For Young Stroke Survivors, A Long And Uncertain Future

A week before Shannel Pearman gave birth to her first child, she started experiencing bizarre symptoms. Her blood pressure was high, she gained an immense amount of weight quickly, and she was exceptionally swollen. She complained to her doctor, who said everything was normal. After running some tests, she was eventually sent home. 

Pearman, who was 29 at the time, still didn’t feel well, so she contacted her doctor again. Once again, they dismissed her concerns. 

A week later, Pearman successfully delivered her baby through an emergency C-section and had a few days of bliss with her newborn son— although her symptoms never went away. And then, several days after giving birth, something terrible happened.

It was a perfect Saturday in 2019. Pearman says she and her husband Jared had family over to meet her infant son, Jayce, for the first time. Toward the evening, Pearman began experiencing an excruciating headache. She wanted to sleep it off — but her newborn was crying and keeping her awake. Then, she had the urge to throw up. 

“I remember looking up at Jared with my head still in the toilet, and then all of a sudden half of my vision went,” Pearman said, “I remember not being able to see half of his face.”

Pearman called her mom, a nurse, who instructed her to go to the hospital immediately. She, Jared, and their one-week-old baby hopped in the car and went to a Baltimore hospital. Her mom and stepdad drove from Delaware to meet them there.

“The hospital thought it was pregnancy-related. It wasn’t until my mom asked the nurses, “What did the CT scan show?’ And the nurse told my mom that they didn’t run a CT scan. And mom lost it,” Pearman said. “They ordered the CT scan right after. And that’s when they saw that I had a brain hemorrhage.”

“My brain had been bleeding all this time. I had had a stroke.”

The official diagnosis: postpartum preeclampsia, a potentially dangerous pregnancy complication characterized by high blood pressure. According to Pearman, the signs were there all along. Preeclampsia can be controlled with medication when caught in time. But when it’s not treated, it causes elevated blood pressure, which can cause a brain hemorrhage or stroke. 

“Thankfully, Jayce was being a newborn baby and doing what newborn babies do, and he was just crying and fussing and would not go to sleep that night,” Pearman said. “Jayce was my angel, and he saved my life by keeping me awake.”

Pearman was transferred to a more advanced hospital where she had emergency brain surgery. As she recovered, she learned the brain bleed was close to hitting the part of her brain that controls motor skills. 

Two years later, the road to recovery has been long and arduous. Pearman has peripheral vision loss in both eyes, and the stroke caused a multitude of cognitive issues. The first-time mom, wife, and former television news reporter in Baltimore says her life was close to perfect. Now, she doesn’t drive, she’s lost her job and career, and she battles with daily headaches, depression, and anxiety. 

As a young stroke survivor, she says, her future is uncertain, and that there are so many layers to stroke recovery.

“The initial part of recovery is dealing with the physical aspect. Even though I wasn’t permanently paralyzed, I did have weakness on my left side, so I had to learn how to walk again. And I had to recover from emergency brain surgery and then a second brain surgery because I had my skull removed to help my brain heal. So I essentially had two brain surgeries that I had to heal from.”

“So there’s the physical aspect of healing from a stroke. And then there’s the emotional aspect of dealing with the anxiety, the depression, and emotions that come with trying to process what happened. Why did this happen? And what will my life look like now?” 

Strokes in young people are uncommon; about 10 to 15 percent of strokes occur in children and adults under 45. According to Dr. Raymond Mirasol, an Assistant Professor of Neurology and Stroke at Rutgers, Robert Wood Johnson Medical School, there are two main strokes: ischemic and hemorrhagic. Ischemic strokes result from artery-blood clots that travel to the brain; these are the more common type of stroke. Hemorrhagic strokes are less common, and happen when a blood vessel in or near the brain ruptures. 

Generally, Dr. Mirasol says, young people don’t have the traditional vascular risk factors that predispose them to strokes, meaning care looks a bit different when a young person comes into the hospital with stroke symptoms.

“We work to exclude traditional risk factors. But we almost invariably go on to do a more intensive workup that includes screening for genetic causes of increased coagulation or structural abnormalities of their heart that might predispose to clot formation,” Dr. Mirasol explained.

23-year-old Olivia Lewis had four strokes during her senior year in college, about two years ago. They were the result of bilateral vertebral artery tears on both sides of her neck. The tears led to excessive bleeding and blood clotting, which blocked blood flow and oxygen to her brain, causing the strokes. Lewis and her doctors still have no idea what caused the tears in her neck, which ultimately led to the strokes and then to something called locked-in syndrome. 

According to the National Center for Advancing Traditional Sciences, locked-in syndrome is a rare neurological disorder characterized by complete paralysis of voluntary muscles, except for those that control the eyes. People with locked-in syndrome are conscious and can think and reason but are unable to speak or move. It is an extremely rare disorder with no treatment or cure.

Because most people don’t typically recover from locked-in syndrome, Lewis says, doctors immediately told her family she’d have to be put in a nursing home— something her family refused to do.

“I think that a lot of the medical professionals that were working with me were trying their best in what my situation was, and they, you know, they thought that the nursing home was my only option,” Lewis said. 

“But I think because of that, I mean, I had to make my own path.”

