Stroke Awareness: Can You Miss The Signs?

Strokes are a life-threatening medical emergency that require immediate attention to prevent permanent damage or death. They occur when there is an interruption in the blood flow to the brain, causing brain cells to die from a lack of oxygen. The signs of a stroke include sudden numbness or weakness in the face, arm, or leg, confusion, trouble speaking or understanding speech, sudden loss of vision, dizziness, severe headaches, nausea, and vomiting. Recognizing these signs and acting quickly is crucial, as the risk of permanent damage or death increases with delay. Knowing the symptoms and taking immediate action can be the difference between life and disability or death.

Warning signs: FAST (face, arms, speech, time)

The FAST (Face, Arm, Speech, Time) acronym is a screening tool that helps identify whether someone is having a stroke, and facilitates quick access to medical care. Here are the warning signs to look out for:

Face:

Ask the person to smile and check for a droop on one or both sides of their face. This could indicate muscle weakness or paralysis.

Arm:

Ask the person to raise both arms. If they have one-sided weakness, one arm will stay higher, while the other will sag and drop.

Speech:

Strokes often cause a person to lose their ability to speak. They may slur their words or have trouble choosing the right words or understanding speech.

Time:

Time is critical when responding to a stroke. If you observe any of the above symptoms, immediately call for an ambulance so that medical personnel can begin treatment as soon as possible. Also, note the time that the symptoms started, as this information will help healthcare providers determine the best treatment options.

Risk factors: age, race, gender, medical history, lifestyle choices

While anyone can have a stroke at any age, certain factors can increase the chances of having one. Some risk factors, such as age, race, gender, and family history, are beyond our control, but there are steps we can take to lower our chances of having a stroke.

Age

The likelihood of having a stroke increases with age. While strokes are more common in older adults, many people under 65 also experience strokes. In fact, about one in seven strokes occur in adolescents and young adults aged 15 to 49. The risk of having a stroke doubles every ten years after the age of 55.

Race

People who are non-Hispanic Black or Pacific Islanders are more likely to die from a stroke than those who are non-Hispanic White, Hispanic, American Indian, Alaska Native, or Asian. The risk of having an initial stroke is nearly twice as high for Black people as it is for White people.

Gender

Stroke is more common in women than in men, and women of all ages are more likely to die from a stroke. One in five women will have a stroke, and about 55,000 more women than men have a stroke each year. Pregnancy and the use of birth control pills pose additional stroke risks for women.

Medical History

A previous stroke or transient ischemic attack (TIA), also known as a "mini-stroke," significantly increases the chances of having another stroke. Other medical conditions that increase the risk of stroke include high blood pressure, high cholesterol, diabetes, obesity, heart disorders, and sickle cell disease.

Lifestyle Choices

Lifestyle choices can significantly impact stroke risk. Unhealthy behaviours such as smoking, excessive alcohol consumption, and a sedentary lifestyle contribute to an increased risk of stroke. A diet high in saturated fats, trans fat, cholesterol, and salt can also raise blood pressure and cholesterol levels, leading to a higher risk of stroke. However, adopting healthy behaviours, such as regular exercise and a nutritious diet, can effectively lower the chances of having a stroke.

Types: ischemic and hemorrhagic

There are two major types of strokes: ischemic and hemorrhagic. Ischemic strokes are the most common and happen when there is a blockage in a blood vessel in the brain, usually due to a blood clot or a buildup of fatty deposits and cholesterol (a substance known as plaque). This blockage reduces blood flow to the brain, preventing oxygen and nutrients from reaching brain cells. Ischemic strokes can also be caused by thrombosis, embolism, or stenosis. Thrombosis refers to a clot forming in a blood vessel of the brain or neck, while embolism involves a clot travelling from another part of the body, such as the heart, to the neck or brain. Stenosis occurs when a blood vessel in the brain narrows due to fatty deposits lining the walls of the artery.

