Signs of Stroke: Your Guide to Understanding & Treating This Life-Threatening Condition
Medically Reviewed by Dr. Samantha Miller, MBChB
A stroke is a serious and potentially life-threatening medical condition that affects the blood vessels leading to and within the brain. As a result, the affected portion of the brain stops receiving oxygen as well as the nutrients required for normal function, which, in turn, causes the surrounding tissue to become damaged or die.
If left untreated, stroke can lead to permanent brain damage, paralysis and even death. There are two types of stroke – ischemic, which is caused by a clot, and hemorrhagic, which is caused by a bleed. Often, they are difficult to tell apart due to overlapping symptoms, which can include weakness, difficulty speaking, and confusion.
Strokes are quite common, so much so that they are the 5th most common cause of death in the United States. Moreover, many survivors experience disabilities as a result of a stroke. To put it more concretely, around 795,000 Americans suffer from a stroke every year, with over 150,000 dying as a result of stroke. Although a stroke can occur at any age, likelihood increases as one gets older. Additionally, folks who have had a stroke before are more likely to have another.
Symptoms Associated With Stroke
- Common symptoms of stroke include sudden physical weakness or numbness in the face, arm or leg. This is typically one-sided, but can affect both sides of the body. This may present with a sudden asymmetry to the face, with a “drooping” of the mouth or eyelid. If the stroke is affecting the arms, the individual may not be able to raise one or both arms, or might suddenly drop something as grip strength is affected.
- Another common symptom of stroke is difficulty speaking, which may manifest as newly slurred or garbled speech. Some people may not make sense when they speak, while other may not be able to speak at all.
- Other symptoms of stroke may include a loss of coordination, which can lead to falls or decreased mobility. A sudden onset severe headache is also a symptom of stroke.
- A stroke can cause a sudden loss of vision, affecting all or part of the visual field. It may also cause blurred or distorted vision.
If someone experiences any of the above symptoms, it’s important to seek emergency medical attention. Symptoms typically occur suddenly, but can also develop over days or weeks. Moreover, the most common symptoms of stroke can be remembered by the acronym FAST, which means the following:
- F = Face
- A = Arms
- S = Speech
- T = Time to Act
Causes & Types of Stroke
There are two broad types of stroke: ischemic stroke and hemorrhagic stroke. They are characterized in the following ways.
Ischemic strokes are more common, making up approximately 85% of all strokes. This type of stroke occurs when a blood vessel in the brain becomes blocked due to a clot. The clot may be formed within the vessel itself, known as a thrombus, or a clot may have broken off from another part of the body, known as an embolism.
Thrombotic strokes are consequences of damaged cerebral arteries that are blocked by blood clots or plaque buildup and may also be known as cerebral thrombosis or cerebral infarction. Plaque typically contains cholesterol molecules (particularly low-density lipoproteins, LDL) and blood cells, and can develop gradually over time to a point where blood flow is severely hindered.
Embolic strokes occur as a result of free-traveling blood clots that have developed elsewhere than the brain. For example, a section of a plaque from the heart can break off and travel through the bloodstream until it becomes lodged in the smaller, narrower vessels in the brain, causing stroke.
Additionally, embolic strokes can also be caused by other debris, such as fat, air bubbles, cancer cells or clumps of bacteria. Sometimes, irregular heart beating, such as atrial fibrillation, contributes to free-traveling clot formation due to irregular blood flow. While embolic strokes can be treated by dissolving the blockage, the underlying source of the free-traveling plaque or debris will need to be addressed to prevent future recurring cases.
The second type of stroke, hemorrhagic strokes, occurs due to a leakage or a ruptured artery in the brain. Although hemorrhagic strokes are rare in comparison to ischemic strokes, they are often more deadly, because the bleeding in the brain can quickly turn fatal.
