A stroke happens when blood flow to part of the brain is blocked or when a blood vessel in the brain bleeds. Brain cells deprived of oxygen begin to die within minutes, which is why doctors say "time is brain." Recognizing the warning signs and calling for help immediately is the single most important thing you can do to improve the outcome.
Equally important is what happens before a major stroke. Many people experience a warning event, a transient ischemic attack (TIA), days or weeks earlier. Taking that warning seriously can prevent a disabling stroke.
Know the Warning Signs: BE FAST
The acronym BE FAST helps you remember the most common signs of stroke:
- B – Balance: sudden loss of balance, dizziness or trouble walking.
- E – Eyes: sudden loss of vision in one or both eyes, or double vision.
- F – Face: one side of the face droops or feels numb. Ask the person to smile.
- A – Arms: weakness or numbness in one arm or leg. Ask the person to raise both arms; does one drift down?
- S – Speech: slurred speech, trouble finding words or understanding others.
- T – Time: call 911 right away and note the time symptoms started.
Other possible signs include a sudden, severe headache unlike any before, and sudden confusion. The key word is sudden.
What to do
- Call 911. Do not drive yourself, and do not wait to see whether symptoms go away. Paramedics can alert the hospital and start care on the way.
- Note the time the person was last known to be normal. This determines which treatments are possible.
- Do not give food, drink or medication, including aspirin, until the person has been evaluated, because some strokes are caused by bleeding.
Types of Stroke
- Ischemic stroke, the most common type, occurs when a clot blocks an artery. The clot may form in a narrowed artery or travel from the heart or from plaque in the neck arteries.
- Hemorrhagic stroke occurs when a blood vessel ruptures and bleeds into or around the brain, often related to high blood pressure or a weak spot in a vessel.
Why Speed Matters
For ischemic stroke, there are emergency treatments that can restore blood flow, but they work only within limited time windows. Clot-dissolving medication is generally given within a few hours of symptom onset, and for selected patients with a large artery blockage, a catheter procedure called thrombectomy can remove the clot, sometimes up to a day after onset in carefully chosen cases. The sooner treatment begins, the more brain tissue can be saved and the better the chance of recovery.
TIA: The Warning You Should Never Ignore
A transient ischemic attack, sometimes called a "mini-stroke," causes the same kinds of symptoms as a stroke, but they resolve, often within minutes. Because the symptoms go away, many people shrug them off. That is a dangerous mistake.
A TIA means that a blood vessel was temporarily blocked, and the risk of a full stroke is highest in the first days after the event. A TIA should be treated as a medical emergency. Prompt evaluation allows doctors to find the cause and start prevention before a permanent stroke occurs.
Examples of TIA symptoms include brief weakness or numbness of one side, a few minutes of garbled speech, or temporary loss of vision in one eye that feels like a curtain coming down.
How a Stroke or TIA Is Evaluated
After emergency care, or when a TIA is suspected, the goal is to find out why it happened. The evaluation commonly includes:
- Brain imaging with CT and/or MRI.
- Imaging of the blood vessels, such as carotid duplex ultrasound, transcranial Doppler, CT angiography or MR angiography. Learn more about carotid ultrasound and transcranial Doppler.
- Heart evaluation, including an ECG, heart rhythm monitoring to look for atrial fibrillation and an echocardiogram.
- Blood tests, including cholesterol, blood sugar and clotting factors when appropriate.
Who Is at Higher Risk?
Stroke can happen at any age, but the risk rises with age and is higher in people with high blood pressure, diabetes, high cholesterol, atrial fibrillation or other heart disease, a previous stroke or TIA, narrowed carotid arteries, smoking, obesity, physical inactivity, heavy alcohol use and a family history of stroke. Having several risk factors at once multiplies the risk. Knowing your numbers, especially blood pressure, cholesterol and blood sugar, is a practical first step that you can take with your primary care physician.
Preventing Stroke
Most strokes are linked to risk factors that can be changed. After a stroke or TIA, preventing another one becomes a top priority.
Medical treatment
- Blood pressure control is the most important step for most people.
- Cholesterol-lowering medication, usually a statin.
- Antiplatelet medication, such as aspirin or clopidogrel, for many ischemic strokes and TIAs, as directed by your doctor.
- Anticoagulation for atrial fibrillation and certain other heart conditions.
- Diabetes management.
- Procedures to open a severely narrowed carotid artery in selected patients.
Lifestyle changes
- Stop smoking and avoid secondhand smoke.
- Be physically active most days of the week.
- Eat a diet rich in vegetables, fruit, whole grains, fish and olive oil, and lower in salt and processed foods.
- Limit alcohol and maintain a healthy weight.
- Have snoring or daytime sleepiness evaluated, since sleep apnea increases stroke risk.
Life After Stroke
Recovery often continues for months. Physical, occupational and speech therapy help the brain relearn skills. Neurologists also manage common after-effects, including muscle stiffness (spasticity), which can sometimes be treated with Botox injections, as well as fatigue, mood changes and memory or thinking problems. Stroke is also an important cause of cognitive decline; read about the early signs of dementia.
Stroke Prevention and Follow-Up Care in Westwood, NJ
Stroke is a clinical interest of Dr. Lorraine S. Lira, and Dr. David D. Van Slooten is board certified in Neurosonology, the ultrasound evaluation of blood vessels supplying the brain. Our office provides carotid and transcranial testing as part of stroke risk evaluation and follow-up after a stroke or TIA.
If you are having stroke symptoms right now, call 911. For follow-up care and prevention, review our neurology services or visit our contact page for directions.
Have questions about your symptoms? Our neurologists in Westwood, NJ can help. Download our new-patient forms and get directions to the office.
This article is for general education and does not replace advice from your own physician. If you think you are having a medical emergency, call 911.
