Stroke Know the Warning Signs

As the command center for every system in the body, a healthy brain requires a lot of blood to stay functional; in fact, every minute, it makes use of ¼ of the blood pumped by the heart. A diminished blood supply (for example, caused by a blood clot) starves the brain of oxygen, and brain tissue begins to die—a condition we recognize as stroke.

Stroke is the fifth most common cause of death in the United States (and number two worldwide). It occurs suddenly and often leaves very little time for effective medical intervention.

This deadly byproduct of cardiovascular disease affects over two million Americans each year, and 150,000 of those affected do not survive. Among the survivors, nearly eight million Americans must live with the aftereffects: often irreversible damage that impacts their daily lives.

And stroke is not necessarily a disease of older age—risk factors are increasing across all age groups, particularly younger adults. Our best defense is prevention.

Time Is Brain

What causes a stroke? There are two types of stroke:

• Ischemic stroke is similar to heart attack: an artery supplying the brain with blood is blocked, usually by a clot, resulting in tissue death. Ischemic stroke is four times more common than hemorrhagic stroke.
• In hemorrhagic stroke, a blood vessel in the brain ruptures and bleeds. Brain tissue is damaged as blood accumulates where it doesn’t belong.

The moment that a stroke begins, the clock is ticking. Damage sweeps very rapidly through the affected area of the brain, so the faster medical attention can be given, the more likely we are to save brain function and avoid devastating consequences for the patient.

Without treatment, brain tissue can be damaged beyond repair in about 4½ hours. Surviving stroke victims may suffer from paralysis, numbness, or weakness on one side of the body, creating difficulty in walking and use of the hands. Stroke can also affect speech, swallowing, memory, learning, and emotional health.

Stroke recovery is typically very slow and often limited. The brain cannot heal the injured tissue—stroke damage is permanent. In many cases, some areas of surviving brain tissue can learn new skills and compensate. But that rewiring typically takes six to eight months—and full functional recovery is rare.

Symptoms of Stroke: BE FAST

In some patients, a small blood clot may cause what we refer to as a mini-stroke or a transient ischemic attack (TIA), which behaves almost the same way that a larger stroke does. However, mini-stroke symptoms may subside very quickly, often in as little as five minutes.

TIA is a warning sign that a larger stroke may be imminent. Consider it a medical emergency and get the medical attention needed to prevent a larger event.

If or when that larger event occurs, urgent action is vital to preserve brain tissue. Stroke rarely produces pain, so look instead for these five classic stroke symptoms that happen suddenly. Use the acronym BE FAST to remember what to look for.

The BE FAST Checklist

Call 911 immediately if any of these stroke symptoms suddenly occurs:

B—Balance: leaning, staggering, or difficulty walking

E—Eyes: any visual impairment of one or both eyes, including visual field narrowing, blurry or double vision, or one eye not moving normally

F—Face: drooping on one side or a lopsided smile

A—Arms: weakness on one side, such as inability to fully raise the arm or hold onto something

S—Speech: speech is slurred or hard to understand, or the patient is inarticulate, unable to make meaningful conversation

T—Time: act immediately if you see or experience one or more of the symptoms above. Call 911 and get to a hospital as quickly as possible, where emergency treatment can begin.

Treatment

For a stroke victim who reaches the hospital quickly, treatment involves recanalization—opening vessels to restore blood flow.

We first complete a thorough neurological exam, and may order emergency radiology imaging studies. We use CT and MRI to confirm stroke and assess any bleeding damage. We treat quickly, potentially using both drugs and surgery to clear a blocked blood vessel, depending on location and severity.

When a blood clot causes a small blockage, we use thrombolytic medications, also known as tPA or clot-busters, to get the blood flowing again. We perform surgery to stop bleeding in the case of hemorrhagic stroke, when a larger artery has ruptured. In some cases, catheterization alone may be effective—we can potentially pass a thin tube through a large blood vessel and navigate it to the site of the blockage.

Because about one in four stroke patients will suffer another stroke within five years, we typically prescribe antithrombotic medications such as aspirin to prevent clotting that may cause additional strokes. And after treatment and initial recovery, rehabilitation is typically recommended, to help the patient strengthen weakened muscles and improve swallowing, speech, and other critical functions.

Patients are in the best possible hands here at MedStar Washington Hospital Center. We are a Comprehensive Stroke Center, with an advanced care team that includes highly trained neurologists, neurosurgeons, emergency physicians, nurses, and rehabilitation professionals. Many of our team members participate in key research in the area of stroke.

The Hospital Center makes use of the latest and most effective medications, and offers advanced imaging technology focused specifically on diagnosing neurological problems. We are equipped to act in the shortest amount of time to achieve the best possible results for our stroke patients.

Prevention, the Best Medicine

Traditional stroke risks include high blood pressure, high LDL cholesterol, atrial fibrillation, diabetes, tobacco use, advanced age, and a prior stroke history. And recently, the COVID-19 virus has caused life-threatening clotting in some patients as well.

Managing your health and adopting a healthy lifestyle are the best ways to prevent stroke—and prevention is significantly better than treatment.

• Control weight gain—try to maintain a belly circumference of less than 34 inches.
• Exercise at moderate intensity for at least 30 minutes, three days per week.
• Avoid tobacco and illicit drugs.
• Drink alcohol in moderation.
• Eat nutritionally balanced meals that include more fruits and vegetables than meat and that minimize sodium and fat.
• Take all recommended precautions against COVID-19—mask up, practice social distancing, avoid crowds, isolate when ill, and get vaccinated.
• Schedule regular checkups with your primary care physician, who will work with you to manage any underlying conditions such as high blood pressure, diabetes, atrial fibrillation, or clotting disorders.