A number of things can cause a hemorrhagic stroke, including trauma, pre-existing weak spots in a vessel (an aneurysm) or high blood pressure. These strokes can affect a younger population and more often affect people that have no known underlying conditions. Furthermore, hemorrhagic stroke can be subcategorized into intracerebral and subarachnoid.
In an intracerebral hemorrhage, a blood vessel deep inside the brain becomes weak and ruptures, spilling blood into the surrounding brain tissue and causing severe pressure and damage to the area. Brain cells beyond the rupture are also injured due to blood deprivation at the hemorrhage site. Hypertension (high blood pressure) is the main culprit in intracerebral hemorrhages, as it makes small vessels inside the brain more susceptible to cracking and leaking.
In a subarachnoid hemorrhage, an artery on or near the surface of the brain ruptures, and blood is spilled into the space between the brain and the skull. The hemorrhage is often signaled as a sudden, severe headache, usually described as a "thunderclap" effect, accompanied by a sudden urge to vomit. This type of bleeding is commonly caused by the bursting at a weak spot in a vessel. Affected individuals may quickly become unconscious due to the sudden drastic increase of pressure in the brain. Subarachnoid hemorrhage can affect people of any age.
In both ischemic and hemorrhagic strokes, brain cells become damaged or die due to the lack of oxygen and nutrients that it normally receives from red blood cells. There is no way to predict where or when a stroke may occur, and it is possible for multiple strokes to occur simultaneously.
What Is a Transient Ischemic Attack (TIA)?
A transient ischemic attack (TIA), also known as a "mini stroke," is a brief episode where symptoms similar to those of a stroke are present. The cause of a TIA is a temporary decrease in blood supply to a part of the brain. Similar to an ischemic stroke, an attack occurs when a clot or plaque buildup decreases blood flow to a part of the brain.
But unlike a stroke, a TIA does not have a lasting effect, as it only decreases the blood flow, and does not usually cause permanent tissue damage. Many TIAs last less than 5 minutes, and symptoms can include sudden weakness in one side of the body, blurred vision, vertigo or sudden, severe headache with no known cause. Sometimes, the clots that caused the transient ischemic attack may spontaneously dissolve.
While TIAs are temporary and symptoms are brief, it is still crucial to immediately seek emergency care. TIAs are usually indicators of partially blocked or narrowed arteries, and are often precursors to full-blown strokes that can cause permanent damage, or even death.
If you experience any symptoms that are similar to a stroke, then you may have a transient ischemic attack. If this is the case, see your doctor as soon as possible.
Risk Factors Associated With Stroke
There are certain uncontrollable risk factors, such as family history, age, gender and ethnicity which increase an individual’s risk of stroke. There are also modifiable risk factors such as smoking, having a sedentary lifestyle and being overweight.
- Older people have a high chance of having a stroke than younger people, with two thirds of stroke sufferers being over the age of 65. However, stroke can occur at any age.
Sex Assigned at Birth
- Male patients are at higher risk of stroke than female patients.
- Genes often determine the development of medical conditions that can lead to a stroke, including hypertension, heart disease, diabetes and vascular conditions. Thus, individuals who have a family history of stroke also have increased chances of stroke themselves.
Pre-existing Medical Conditions
- Since stroke mainly targets the blood vessels, individuals with other conditions that affect the vessels may be at greater risk. High blood pressure (hypertension) is a common risk factor that can be managed through medication and lifestyle changes.
- Heart conditions, including cardiac arrhythmias, enlarged heart, and problems with the heart valves, can also increase the risk of clots developing within the heart that can break off and cause an ischemic stroke.
- Increased blood cholesterol is another common risk factor. When the fatty deposits from cholesterol build up on the interior of blood vessel walls, they narrow the diameter of blood vessels and increase the chances of a stroke.
- Diabetes is also linked to stroke, as the increased sugar levels can facilitate thrombus formation.
- People who had past strokes or transient ischemic attacks (TIA), also known as "mini strokes," also have a higher risk for further events.
