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Learn to recognize the signs of a stroke

Lauren Steele writer headshot By | May 11, 2020
Medically reviewed by Anis Rehman, MD

There’s a good chance you know someone who has had a stroke, or you will in your lifetime—and that’s because strokes are prevalent. More than 795,000 people in the United States have a stroke every year, according to the Centers for Disease Control and Prevention (CDC). In other figures, someone in the United States has a stroke every 40 seconds. Every 4 minutes, someone dies of a stroke. And for those who survive, strokes are the leading cause of serious long-term disability.

 Strokes are dangerous and common, but there is still a lot of confusion surrounding them—what is a stroke? What are the signs of a stroke? How can you prevent a stroke? Here, find the answers you need.

What is a stroke?

To put it as plainly as possible, “a stroke is damage to the brain caused by not enough blood getting to the brain,” says Stephen Devries, MD, a preventive cardiologist and executive director of the nonprofit Gaples Institute for Integrative Cardiology. “A stroke is caused by a problem with the blood vessels that go to the brain, which can happen either because the blood vessel becomes clogged from a cholesterol plaque or blood clot, or when a blood vessel in the brain bursts open due to high blood pressure or an inherited weakness in the artery.”

You often hear “stroke” in the same sentence as “heart attack” because they are related complications, but they are not the same thing. “Stroke occurs as a result of a blockage in the vessels that supply the brain with oxygenated blood, while a heart attack occurs due to a blockage that develops in the vessels that supply the heart muscle,” explains Regina S. Druz, MD, FACC, a cardiologist with Catholic Health Services of Long Island and Chief Medical Officer with the Holistic Heart Centers of America (HHCA). “While the organs are very different, the vascular and systemic events that involve stroke and heart attack are closely related, as are the underlying risk conditions.”

What are the risk factors of a stroke?

According to the National Heart, Lung, and Blood Institute, some of the major risk factors that increase your chances of having a stroke include:

  • High blood pressure
  • Diabetes
  • Heart disease
  • Smoking
  • High LDL cholesterol levels
  • Atrial fibrillation (abnormal heart rhythm)
  • Brain aneurysms or arteriovenous malformations (AVMs)
  • Infections or conditions that cause inflammation (such as lupus or rheumatoid arthritis)
  • Family history of stroke
  • Sex (women are more likely to have a stroke)
  • Prior history of stroke or Transient Ischemic Attack (TIA) also known as a mini-stroke 

Other, lesser-known stroke risk factors include anxiety, depression, high stress levels, frequent illicit drug use, excessive drinking, obesity, getting too much sleep (more than nine hours regularly), estrogen replacement, oral contraceptive pills, and living in areas with air pollution.

What are the first signs of a stroke?

“Face drooping, arm weakness, and speech difficulty are all indicators of a stroke,” Dr. Druz says. According to the CDC, early symptoms of a stroke also include:

  • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
  • Sudden confusion, trouble speaking, or difficulty understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or lack of coordination
  • Sudden severe headache with no known cause

Stroke symptoms can be different in women than they are in men. According to the American Stroke Association, women may report symptoms such as:

  • General weakness
  • Difficulty breathing or shortness of breath
  • Confusion, unresponsiveness, or disorientation
  • Sudden behavioral change
  • Agitation
  • Hallucination
  • Nausea or vomiting
  • Pain
  • Seizures
  • Loss of consciousness or fainting

How long do you have symptoms before a stroke?

Stroke warning signs may present up to seven days before a stroke, according to research published in Neurology. “Warning signs of a stroke are the same as the stroke itself—but the difference is that, prior to the actual stroke, the warning symptoms resolve quickly, sometimes in a manner of a few minutes,” Dr. Devries explains. “Too often, these alarms are disregarded and people don’t seek the medical attention that could be life-saving.” Seeking immediate medical help at the first hint of a symptom can help to prevent brain damage.

What should you do if you recognize signs of a stroke?

“If these are new conditions then you should immediately call 911. This constellation of symptoms and signs is known as the acronym ‘FAST’—helping you to remember these three symptoms, with an added ‘T’ indicating that time is of the essence.” explains Dr. Druz.

The National Heart, Lung, and Blood Institute (NHLBI) breaks down FAST with the symptoms and the action you should take to confirm a possible stroke patient’s condition like this:

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 right away. Early treatment is essential.

If you think you or someone else is having a transient ischemic attack (TIA) or stroke, don’t drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.

Can a stroke go unnoticed?

There is such a thing as a mini stroke—or a TIA—which can go unnoticed by both the person experiencing it and bystanders. A TIA is a problem in the blood vessels of the brain that causes a temporary decrease in blood flow to a certain brain region, according to Harvard Health. Dr. Louis Caplan, professor of neurology at Harvard-affiliated Beth Israel Deaconess Medical Center says that these episodes are very brief, lasting less than an hour to up to 24 hours. 

In fact, most TIAs are over within a few minutes. The chain of events that leads to a TIA is the same that leads to a stroke, but on a smaller scale. This is dangerous because a TIA can cause permanent damage and is very likely to cause a stroke in the near future.

What conditions can mimic a stroke?

According to research published in 2017, there are several medical conditions that can mimic the signs and symptoms of a stroke, such as: brain tumors, metabolic disorders (like hypoglycemia or hyperthyroidism), infectious diseases (like meningoencephalitis), and psychological disorders (like migraine or seizures).

This makes recognizing a stroke even more difficult, but waiting on treatment can cause irreversible complications. If you think there’s any chance it could be a stroke, it’s time to go to the hospital. Even if it ends up being a mimic condition, it’s better to be safe than sorry.

How to prevent a stroke

While there are many risk factors that are out of our control (such as family history and genetics), there are many ways to significantly reduce your risk of stroke. “People have much more power over their health with diet and lifestyle than they often realize,” Dr. Devries says. 

Patients who have diabetes, atrial fibrillation, high cholesterol, and hypertension are at increased risk of developing a stroke. Controlling these underlying conditions with their respective treatments will help prevent a stroke. 

These five steps can help to prevent a stroke:

  1. Quit smoking. “Smoking is a big risk factor, and nothing could be a more positive step toward better health than to quit,” says Dr. Devries.
  2. Reduce the salt in your diet, and consume less processed foods. “High blood pressure is also one of the strongest risk factors for stroke,” says Dr. Devries. “Dietary changes can go a long way to help with blood pressure—especially limiting the salt in your diet (found in many packaged processed foods, as well as in bread, processed meats like bacon and sausage, and pizza).”
  3. Eat more fruits, beans, and greens. “On the positive side, foods high in potassium, like many fruits, beans, and greens, actually help to lower blood pressure,” says Dr. Devries.
  4. Limit consumption of alcohol. “Excess alcohol can also raise blood pressure—a fact that many people are not aware of,” notes Dr. Devries.
  5. Get regular exercise. “Other lifestyle changes that can help prevent stroke include regular exercise, including sustained walking, and stress management with tools like meditation,” says Dr. Devries.

If you’ve already had a stroke, your doctor might treat you with aspirin, clopidogrel (Plavix), and statin medications to prevent a second stroke. 

“The two-pronged approach to avoiding a recurrence of stroke is to get regular medical checkups and to do all you can to optimize your lifestyle opportunities,” Dr. Devries says. “Regular medical checkups are essential to keep blood pressure, cholesterol, and sugar levels in check. But even with the right medicine, making lifestyle changes remain essential.” Stroke patients are treated with aspirin, clopidogrel (Plavix) as well as statin medications to prevent a second stroke.