Eight years ago, at the age of 53, Jeff Miller woke up, got out of bed and fell to the floor. Although he was having trouble seeing, he managed to get down the stairs to the first floor of his home where he called 911. He knew something was wrong and was later told that his speech during that emergency call made no sense.
The last thing he remembers was an ambulance taking him to his local hospital in a small town outside of Chicago. Shortly after, he was transferred to Northwestern Memorial Hospital’s Comprehensive Stroke Center in Chicago.
Due to the narrowing of one of the major arteries feeding the left side of his brain, Miller had experienced an ischemic stroke. A stent was inserted into the artery to open the blockage. When he stabilized, he was sent for rehabilitation to improve the damage the stroke had inflicted on his mobility, speech and other neurological functions.
Today, Miller continues to take medication to prevent recurrent strokes and hasn’t had another stroke since.
“Because strokes can strike at any age, it’s important to be aware of how your brain works and the signs and symptoms of stroke,” says Dr. Fan Caprio, medical director of the Comprehensive Stroke Center at Northwestern Memorial Hospital. “You should see your primary care physician regularly to reduce any risk factors you may have for a stroke and work at keeping yourself physically and neurologically healthy.”
What Is a Stroke?
A stroke can be a life-threatening condition that occurs when blood flow to a part of the brain is interrupted because of a blockage or tear in a blood vessel. To function properly, a constant supply of blood carrying oxygen and nutrients to the brain is needed. When blood flow to the brain is blocked, brain cells begin to die within minutes.
In the United States, stroke is the fifth leading cause of death and the leading cause of disability. Every year, nearly 800,000 people have a stroke, and more than 140,000 people die. Of the approximately 7 million stroke survivors living in the U.S., about two-thirds are disabled. If you’ve had a first stroke, your chance of having another one is about 25%.
Strokes can occur at any age, and almost a quarter happen in people younger than 65. Your risk doubles every decade after the age of 55.
“Risk factors for stroke are often silent and don’t show themselves until a stroke hits, but many strokes could be preventable with proper lifestyle modifications,” says Dr. Mona Bahouth, a vascular neurologist at Johns Hopkins School of Medicine in Baltimore.
[READ Navigating the Road to Recovery After a Stroke]
Types of Strokes
The types of strokes are:
— Ischemic stroke. This is the most common kind of stroke and accounts for 87% of all strokes or about 9 out of 10 strokes. It occurs when a blood clot obstructs an artery and blocks the flow of blood to the brain. Without a continuous blood supply, brain cells become damaged and die. Two kinds of blood clots cause an ischemic stroke:
— Cerebral thrombosis. A blood clot forms in the artery in the brain, usually due to the buildup of plaque inside the arteries (atherosclerosis). Over time the plaque totally blocks the artery.
— Cerebral embolism. This occurs when a clot forms in one part of the body and travels through the blood stream to the brain, where it blocks oxygen and blood flow.
— Hemorrhagic stroke. The most common cause of this kind of stroke is high blood pressure. It happens when a blood vessel in the brain bursts and blood leaks into the surrounding area. The pooling blood creates pressure and injures brain tissue. The following are the two types of hemorrhagic strokes:
— Intracerebral hemorrhage. The rupture happens in the brain.
— Subarachnoid hemorrhage. The rupture occurs in the space between the brain and the membrane that covers the brain.
— Transient ischemic attack (TIA). TIA is a temporary stroke that is caused by a temporary blockage of blood flow that lasts for minutes and then reverses. Symptoms of a TIA often last less than 5 minutes. If you’ve had a TIA, you are at high risk of a permanent stroke in the first 7 to 14 days after it occurs. If you have a TIA, you should go to the hospital for emergency care to reduce your chances for a major disabling stroke.
[Related:Understanding Medicare Eligibility for Individuals Under 65 With Disabilities]
Warning Signs and Symptoms of Stroke
Stroke symptoms usually appear suddenly, so it’s important to be aware of warning signs.