Remarkably, Lewis has fully recovered. After months of inpatient and outpatient therapy, she went from being immobile to using a power wheelchair, using a manual wheelchair, a cane, and now being able to walk— even though she still has a slight limp. She also went from being unable to speak to being entirely verbal once again. 

“I like to say that everything is impossible until it’s done. I feel like I said that to myself my whole recovery because every single person had no idea what was possible, and was very negative, so I had to make it possible for myself and everyone else,” she said. 

There is no magic pill. Everyone’s stroke recovery looks different. But according to Dr. Mirasol, medical professionals hold out more hope that young stroke survivors will be able to recover fully, or at least partially, because of the durability of a younger brain. 

“There’s the side where these patients are so young, and then they become disabled early on in life, and there are all these years of medical care that they’re going to have to have. If they become severely disabled, they will potentially need supportive treatment for the rest of their life,” Dr. Mirasol explained. “On the other hand, when patients are younger, they have a more cerebral reserve, meaning that they have a greater ability for their brain to adapt to injuries that occur to them.” 

“So, you know, from a personal standpoint, there’s all these years of disability that they are potentially facing. From an economic standpoint, it leads to even greater losses than an older patient, who we wouldn’t expect to have that many working years left. But on the other hand, we hold out a little more hope that they can potentially recover more than an older stroke patient can. That’s a potential saving grace for them.”

But the recovery process — Lewis and Pearman said — is grueling.

After Lewis’s stroke, her relationship with her boyfriend ended. Her friends were all going off to college and beginning what many consider “the start of a person’s life.” Instead of graduating and beginning her career in advertising, Lewis was instead learning how to walk, talk, and perform basic life skills again. 

She has since gone back to school and just graduated college. She started The New Brain Foundation to spread awareness about young strokes and brain injury while helping other young stroke survivors feel less alone, something she says she often felt. 

After her stroke, Pearman had similar feelings, while wrestling with her new reality.  

“I still fear for my future, and it honestly results in lots of tears and a lot of therapy sessions,” Pearman said. “But it’s the uncertainty of my future in pretty much every aspect of my life… my future career, you know, what does that even look like?”

Pearman had worked tirelessly for years to become a television news reporter. She studied journalism in college and spent years in small television markets, ending in Baltimore. But after her stroke, Pearman lost her job. She still doesn’t know if she’ll be able to get a job in the industry again. 

She also fears what her future will look like as a mother — especially since she is still very much entirely dependent on her family. Pearman still can’t drive; she feels as though she’s lost much independence. 

“The thoughts of all the things that I wanted to do with my son that I know I am not able to do. I’ve never been able to take my son out on a drive anywhere. I can’t just take Jayce to a park by myself, and take mommy and me classes with Jayce and do all the things that I wanted to do,” she said.

“The stroke robbed me of the future that I worked so hard to create and dreamt of.”

To cope, Pearman goes to therapy, which she started during the early days of her recovery. Here, she talks about the struggles she faces now and the fact that she feels her stroke would have never happened if her doctors had listened to her concerns before giving birth. 

Pearman believes her stroke resulted from inherent bias in the medical field against Black people — specifically women. 

According to Stacey Stewart, the president and CEO of March of Dimes, there has been a maternal and infant health crisis for all women in the United States for years. The U.S. is already among the most dangerous of the developed nations in the world to give birth. For people of color, that danger is even worse. 

Every year, Stewart says, 700-900 women die in the United States due to pregnancy and childbirth complications, and another 50,000 women come close to death in what are called ‘near misses.’ Black women die at a rate of three to four times compared to white women.

“I can’t speak exactly on my doctor’s mindset, but I do believe that there are inherent biases within the healthcare profession, where Black women are constantly dismissed, and their concerns aren’t heard. And I do believe that I was one of those people,” Pearman said.

“I had clear concerns, and my concerns were dismissed and ultimately led to my stroke.”

Pearman is working on getting her life back — at least as close as possible, although currently, she still feels stuck in limbo — unsure of what’s next and what the future holds. 

What keeps her going is her husband and son, who is now two years old.

“Being a young stroke survivor is more than just surviving the initial event of having a stroke,” Pearman said. 

“For a lot of us, we can heal from the physical wounds, whether it’s brain surgery or whatever the case may be. But there’s a whole other layer of recovery that happens that I don’t think a lot of people know, or could fully understand or grasp.”

“I know for myself, most of my disabilities are invisible. So when people look at me, they think I’m healed, and I’m recovered, and I’m okay now. And they have no idea of the day-to-day struggles or issues that I go through.”

Dr. Mirasol recommends the public be aware of the BE FAST campaign to help identify if you are having a stroke:

B- is for balance issues (if a person develops acute balance issues that can’t be explained.)

E- is for eyes (if a person has sudden, onset visual problems like double vision)

F- is for face (if a person notices a droop in their face, especially on one side.)

A- is for arms (if a person has trouble moving one arm, hands or fingers.) 

S- is for speech abnormalities (if a person has a sudden onset, slurred speech, or difficulty understanding speech or producing speech.) 

T- is for time (a reminder that if symptoms are recognized, a person should rush to the ER as the faster the stroke is caught and treatment is started, the more substantial possibility of recovery.