- Rare conditions can also predispose to stroke. One such condition is sickle cell anemia, a blood disorder characterized by sickle-shaped red blood cells that, due to their shape, are prone to clog arteries.
- Certain behavioral habits increase an individual's susceptibility to stroke, as they may set the platform for cardiovascular diseases. One of the most significant risk factors for stroke is smoking. Cigarette smoking and smoke inhalation from secondhand smoke will increase the body's level of carbon monoxide. This component, found in all cigarette smoke, reduces the amount of oxygen carried by red blood cells and speeds up the hardening of the arteries.
- A poor diet with high levels of fat, cholesterol and sodium is also linked to stroke as this can result in high blood pressure and plaque formation along artery walls.
- An inactive lifestyle may lead to excessive weight gain, which leads to hypertension and high cholesterol.
- Abuse of hard drugs, such as cocaine, heroin or amphetamines, are also responsible for stroke in younger populations.
- Excessive alcohol use can lead to hypertension and hardening of the arteries, due to increased cholesterol.
What Happens After an Individual Has a Stroke?
Often people who have symptoms of a stroke are admitted directly to a stroke unit, where there are expert physicians and the resources required for rapid diagnosis and treatment.
- The doctor will begin by asking questions about the onset of symptoms, and about any relevant medical history. It is important at this time to let your health care provider know about any family history of heart or blood problems.
- Next, the doctor will perform a physical examination, which includes vital signs such as heart rate and blood pressure, and may involve testing the strength of the muscles, reflexes and aspects of vision and comprehension.
- It’s important that the doctor must first diagnose the stroke type before implementing any treatment. The most common diagnostic tool is imaging, which may be with either computed tomography (CT) or magnetic resonance imaging (MRI). In some cases a computed tomography arteriogram (CTA) is performed, which is a specialized CT scan using contrast dye which can accurately pinpoint the area of stroke. An MRI scan uses strong magnetic fields and radio waves are used to produce a 3D image of the brain so the doctor can detect damaged brain tissues in ischemic strokes. They can also detect other brain abnormalities, such as tumors, so the healthcare professional can rule out other medical conditions that share similar symptoms with stroke.
- Blood tests may be run to help determine glucose and cholesterol levels, as well as blood chemical balance. Blood tests can also rule out any other blood abnormalities or medical conditions that may require an altered treatment for stroke.
- Carotid Doppler Ultrasound: This test uses ultrasound to detect and measure the flow in the large arteries in the neck that lead up to the brain. In some individuals, there may be plaque formation or narrowing in these arteries, which may be the underlying reason for stroke.
- Arteriography: In this procedure, the doctor will insert a thin, flexible catheter from the groin into the major carotid or vertebral artery. Then, a dye will be injected to show contrast, so an image of the arteries around the head area can be taken and searched for signs of blockage. The images also allow the doctor to observe blood flow through the brain.
- Electrocardiogram (EKG): This is a measure of the electrical activity of the heart, and helps to identify irregular rhythms (arrhythmias) which may have contributed to turbulent blood flow and subsequent stroke.
- Echocardiogram: This uses ultrasound to visualize the heart muscle in motion, to check if the heart is pumping correctly and if there are any abnormalities in the valves.
Treatment & Management
Once the type of stroke is diagnosed, the doctor will implement the appropriate treatment.
For ischemic strokes, the aim is to remove or dissolve the clot and restore blood flow to the brain. As a result, medical professionals may give the patient anticoagulant medications, such as tPA (tissue plasminogen activator) or a variation of aspirin, to help dissolve the thrombus.
For hemorrhagic strokes, the aim is to remove or manage the excess pressure caused by leaking blood. That being said, treatment will vary based on the cause of the leakage as well as the extent of the already-inflicted damage. The physician will try to control and stop the bleeding within the brain by regulating other factors that may encourage leakage, such as blood pressure. In more serious cases, doctors may choose to drain the pooled blood in the skull by needles and catheters to relieve pressure, hopefully halting further tissue damage.
