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Can Stress Cause a Stroke? Plus 6 Uncommon Causes of Stroke to Know

stroke survivor lifting weights. Her stroke was likely caused by common and uncommon causes

People say it all the time when caught off-guard or stressed out. “You almost gave me a stroke!” But can stress cause a stroke? Or is that just an exaggeration? Nope, stress can up your stroke risk. And here are 6 more uncommon causes of stroke you need to know about.

Stroke is a leading cause of death and disability in the United States. It can happen to anyone at any age. The Centers for Disease Control (CDC) lists high blood pressure, heart disease, high cholesterol, diabetes, and smoking as the most common stroke causes. But there are more uncommon reasons why people have a stroke.

6 Uncommon Causes of Stroke

Cocaine

Use of this illegal drug can:

Other drugs may cause stroke, including marijuana, methamphetamine, and heroin. And consuming energy drinks in excessive amounts may increase your stroke risk, too.

Hole in the Heart

Everyone is born with a small hole in the heart. As a baby grows in the mother’s uterus, this opening allows blood to flow from the right side of the heart to the left. In normal development, the hole closes soon after birth. Then, the baby begins using the lungs to breathe.

But for about 1 in 4 people, this hole doesn’t close. Most of the time, it doesn’t cause problems. Some people never know they have one. But this structural defect is an uncommon cause of stroke.

“Blood leaking from the right atrium into the left may cause blood clots to form. These may travel to the brain, causing a stroke,” says vascular neurologist Necrisha Roach, MD, of UVA Health's Comprehensive Stroke Center.

Blood Clots in the Leg & Pelvis

Blood clots sometimes form within the deep veins of the legs and pelvis. This can happen because of injury, lack of movement, birth control pills, hormone therapy, or blood clotting disorders. Pregnant women also have a high risk for this condition, called deep vein thrombosis (DVT).

“These clots can break off and get stuck in an artery that feeds the brain,” Roach says.  

Hormonal Birth Control Pills

Oral birth control with high doses of estrogen may increase stroke risk. This is especially true for women with high blood pressure or obesity, and for smokers. Hormonal birth control may trigger the body’s clot-forming mechanisms.

The good news? Today’s birth control pills contain much lower doses of estrogen than in the 1970s and 1980s. They are much safer for women without other risk factors.

A Tear in Your Neck Artery

A neck injury or certain medical conditions may cause a tear within the wall of an artery in the neck. After the tissue splits, blood leaks out and forms a clot. If large enough, the clot can block or reduce blood flow to the brain.

“A cervical (neck) artery dissection was once thought to be very rare. But it’s not an uncommon cause of stroke,” says Andy Southerland, MD, a UVA Health neurologist. He notes that neck artery tears cause “1 in 5 strokes in people under the age of 60.”

Neck artery tears usually do not need surgery. Your body can repair the dissection on its own within weeks or months.

Your doctor may prescribe a blood thinner to help you heal. While healing, you should avoid strenuous activity, chiropractic neck manipulations, and other activities.

Breast Cancer Treatment

For stroke survivor Nancy Shaver of Charlottesville, no “smoking gun” was found to be the cause of her stroke. But a few common and uncommon causes of stroke likely played a role, says Nancy's neurologist, Southerland. “Nancy had high blood pressure and high cholesterol. Another thing worth noting is she had been treated previously for breast cancer, which can sometimes cause your blood to form clots."

Worried About Your Stroke Risk?

Talk to a UVA Health provider about your health. They can help you manage the common & uncommon things that can cause a stroke.

Other Rare Causes of Stroke

A number of blood disorders and inherited conditions can lead to stroke, including:

Stress: Uncommon Cause of Stroke?

Do your emotions sometimes get the best of you? Living with constant anxiety and stress may increase your blood pressure. Over time, heightened blood pressure may damage the blood vessels. That could lead to a stroke. Nancy Shaver thinks stress was likely an uncommon cause of her stroke. “I would have come very close to killing myself with the way that I was working. I was on 24-7,” Nancy says, adding that she never took a break from checking her mobile phone. Now she takes time to meditate each day.

Stroke expert Southerland says stress could have been a contributing factor with Nancy's stroke.

“The relationship between stress and cardiovascular events like stroke and heart attack is not as strong as risk factors such as diabetes, high blood pressure, and smoking. It’s difficult to define and measure stress. But our best understanding is that stress likely has a negative effect on those risk factors like high blood pressure and puts additional strain on your heart.”

The pandemic likely made matters worse. The strain of lockdowns and social distancing caused widespread stress and anxiety. 

“In the early stage of the pandemic, you took a society already plagued with obesity, and you put them in their homes — not walking, or exercising, and not able to go to the gym,” Roach says. “And people were suffering more from depression, anxiety, and stressors of the pandemic. So now you push them further down the road to developing medical conditions from unhealthy eating habits and lack of exercise. This increases those chances of having a stroke.”

Tags: neuro, stroke

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