John Murphy remembers feeling a little strange around mile 23 of the 2005 Chicago Marathon.

The race had started well. He had cruised along the shoreline of Lake Michigan, looped back near Wrigley Field and run through the financial district. But just before the course veered back into downtown, he felt dizzy. His left hamstring cramped. He had trouble seeing with his right eye. The Austin, Texas, marketing professional figured he was just dehydrated. He drank some water, stretched a bit, then ran on. Annoyed because he'd lost time, he picked up the pace, crossing the finish line in three hours and six minutes.

Not his fastest time, but not bad for the 46-year-old former high school and college track star.

Nothing's been the same since. Murphy didn't realize it then, but as he ran the marathon, he suffered the precursors of a stroke that nearly killed him that night.

Now, Murphy's running a whole new marathon, one that started with learning how to walk again. One that's taken away competitive running and changed his personality. One that might never end.

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain bursts or is blocked by a clot.

About 700,000 Americans each year suffer a stroke, and more than 150,000 die, according to the American Stroke Association.

People think of stroke as a disease of the elderly. It's true, most stroke victims are older and, as the country's population ages, the incidence of stroke is going up. But stroke in people younger than 50 is also increasingly common, says Lauren Brandt, director of neurosciences for the Brain and Spine Center at Brackenridge Hospital in Austin.

"It used to be that after 55 was when you'd start thinking of stroke, and the 60s and 70s were when it happened," Brandt says. "We're now seeing people with stroke in their 30s and 40s, people with arteriosclerosis (a buildup of plaque in the arteries), hypertension, diabetes and a sedentary lifestyle. Because of our supersized economy, we're getting fatter, lazier.

When stroke does occur in younger people, it can be more damaging. That's because as the body ages, the brain shrinks a little. Older people have room to accommodate some swelling inside their skulls. Younger people don't. "There's not as much room for everything to fit, and sometimes they have a worse outcome," Brandt says.

Time is critical. If a patient gets to an emergency room within three hours, doctors can administer clot-busting drugs or surgically remove the clot - both of which can improve the prognosis for a stroke survivor. Waiting can be disastrous. After eight hours, there's little medical experts can do. That's why it's so important to recognize stroke symptoms: sudden numbness, confusion, trouble speaking or understanding, vision problems, dizziness or a severe headache with no known cause.

"There's going to be brain damage, but (anti-clot drugs are) the best shot at a smaller degree of brain damage," says Dr Thomas Hill, who is Murphy's neurologist in Austin. "Not every stroke is going to kill you or leave you devastated, but stroke is a life-changing event."

A large percentage of patients still show up at a hospital 24 hours or more after they've had a stroke, Brandt says. "People don't want to believe it's a stroke, or they think 'I'm too young' or 'I'm too fit,' so they wait to see if it gets better."

A stroke was the furthest thing from his mind when Murphy began feeling bad during the Chicago Marathon. Despite his high level of fitness and relatively young age, Murphy now thinks he had hidden risk factors. He worked a high-stress job. He pushed himself, even at play.

He was captain of the Harvard University track team. He worked as a teacher and athletic director, then a marketing executive.

He kept running, trying to run farther and faster. He entered marathons, including Boston's famed 26.2-miler.

"I was the runner almost to the point of being annoying," he says. He was a self-proclaimed running snob who wouldn't run for fun.

He lived in Austin, Texas, but signed up for that life-changing 2005 Chicago Marathon.

After finishing, his eye still wasn't right, but he didn't feel too bad. That night, they headed to a bowling club to celebrate.

Then his left leg started to cramp. He lay on the floor to stretch. He couldn't get up.

They called an ambulance. Nobody had recognized his classic signs of stroke: non-responsive left side, bulging eye, slurred speech.

A clot had formed in Murphy's carotid artery and blocked blood flow to his brain. But symptoms eased and he had no family stroke history, so doctors didn't immediately diagnose it.

Then his brain swelled. Doctors poked Murphy's left foot with a pin. He couldn't feel it. He couldn't move his left arm or leg. "At some point, they told me I had a stroke," he says. "I couldn't believe it."

Doctors told the family he might die. A priest performed last rites. Murphy slipped in and out of consciousness.

Murphy hung on.

His stroke was a dissection - a spontaneous tear in the wall of the carotid artery, which has three layers. When the inner layer tore, blood filled the middle section, which swelled and blocked the artery. Initially, Murphy had so much swelling doctors thought he might die or need brain surgery to release pressure. But the swelling eased.

After four days in intensive care, he was moved to a hospital rehabilitation center.

"It was a bad stroke," says Hill, Murphy's Austin neurologist. He can't say for sure what caused it, but he says "it was probably not caused by running the marathon." Fitness aided recovery.

At first, Murphy made rapid gains. He stood. He learned to walk again. He spent hours learning to pick up coins and button shirts.

A month after the stroke, he flew back to Austin, where he started out-patient rehab. "At first, he couldn't open a door or type," says Bob Whitford, a senior occupational therapist. "That was a goal, because typing's a key part of his job. But he soon realized that's not as important as buttoning his pants or putting a piece of food in his mouth."

Murphy leaped into rehab with the same competitive drive that helped him win foot races. "Most people who've had as severe a stroke as he did never live independently again," Whitford says.

Murphy, who is single, does live alone now, but life has changed.

His left leg and hand don't function well. It's hard to sleep because of painful leg spasms. His body feels tired and achy, like he's coming down with the flu. He doesn't read much because it's hard to hold and turn book pages.

The uncertainty of life depresses him. He doesn't know if he'll get any better. "The little 4-year-old in me says, 'I don't want to play stroke anymore.' "

He frets, too. "Like this morning, I couldn't find my cellphone, and I don't know if it's my stroke acting up again," he says. "It's not just the sensation you're no longer making progress, it's the sense you're regressing.

"What I miss most is that euphoria of just being able to go. I used to love to dance, but now I have to think about every movement."

He's had setbacks - a seizure in July, doctors call it minor.

He tools around town on his bicycle, swims at the YMCA, takes cognitive rehabilitation therapy.

He functions better than most stroke victims.

But because of his limitations, he's running a new course.

Murphy's mission now is helping others who have had strokes or are at risk.

He is active in stroke education and fundraising, using his skills in marketing.

"I refuse to sit on the sidelines," he says, "and not use my new knowledge and the skills I have reacquired."

Murphy is not running marathons any longer, but he's still running hard.

(Shanghai Daily December 19, 2007)