Stroke patients may develop disabilities due to extensive brain damage, and may need long-term therapy and rehabilitation to recover. Sometimes, affected individuals are not able to regain basic functions, while others may recover almost completely. The sooner you see a doctor, the better the prognosis for stroke treatment will be. Therefore, it is very important to seek emergency care immediately upon the first signs of stroke symptoms.
Can a Stroke Be Prevented?
Strokes can be unpredictable, as blood vessel blockages can occur without symptoms or warning signs. Most people who have strokes have at least one risk factor for stroke, so it’s important to reduce your risk as low as possible. This includes avoiding high blood pressure, high cholesterol, diabetes and heart disease. While these medical conditions happen partly due to genetics, appropriate medical intervention and modifications in diet and lifestyle can still decrease one's susceptibility to stroke.
See Your Doctor
Medical professionals recommend undergoing annual physical exams as a preventative measure for all possible medical conditions. During your checkup, a doctor will ask a series of questions regarding diet and lifestyle habits. These questions can help the physician determine whether such factors can place the patient at risk for problems later in life, since chronic conditions usually develop as a consequence of years of unhealthy lifestyle choices.
Routine blood tests may be taken as part of the physical to check cholesterol and glucose levels, and it is important to follow up and discuss the test results with the doctor, so he or she can give appropriate health advice and tips to help correct abnormal results that may indicate an increased susceptibility to stroke.
If you have any pre-existing medical conditions it’s particularly important to regularly engage with your primary care physician. Sometimes, doctors may recommend a daily supplement of an anticoagulant, such as aspirin, for individuals who are more prone to thrombus formation. However, be sure to consult a doctor before implementing any self-remedies, since each individual varies case by case.
Increase Physical Activity
Doctors generally recommend at least 30 minutes of aerobic activity daily to keep the body healthy. An active lifestyle can help prevent stroke symptoms by relieving stress, lowering cholesterol, keeping blood pressure under control and maintaining a healthy weight.
Obesity, which is a very common medical condition, is one of the major risk factors for stroke, as it often accompanies type 2 diabetes, hypertension and high cholesterol. Exercising can help to retain a healthy body mass index (BMI) and keep stroke at bay. Seeking a doctor's advice on an exercise plan formulated for your body's composition is strongly encouraged.
Adopt a Healthy, Balanced Diet
Remember the phrase: “you are what you eat”. It is important to take care of your body and to make sure everything consumed is healthy and nutritious. Generally, foods high in saturated fat, sodium, cholesterol and sugar should be avoided.
A high-fiber diet can help keep cholesterol under control, so a diet with ample amounts of complex grains, fruits and vegetables will help prevent stroke. In addition, a lean, balanced diet will help maintain a healthy weight and ward off obesity. Since every individual's body needs and composition is different, it is important to talk to a medical professional or registered dietician to consult a nutrition plan that works for you before attempting any self-remedied diet plans.
Quit Smoking and/or Reduce Your Alcohol Intake
Smoking can increase the chance of a stroke, as cigarette smoke inhalation increases carbon monoxide and hardens arteries.
Excessive alcohol consumption has also been linked to high blood pressure and hardening of the arteries. It is advisable to seek a physician for ways to help quit smoking, as well as moderating alcohol intake.
Seek Rapid Treatment
A stroke is a medical emergency that requires immediate treatment in order to prevent worsening complications and irreversible brain damage. Revise the main symptoms of stroke so you know exactly what things to look out for and if you or anyone you know experiences these symptoms, it’s imperative to call 911 immediately.
Stroke is a common condition, with a high morbidity and mortality. As such, it’s important to be aware of the risk factors for stroke, as many can be modified to reduce your own personal risk. Moreover, one should remain vigilant when looking out for symptoms of stroke since rapid, emergency treatment is associated with a better prognosis and recovery. If you are worried about your risk of stroke, speak with your primary care practitioner for personalized advice.
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