As strokes become more common among younger adults, Boston resident Patrick Mascoli is speaking about the one he suffered at age 27, despite being fit and running about 40 miles each week.
In July 2024, after a 10-mile run and a gym workout, Mascoli was changing in the locker room when a sudden, intense pain struck the right side of his head. He had a history of migraines but said he had experienced no warning signs like this before.
His vision quickly blurred, and when he tried to stand, his legs moved in the wrong direction and he stumbled into a wall. He texted his sister, then collapsed and began vomiting. Stroke crossed his mind, but he dismissed the possibility because he was young and healthy.
His sister found him on the gym bathroom floor, drenched in sweat, and called 911. First responders thought dehydration might be to blame, given that he had exercised in the heat. IV fluids did not help, and treatment for possible vertigo also failed to ease his symptoms.
Doctors at Boston Medical Center eventually spotted the stroke on a CT scan and confirmed it with an MRI. By the next morning, the pain had eased, but he had serious trouble moving, especially on his right side. After several days in the hospital, he began walking again with a walker.
Doctors ran tests for clotting disorders and other possible causes, but found no clear explanation. A heart ultrasound revealed a patent foramen ovale, or PFO: an opening between the heart’s upper chambers that usually closes soon after birth but remains open in some people.
Dr. Dheeraj Khurana, a cardiologist who did not treat Mascoli, said that in rare cases a clot can pass through a PFO, travel to the brain and cause a stroke. Most people with a PFO do not develop related health problems. For younger stroke patients without typical risk factors or an obvious cause, doctors may use an echocardiogram to check for one.
Mascoli’s doctors believed the opening may have allowed a clot to reach his brain, though they could not determine why the clot formed. About a month after the stroke, he had a catheter procedure to close the PFO with a mesh device. Knowing that the suspected route had been addressed helped reassure him.
Therapy has improved his mobility, but he still has trouble with fine motor tasks. He said he can become frustrated when his hands shake or his handwriting looks different. Getting back to running also brought anxiety: he began keeping track of distance because he worried about being too far from home if something went wrong.
His girlfriend gave him a fitness watch and encouraged him to enter races, which he said helped keep him motivated physically and mentally. In October 2026, he completed the Chicago Marathon with Team Abbott, representing the company that made his heart implant. After the race, he listened to an emotional message from his sister, who had called for help when he collapsed.
Mascoli encouraged people recovering from serious health events to be patient with themselves and not let the experience define them. Progress, he said, does not have to mean running a marathon; taking whatever steps are possible matters.
Possible stroke risk factors in younger adults include high blood pressure, smoking, unhealthy cholesterol levels, clotting disorders, some heart conditions and tears in arteries supplying the brain, Khurana said. Symptoms such as dizziness, vomiting and headache can be mistaken for exhaustion or migraine, particularly after exercise. Other warning signs may include vision changes, speech difficulty, weakness, unusual lethargy or seizures.
Dr. Sean Levchuck, a pediatric cardiologist, advised young adults to remain active, replace fluids after strenuous exercise and avoid smoking and tobacco products. The American Stroke Association says anyone with sudden balance problems, vision changes, facial drooping, arm weakness or difficulty speaking should call 911 immediately, regardless of age or fitness level.