Signs and symptoms of a stroke include:
— Weakness or numbness, especially in the face, arms, legs, vision and on one side of the body
— Trouble speaking or garbled, unclear speech
— Vision problems, such as dim vision or loss of vision in one or both eyes
— Balance and coordination, such as an inability to stay upright or to control your body movements
— Walking, such as an inability to either walk steadily or at all
— Headache, such as a sudden, severe headache with no known reason
— Nausea and vomiting, such as sudden nausea or vomiting not caused by a systemic illness, like a virus
— Loss of consciousness, including fainting, confusion, seizures and coma
— Memory problems, such as sudden memory loss and difficulty or inability to think
[Read: How to Properly Take and Read Your Blood Pressure at Home.]
Risk Factors for Stroke
Strokes can occur at any age. Some risk factors can be managed with lifestyle changes, while others may be out of your control.
Modifiable risk factors
— High blood pressure. High blood pressure is the leading cause of stroke and the most controllable of all risk factors. Pressure of 140/90 millimeters of mercury or higher can damage blood vessels that supply blood to the brain.
— High blood cholesterol. Cholesterol is a fat-like substance in your blood. It increases the risk of blocked arteries due to the buildup of plaque, decreasing blood flow to the brain and raising your risk for stroke, which is why it’s important to track your cholesterol levels.
— Cardiovascular disease. Plaque buildup in your arteries supplying blood to your heart muscle can trigger an attack and affect the flow of blood to your brain, potentially causing stroke.
— Lack of physical exercise. A lack of physical activity can increase your risk because leading a sedentary lifestyle can increase heart disease, obesity, high blood pressure, high blood cholesterol and diabetes.
— Obesity. Being overweight increases your risk for high blood pressure, heart disease, high cholesterol and Type 2 diabetes, all risk factors for stroke.
— Diet. Diets high in saturated fat, trans fat and cholesterol can raise your blood cholesterol level. Sodium can increase your blood pressure, and food high in calories can lead to obesity and thus higher risk for stroke. You should cut out ultraprocessed foods, added sugars and eat more fruits and vegetables.
— Birth control pills or hormone therapy. Estrogen can increase your risk for stroke. Studies indicate that hormone therapy in standard doses increases your relative risk of stroke by about one-third. The chance for stroke increases when you take estrogen for menopause or gender transition.
— Alcohol. High and moderate consumption of alcohol can increase your risk for stroke by damaging your circulatory system.
— Smoking. The nicotine and carbon monoxide in cigarette smoke can damage your heart and blood vessels. Smoking and exposure to secondhand smoke nearly doubles your risk for stroke. Of all stroke survivors, 58.8% have a history of smoking.
— Diabetes. People who have Type 2 diabetes tend to be overweight, have high blood pressure and are at higher risk for stroke.
— Illegal drugs. Drugs like cocaine and methamphetamine can cause blood clots, putting you at higher risk for stroke.
— Obstructive sleep apnea. More than half of people who have a stroke also have sleep apnea.
— Peripheral artery disease (PAD). PAD is a collection of fat and cholesterol that narrows the arteries in your arms or legs, putting you at higher risk for stroke. It can be treated with lifestyle changes — including exercise, diet and smoking cessation — and medication.
Nonmodifiable risk factors
— Age. For each decade of life after the age of 55, your risk factor for stroke more than doubles.
— Race. Those who are African American, Hispanic, Native American and Native Alaskan are at higher risk of death or disability from stroke. As population groups, they tend to have more high blood pressure than those who are white. Research suggests that’s because they tend to live in areas where it’s difficult to access healthy food, doctors and other services that are more easily available to the white population.
— Sex. Men and women have similar risk factors for stroke. However, women tend to live longer and get older, putting them at higher risk for stroke. As they age, women are more likely to die of stroke than men. Pregnancy and the use of post-menopausal estrogen may also contribute to the higher stroke risk for women.
— Family and personal history. Genes you inherit from your parents, such as those for sickle cell anemia, may increase your risk for stroke. Once you have had a stroke, you are at higher risk of having another one. Putting together a family medical history can help you get a better picture of what you’re at risk for.