Hemorrhagic strokes, on the other hand, are characterised by the bursting of a blood vessel, leading to bleeding into or around the brain. This break in the vessel results in reduced oxygen and nutrient delivery to brain cells and exposes the brain tissue to toxic substances. Additionally, the bleeding increases pressure inside the skull, causing further damage by compressing the brain tissue.

Ischemic strokes account for about 80% of all strokes and typically occur through thrombosis, embolism, lacunar stroke, or unknown reasons (cryptogenic strokes). Hemorrhagic strokes can be either intracerebral or subarachnoid. Intracerebral haemorrhage occurs when a blood vessel inside the brain tears or breaks open, causing bleeding that puts pressure on the surrounding brain tissue. Subarachnoid haemorrhage, on the other hand, involves bleeding into the space between the brain and its outer covering, known as the subarachnoid space. This type of haemorrhage damages blood vessels that pass through the arachnoid membrane, a thin layer of tissue surrounding the brain.

Diagnosis: neurological exam, imaging, blood tests, ECG

A stroke is a medical emergency and requires immediate attention. A doctor will diagnose a stroke based on symptoms, medical history, a physical exam, and test results. The neurological exam will involve checking the patient for:

• Coordination and balance
• Numbness or weakness in the face, arms, and legs
• Trouble speaking or seeing clearly

The neurological exam helps determine the severity of the stroke and plan treatment.

Imaging tests are used to look at the blood vessels in the brain and determine the type of stroke and where it occurred. The faster these tests can be done, the better the chances of an accurate diagnosis and effective treatment. Some of the imaging tests used include:

• Computed tomography (CT) scan: This uses X-rays to take clear, detailed pictures of the brain. It is often done right after a suspected stroke to check for bleeding in the brain or damage to brain cells.
• Magnetic resonance imaging (MRI): This uses magnets and radio waves to create pictures of the brain. It may be used instead of or in addition to a CT scan to diagnose a stroke.
• Digital subtraction angiography (DSA) and positron emission tomography (PET): These tests are used to look for narrowed blood vessels in the neck, an aneurysm, or an arteriovenous malformation in the brain.

Blood tests are also used to check red blood cell and platelet count and glucose levels in the blood. They can also help determine if a specific medicine can be used to treat the stroke. Additionally, blood tests can be used to check how well the blood is clotting and to look for muscle damage.

An electrocardiogram (ECG or EKG) can help find heart problems that may have led to a stroke, such as atrial fibrillation or a previous heart attack.

Treatment: medicines, surgery, therapy

Treatment for a stroke depends on the type of stroke and how soon the patient receives treatment. Immediate medical attention is critical to prevent permanent damage or death. The two main types of strokes are ischemic and hemorrhagic. Ischemic strokes are caused by blocked blood vessels in the brain, usually due to a blood clot or a buildup of fatty deposits and cholesterol, whereas hemorrhagic strokes are caused by bleeding in or around the brain due to a burst blood vessel.

Medicines

Medicines used to treat strokes include thrombolytics, which dissolve blood clots that block blood flow to the brain in ischemic strokes. Thrombolytics must be given within three to four and a half hours of a stroke occurring to be effective. Other medications used include neuroprotective medicines, which help protect the brain from damage and lack of oxygen, and medications to reduce or control brain swelling, especially after a hemorrhagic stroke.

Surgery

Surgery may be required to relieve pressure on the brain from accumulated blood after a hemorrhagic stroke. A craniotomy, a type of brain surgery, can be performed to remove blood clots, relieve pressure, or repair bleeding in the brain. Other surgical procedures used to treat or prevent strokes include carotid endarterectomy, carotid stenting, and surgery to repair aneurysms and AVMs (arteriovenous malformations).

Therapy

Therapy is an important part of stroke recovery, helping patients regain abilities they had before the stroke. Types of therapy include speech therapy, physical therapy, occupational therapy, and cognitive therapy. Speech therapy helps patients regain language and speaking abilities, physical therapy assists in improving motor activities, and occupational therapy retrains everyday activities such as eating, drinking, and bathing. Cognitive therapy is beneficial for those experiencing memory problems or difficulty with activities requiring focus and concentration.

Frequently asked questions