and collapsed,' says Cija. My right side was totally paralysed and my speech had gone - but luckily Byron, who was downstairs, heard me fall. Cija was rushed by ambulance to her local hospital where a CT scan revealed a tear in an artery in her neck which had caused a blood clot and a stroke. 'Being a nurse I knew as soon as I collapsed that it was a stroke,' says Cija. 'I'd worked on a stroke unit during my training and I'd seen people left unable to speak at all and stuck in a wheelchair for the rest of their life. 'I was hoping that it was a minor stroke, and that I'd be fine, but I was terrified.' Trigger: Cija's bungee jumping escapade resulted in a tear inside an artery, leading to her strokes Fortunately, her movement returned within hours, but while her speech showed some improvement - within a day she could say the odd word - it was very slurred. Then, three days after the initial stroke and while she was still in hospital, Cija felt tunnel vision coming on again. I felt this pain building in my head. Then I lost my speech completely again and my body went into spasm; my right side was completely paralysed, but whereas after the first one the paralysis eased off, this time that didn't happen,' she says. Swelling from the initial stroke had caused a second one and Cija was moved to Addenbrooke's Hospital in Cambridge, which had the facilities for surgery should the swelling increase. 'I kept thinking: "This can't be happening to me," ' recalls Cija. It was so scary because I had no means of telling people what I was thinking or feeling. Strokes are usually associated with old age, but while the rate in older people has declined by 40 per cent since the mid-Nineties, the figure for younger people is rising; the number of those aged 20 to 64 affected is up by a quarter worldwide, according to new figures. As many as a quarter of strokes in the UK each year are in the under-65s. Obesity and other lifestyle factors are thought to be the primary cause. A stroke occurs when blood flow to the brain is interrupted, usually because of a blood clot. And in around a quarter of cases in the under-45s, the cause is a tear - or 'dissection' - inside an artery; this slows the blood flow, leading to a clot. The dissection rate in the under-45s is much higher than for all age groups, where it is 2 per cent. 'I kept thinking: "This can't be happening to me." 'The tear will be triggered by some form of trauma that can be quite trivial,' explains Dr Richard Perry, a consultant neurologist at University College Hospital London. We hear quite a lot of people going to the hairdresser, putting their head back to have their hair washed and suffering a dissection. Doing the butterfly stroke swimming can also trigger it as it requires people to put their neck up quite suddenly. There have also been stories of strokes following a visit to the chiropractor where people have their neck 'cracked', he says. 'The symptoms of the stroke normally come on hours rather than days after the event,' adds Dr Perry. But most people can go through their life going to the hairdresser or even bungee-jumping without a dissection or a stroke, he says. 'That's why there is the idea -not proven - that there must be some predisposition,' he says. A study of people who'd had a dissection found they had very minor abnormalities in their collagen, a fibrous protein found in skin and blood vessels. 'There is also a theory that an infection may temporarily weaken the blood vessels - and if you ask someone who has had a dissection if they have had a chest infection in the preceding six weeks, a disproportionate number will tell you that they have,' adds Dr Perry. 'But with most people there is no way of telling they are at risk - not that this is that useful to know, because you can't tell people to spend the rest of their lives wrapped in cotton wool. 'We see people involved in horrific accidents who don't get one, and then we have someone who had one as they turned their neck reversing out of their drive.' The effects of a stroke depend on the part of the brain damaged - in Cija's case it was the central and left side, causing problems with language and movement on her right side. She spent six weeks in hospital having intensive physiotherapy, and when she was discharged, she could only walk the odd step with help, and was also unable to use her right arm. 'But my inability to speak fluently was by far the most disabling thing,' she says. Butterfly stroke: Swimming this way can trigger a stroke because it requires people to put their neck up quite suddenly In the beginning I could use the odd word, but it was slurred and I could not put a sentence together. Slowly, I got better, but I still found I struggled to find the right words. Once, a friend came to see me and rather than saying "You have lost weight," I said "You have gained weight." The physical effort of trying to find the right words was exhausting. Yet before my stroke I had been a talkative, sociable person. Around a third of stroke survivors are left with speaking difficulties, or 'aphasia'. There are several forms - receptive aphasia, a difficulty understanding what is said, expressive aphasia (which Cija had), which causes difficulties expressing yourself, or a combination. And not only do some have trouble finding their words, they may also slur. 'Life can be really frustrating for people left with speech difficulties,' says Katherine Staley, of the Stroke Association. Often symptoms will get worse under pressure - for example, if they are at the front of a long queue at the bank. Speech and language therapy can help, providing exercises to improve muscle co-ordination around the mouth, for instance. But access to speech and language services is 'very patchy' across the country, says Ms Staley. Some people with difficulties will be discharged from hospital without ever seeing a speech and language therapist again. And some stroke units have no speech and language therapists at all. Cija, however, was lucky - she had intensive speech and language therapy at hospital and at home. But it hasn't been easy. 'I avoided people to begin with because I was embarrassed at how little I could say,' she says. Her speech has recovered enough that she can handle most situations, 'but it requires thought and effort to talk'. It's good progress, probably helped by her young age. As Dr Perry explains: 'I see young people who have lost half a brain to a stroke, but two years later they walk back into my office and talk to me as normal. This would not happen with an older person. A lot of the recovery from a stroke is about the brain rewiring itself, and the younger brain is better at doing that. Six months since her stroke, Cija can walk independently but slowly. She hasn't regained the use of her right arm or hand so can't use a knife and fork or put on make-up. She takes a daily aspirin to prevent another stroke and hopes to return to work in the New Year. Despite what has happened she's glad she went bungee-jumping - 'although obviously I wish this hadn't happened to me'. She adds: 'Sometimes I get upset as this has affected me in so many ways - we were talking about trying for family before this, but we have put that on hold. 'But I'm determined to get on with life and make the best of it.' stroke.org.uk/aphasia