Stroke is one of those dreadful events that can cause death in an instant. While it is the 3rd leading cause of death in the US, it is more likely that the person suffering this attack on the brain will survive it, sometimes barely. Stroke is a leading cause of disability, robbing people of the ability to do even the simplest of tasks, like feed or dress oneself, walk and talk. Victims are likely to be incapacitated in some way, sometimes for the rest of their life.
You may not know if and when a stroke will strike, but a future of functional disability may be sealed if you fall into a high-risk category and do nothing about it. While strokes are more common in older people, 1 in 4 people who have a stroke are under 65, and that includes young folks of all ages as well as middle-aged adults. It strikes women disproportionately, who are also more likely to be home alone and unable to get immediate help when a stroke strikes. Because when it comes to stroke, every minute matters.
What is a stroke?
A stroke is an attack on the brain, a cerebrovascular accident (CVA) caused by 1 of 2 things; too little blood reaching the brain (ischemic stroke), or too much blood pooling in the brain (hemorrhagic stroke). The distinction is important because while the mechanism that causes these 2 events is different, the symptoms and outcome may be the same. Either way, the timing of treatment is critical to the degree of damage and survival.
Hemorrhagic strokes occur when blood leaks out of a blood vessel, usually an artery, into the brain tissue. Unlike a bleed elsewhere in the body, bleeding in and around the brain cavity is restricted by the skull and the pressure created by the trapped blood damages brain tissue.
Hemorrhagic strokes can happen when the blood vessel wall is weakened by the assault of chronic uncontrolled hypertension, a vascular malformation, aneurysm or traumatic injury. People who take blood thinners that intentionally reduce blood clotting are at higher risk for this type of stroke.
Ischemic strokes on the other hand occur when the brain tissue is starved of blood. Anything that prevents blood from reaching the brain can cause this type of stroke; a narrowed or blocked blood vessel supplying the brain, a clot that has formed in a brain's blood vessel that blocks flow (thrombosis), or a clot that has traveled from elsewhere in the body (embolism).
As soon as the brain is deprived of nutrient- and oxygen-rich blood, brain neurons die. The longer the tissue is starved, the more damage is done. Neurons stop sending and receiving messages to and from parts of the body and faculties begin to falter. Symptoms can last minutes, hours or days and the effect can be large, small, temporary or permanent. About 85% of cerebrovascular accidents are caused by ischemic strokes.
Transient ischemic attacks or TIAs are referred to as mini ischemic strokes because their symptoms are temporary and typically last less then 24 hours. People who have mini TIAs are prone to a full-on stroke in the future.
Who is at risk for a stroke?
Strokes strike out of the blue, without warning and can happen to anyone, even people who are healthy. But risk skyrockets in people who engage in unhealthy behaviors or turn their backs on strategies that deal with problems known to raise the risk.
Risk factors for stroke are similar to those that cause heart attack. That's because blood vessel narrowing and damage that affects the arteries supplying the heart, can also wreak havoc in vessels supplying the brain. Anyone who is lucky enough to survive a stroke is at risk for another: 15% have a secondary stroke within a few years of the first.
Risk Factors for Stroke
- High blood pressure (hypertension) puts vessels under undue pressure, damaging their integrity and making them more prone to clots, hardening or rupture
- Diabetes doubles the risk factor for stroke because people with diabetes tend have the conventional cluster of risk factors that increase risk for heart disease – large waist circumference, obesity, abnormal cholesterol and hypertension – and high sugar and possibly insulin resistance, where insulin produced by the body becomes less effective in transporting glucose in and out of cells, may be additional risk factors that stand on their own
- Atrial fibrillation, a type of heart rhythm disorder, is conducive to making clots that can travel throughout the bloodstream and up to the brain
- Carotid stenosis is the narrowing and hardening (atherosclerosis) of the carotid arteries in the neck, the blood's main highway to the brain
- Smoking tobacco
- High LDL blood cholesterol (hypercholesterolemia)
- Prior stroke or TIA (a third of people who have a TIA will go on to have a stroke in the future)
- Alcohol and drug use (particularly cocaine, amphetamines, heroin)
- Certain medications such as blood thinners (for hemorrhagic stroke) and hormone replacement therapy and oral contraceptives
- Diets low in fruit and vegetables and high in salt and fat
- Sedentary lifestyle
- Central obesity (waist circumference larger than 35 for women and 40 for men)
- Family history of stroke
How will I know I've had a stroke?
You may or may not notice anything unusual, but others observing you might. Symptoms can be telling because deficits typically match the area of the brain affected since the brain is divided into regions that control vision, hearing, movement, cognition and speech. Although it is difficult to tell hemorrhagic and ischemic strokes apart, a loss of consciousness, severe headache, nausea and vomiting may be a clue that pressure is building from a hemorrhagic brain bleed, which tends to be more life threatening. But symptoms are likely to be clinically similar for both types of stroke.
So if the event occurs in the ophthalmic artery or region, vision will be affected. If it occurs in the region of the brain responsible for language, speech will be affected. If weakness occurs on the right side of the body, a left-brain stroke is suspected.
Strokes can also produce seizures and subtle symptoms such as changes in memory, concentration, strength, sleep and mood.
Signs of a Stroke
The signs are critical to learn because the sooner you get to the emergency room the better. Life-saving clot busters administered early can reduce damage to the brain and long-term disability caused by ischemic stroke. And if the stroke is hemorrhagic, it is critical to get to the bleed and stop it before permanent damage is done.
Here are a few of the more common signs a stroke is underway, and the tests that are a tipoff.
Sign: Paralysis, numbness, weakness or pain in the face, arm or leg, especially on one side of the body
Tipoff: Uneven strength or symmetry when asked to show teeth, raise eyebrows, close eyes, pressing, lifting, walking or imitate a movement
Sign: Sudden confusion
Tipoff: Not able to recall where they are, a calendar date or their age correctly
Sign: Trouble speaking or understanding speech
Tipoff: Inability to identify an image, read, speak or follow directions smoothly, have slurred and incoherent speech
Sign: Sudden visual disturbances or trouble seeing clearly in one or both eyes, unusual gaze
Tipoff: Unable to follow finger gaze or see correct number of fingers
Sign: Sudden trouble with walking, dizziness or loss of balance or coordination
Tipoff: Uneven or faltering gait, failing the finger-nose-finger test
Sign: Sudden severe headache
Tipoff: This is often called the worst headache you ever had
If you have any signs of stroke, even if they are fleeting, seek immediate medical attention. Call 9-1-1 or have someone drive you (do not drive yourself).
Click here to calculate your risk for stroke.