Additional risk factors for stroke
— Geographic location. There are more strokes in the Southeastern states where the tobacco use, higher blood pressure and obesity are more common than in other parts of the country. Known as the “Stroke Belt,” research shows that Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia have the highest mortality of stroke in the U.S.
— Lack of means. Stroke is more common in those with lower income because they lack access to quality food, health care and other social support systems.
— COVID-19. Increased blood clots have been associated with complications from COVID-19.
What to Do in a Stroke Emergency
If you’re with someone who you think is having a stroke, call 911 immediately. Time is of the essence because brain cells begin to die shortly after a stroke occurs. The sooner a stroke is treated, the less damage the brain will sustain.
“It’s important to start as quickly as possible to stimulate areas of the brain so it can make new connections,” says Dr. Carolyn Brockington, director of the stroke center at Mount Sinai West and Mount Sinai Morningside in New York.
Symptoms are often ignored because they don’t cause pain, but you should know how to recognize signs of a stroke. The National Stroke Association acronym BE FAST can help you determine if someone is having a stroke.
BEFAST stands for the following:
— F-Face. Ask the person to smile and see if one side of the face is drooping.
— A-Arms. Ask the person to raise both arms to determine whether one drifts down.
— S-Speech. Ask the person to repeat a simple phrase to determine whether speech is missing, slurred or garbled.
— T-Time. Time is very important in getting care for someone who is having a stroke. You should call 911 immediately.
Do not drive to the hospital. Wait for an ambulance that will begin life-saving treatment on the way to the hospital. They will also call ahead to the emergency room where staff will be waiting for you. When a stroke patient is brought in by ambulance, diagnosis and treatment may begin more quickly than for someone who is not brought to the hospital by ambulance. Emergency workers also collect vital information on the way to the hospital, saving time.
Stroke Diagnosis
Once you reach the ER, a specialized stroke team will ask questions to determine when the symptoms began and inquire about your medical history and recent medications. In addition, a physical and neurological exam is performed along with blood tests and imaging (brain and blood vessels) to help decide if the symptoms are due to a recent stroke.
Imaging tests include the following:
— Computer tomography (CT scan). Fast and readily available, the CT scan is used to examine the brain and assess the extent of damage, which helps determine whether the symptoms are due to a recent ischemic or hemorrhage stroke.
— Magnetic resonance imaging (MRI). This scan provides a detailed image of the brain, including any recent or remote injuries.
Stroke Treatments
Acute stroke treatment depends on a variety of factors, including what kind of stroke has occurred and the timing of the symptoms.
Acute ischemic stroke treatment
If you’ve had an acute ischemic stroke, it’s important to reestablish blood flow to the brain as soon as possible. If you arrive at the hospital promptly after the start of stroke symptoms, you may be eligible to receive a thrombolytic drug, a “clot buster,” which is administered intravenously while you’re in the ER to improve blood flow to the brain.
In some patients, minimally invasive catheter-based procedures may be able to unblock blood vessels.
Hemorrhagic stroke treatment
Treatment for a hemorrhagic stroke is determined by a variety of factors, including identifying the cause of the brain hemorrhage and stabilizing the effects of the hemorrhage, such as brain swelling and elevated blood pressure.
In an intensive care environment, treatment is focused on stabilizing your neurological status, including blood pressure control and attending to the swelling of the brain. At times, this kind of medical therapy may not be enough to stabilize a patient’s neurological status and neurosurgical intervention may be required.
You can find the top-rated hospitals for stroke-related care with U.S. News’s Best Hospitals for Strokes.
Stroke Rehabilitation
The degree of disability after a stroke depends on many factors, including your age, the size and location of the stroke, evidence of prior brain injury and the presence of other medical conditions.
Once the brain is injured, that injured part of the brain doesn’t grow back. However, many people recover after a stroke. The neuroplasticity of the brain refers to the brain’s ability to form and reorganize new connections following injury.
“Rehabilitation is instrumental in the recovery process and should begin once your neurological status has been stabilized,” Brockington says. “In many cases, the brain has a tremendous ability to recover if the proper support and treatment is given.”
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Stroke: Types, Causes, Symptoms and Treatments originally appeared on usnews.com
