KATHMANDU, Oct 30: Strokes are widely perceived as a condition affecting the elderly. However, due to unhealthy lifestyles, the number of young people in Nepal suffering from brain strokes has been steadily increasing, according to medical experts.
Dr. Subash Phuyal, a neurointervention radiologist at the Neurology Department of Tribhuvan University Teaching Hospital (TUTH), said that in recent years, stroke cases have been seen even among people in their early to mid-30s. Many of these patients are young individuals who consume alcohol, smoke, or use drugs, or those with heart-related diseases.
According to Dr. Phuyal, out of about 300 patients he treated in recent years, 8–10 percent were young adults. Apart from this age group, the highest number of stroke cases are among people aged 40 to 50. The hospital receives an average of 250 stroke patients each year.
Similarly, Dr. Sunil Koirala, head of the Neurology Department at Bir Hospital, said that 10 percent of stroke patients treated there are aged 20 to 40 — considered the youth age group. Bir Hospital receives about 500 stroke patients annually.
Rising deaths and disabilities
Doctors noted that besides the elderly, the 40–60 age group also has a significant number of stroke cases. The growing number of strokes among different age groups has led to a rise in permanent disability and premature deaths in Nepal.
In 2010–11, stroke was the fifth leading cause of death and disability due to vascular diseases in Nepal, but by 2021–22, it had risen to third place. Statistics show that 20,000 to 30,000 people suffer strokes every year in Nepal, and about 8 percent die from stroke-related complications. Globally, one in four people is likely to experience some form of stroke in their lifetime.
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What is stroke?
Our heart and brain are connected by large and small blood vessels. When a blood vessel supplying the heart is blocked, it causes a heart attack; when one supplying the brain is blocked or ruptured, it causes a brain stroke.
The brain contains centers that control various body functions — such as movement of the hands, legs, eyes, and mouth. These centers rely on proper blood flow to function. When blood circulation stops due to a blockage, brain cells begin to die, leading to paralysis or loss of function in corresponding body parts.
Common stroke symptoms include slurred speech, facial drooping, and weakness or paralysis on one side of the body. If any of these symptoms appear, the patient should be immediately taken to a hospital with neuro services, or to the nearest hospital if unavailable.
The “Golden Hour” for treatment
Doctors refer to the first 4.5 hours after a stroke as the “golden hour.” If treatment begins within this period, the blocked blood clot can often be dissolved with medication — a procedure called thrombolysis.
If the main artery of the brain is blocked, doctors can insert a wire into the artery within 24 hours to remove the clot — a treatment known as mechanical thrombectomy. If performed within this timeframe, the procedure can restore movement and function. However, if patients arrive late, brain damage becomes irreversible, said Dr. Koirala.
Lack of awareness leading to delays
Doctors say most people in Nepal still lack awareness of stroke symptoms and the importance of early treatment. At Bir Hospital, only 10 percent of stroke patients arrive within the golden hour, while the remaining 90 percent come too late.
At TUTH, around 70 percent of stroke patients also arrive late, according to Dr. Phuyal. “Most come after 24 hours. By then, the brain cells are already dead, and there’s little we can do,” he said. Dr. Koirala added that less than 1 percent of patients reach the hospital within the golden hour, and only 4–5 percent arrive within 24 hours.
Doctors emphasized the importance of public awareness and the BE FAST rule — which stands for Balance, Eyes, Face, Arm, Speech, and Time. If someone experiences sudden balance problems, blurred vision, facial drooping, weak arms, or slurred speech, they should immediately go to a hospital.
Lifestyle factors behind youth stroke
According to Dr. Koirala, there are two main categories of stroke risk factors: non-modifiable and modifiable. Non-modifiable factors include old age, family history, gender (male), and Asian ethnicity.
Modifiable factors — now the leading cause among Nepali youth — include stress, sedentary lifestyles, unhealthy diets, lack of sleep, smoking, alcohol consumption, and high cholesterol.
Doctors said that due to such habits, young people are increasingly suffering from high blood pressure, diabetes, and high cholesterol — all of which increase stroke risk. “Young people today sleep less and live under constant stress,” said Dr. Phuyal.
Prevention and modern treatment
Doctors noted that treatment options in Nepal have improved in recent years with access to modern technologies and medicines. To prevent strokes, they recommend adopting a healthy lifestyle — maintaining a balanced diet, avoiding smoking and drinking, exercising regularly, controlling blood pressure and diabetes, and managing stress.
If symptoms occur, patients should seek immediate medical attention. The government has started distributing thrombolysis medicines free of cost, now available in general hospitals outside Kathmandu Valley, according to the Ministry of Health and Population.
Mechanical thrombectomy treatment has also become more accessible in Nepal in recent years. The procedure is now available at TUTH, Kathmandu Medical College, Annapurna Neuro Hospital, Grande Hospital, and Neuro Hospital. Doctors say if patients reach these hospitals within 24 hours of symptom onset, timely treatment can save lives and prevent disability.
