‘I was very fit, so why did I have a stroke?’
Could vigorous exercise have triggered an ultra-runner’s near-fatal collapse at the age of just 35, asks Joan McFadden
Two years ago, Grant MacDonald was jogging home when a blinding headache stopped him in his tracks, bringing him to his knees as he collapsed against a post. He clung to it in a bid to stay upright, barely able to see or move. A passer-by helped him to a nearby hall and an ambulance was called. “The pain was like nothing I’d ever felt – as if someone was reaching inside my head and squeezing my brain,” says MacDonald. “An Alcoholics Anonymous meeting was taking place in the hall; I was confused, slurring, staggering and vomiting, so they probably thought I was in the right place.”
The short journey to Glasgow Victoria Infirmary was a blur of agony. A scan revealed that he’d suffered a subarachnoid brain haemorrhage – the walls of an artery had ruptured. This accounts for one in every 20 strokes in the UK, with 10 per cent of sufferers dying before they reach hospital, a further 60 per cent dying within a month and many survivors left disabled.
Two urgent operations saved Grant’s life, while his fiancée Elsie waited helplessly with his family to see what sort of recovery he would make.
“I don’t remember much but apparently I was conscious a lot of the time,” says the biomedical scientist, now 37, from Strathblane, Scotland. “I think the effect on the brain reduces your inhibitions so I was a bit giddy and it would have been entertaining if it wasn’t so serious.” Despite the indescribable pain and an initial awareness that something catastrophic was happening, it was a while before Grant understood the severity of what had happened. “After the surgery, I was convinced I could go to a big running race despite having a drain attached to my head – I’m not sure how I thought I was going to drag it around with me.”
In the past, strokes traditionally affected older people who were smokers, drinkers or suffering from high blood pressure, but now they are affecting soaring numbers of people in the UK in their forties and fifties, according to the Stroke Association. NHS data shows the number of men aged 40 to 54 in England hospitalised after a stroke grew by 46 per cent from 4,260 in 2000 to 6,221 last year. The figure for women of the same age was 4,604, up by 30 per cent. Between 2000 and 2014, the number of people aged 20 to 64 who had a stroke jumped 25 per cent, according to hospital admissions data, though this is partly explained by better public awareness at spotting the signs of stroke and a rising population.
Obesity increases the risk of ischaemic stroke by 64 per cent, while smoking doubles the risk of death from a stroke, and the biggest controllable risk factor for stroke is high blood pressure, contributing to over half of all strokes in the UK.
But none of these factors applied to MacDonald – there was no family history of stroke or underlying cause and his blood pressure had always been normal. So what happened? “The type of stroke Grant had mostly happens out of the blue,” says Keith Muir, professor of clinical imaging and consultant neurologist at the University of Glasgow, Queen Elizabeth University Hospital. “Apart from not smoking and having your blood pressure checked, there’s not much you can do to prevent it, unless there’s a family history that leads you to investigate it,”
“Strokes affect all ages, but under age 45 they tend to have more uncommon causes (heart defects, damage to blood vessels in the neck, inherited disease and many other things),” Muir adds, “while over 45 the common’ causes – high blood pressure, smoking, diabetes and atrial fibrillation – dominate.”
Being as fit as possible helps recovery.
When the broadcaster Andrew Marr had his stroke in 2013, he blamed vigorous exercise, a link that is often also made when runners collapse during marathons.
However, experts say that exercise can protect against stroke and, should one happen, may help recovery.
“Going from nothing to intense exercise can see a modest increase in the risk of a stroke,” says Dr Andrew Murray, sports and exercise medicine consultant at the University of Edinburgh. “However, the evidence is crystal clear that those who are physically active are significantly less likely – up to 25 per cent – to have a stroke and if they do, are significantly less likely to die. You’re never too old, too fat or too unfit to get active and building it up rather than going hell for leather is the best approach. Grant’s high levels of fitness undoubtedly played a huge part in his recovery.”
This chimes with MacDonald’s view that while doctors think he was simply unlucky, in reality he was fortunate because over the previous five years he’d gone from relatively unfit to being an ultra-runner. “I’d been reasonably fit into my twenties but wasn’t doing much exercise and didn’t want to be a chubby 30year-old,” he explains. “I joined a running club and progressed from 5K runs. Just a month before his stroke, he was seriously fit and came second in the notoriously difficult 60hour, 108-mile Pennine Way Spine Challenger run.
Three weeks after surgery, Grant was back home. “I don’t fit the usual profile for a subarachnoid brain haemorrhage, so my doctors were reluctant to advise me, other than saying that gentle exercise should be fine. I had severe headaches and was utterly fatigued. I’d get up and wash and need a nap. I’d eat something and need a nap. I couldn’t live like that, so I forced myself to go for walks and although it was exhausting, I felt a hundred times better.” Less than six weeks after he collapsed, MacDonald set out on his first run and returned to work just four weeks after that. Five months later he came second in the Glenmore 24, a 124-mile trail race.
“Apparently there’s about a 30 per cent chance of the aneurysm recurring so the long-term follow-up is thorough and includes MRI scans and brain angiograms every two years,” he says. “Anything wrong will hopefully be picked up and mostly I don’t give it a second thought now. I just need to get my running back to where it was. Maybe I’m just getting slower as I get older. I can’t blame the brain haemorrhage forever!”
‘Grant’s high levels of fitness played a part in his recovery’
For more information, see stroke.org.uk, or call the Stroke Association’s Helpline on 0303 3033 100