Stroke: Can It Strike Anyone, Anytime?

Strokes are a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. They can happen randomly to anyone, from children to adults, but certain factors increase the risk of having a stroke. These factors include age, race, ethnicity, family history, high blood pressure, high cholesterol, diabetes, and smoking. Recognizing the signs of a stroke is crucial, as immediate medical attention is critical to prevent permanent damage or death. The F.A.S.T. acronym is a helpful tool to remember the warning signs: Face Drooping, Arm Weakness, Speech Difficulty, and Time to call emergency services. Other symptoms include numbness, confusion, vision problems, dizziness, and severe headaches.

Stroke symptoms and when to call emergency services

A stroke is a life-threatening condition that occurs when there is an issue with blood flow to the brain. This can be due to blocked blood vessels or bleeding in the brain. As a result, brain cells in the affected area begin to die from a lack of oxygen.

Strokes are a medical emergency, and immediate action must be taken to prevent permanent damage or death. To recognise the warning signs of a stroke, remember the acronym BE FAST:

• Balance: Watch out for a sudden loss of balance.
• Eyes: Look for a sudden loss of vision in one or both eyes. Check for double vision.
• Face: Ask the person to smile and observe if one side of their face droops, indicating muscle weakness or paralysis.
• Arms: Check for muscle weakness on one side by asking the person to raise both arms. If one arm droops, this could be a sign of a stroke.
• Speech: Strokes can cause a person to lose their ability to speak. They may have slurred speech or trouble finding the right words.
• Time: Time is critical when responding to a stroke. Note the time when symptoms begin, and call emergency services right away.

Other symptoms of a stroke include:

• Numbness or weakness on one side of the body, especially in the face, arm, or leg.
• Confusion, disorientation, or memory problems.
• Severe headache with no apparent cause.
• Nausea and vomiting.
• Emotional instability and personality changes.

If you or someone you know is exhibiting any of these symptoms, it is crucial to call emergency services immediately. Do not wait for the symptoms to go away, as prompt treatment can significantly impact the chances of recovery and reduce the risk of long-term disability.

The two types of stroke

A stroke is a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. Strokes can happen randomly, and they are a leading cause of death and disability worldwide. There are two main types of strokes: ischemic and hemorrhagic.

Ischemic strokes, which account for about 80% of all strokes, occur when blood flow to the brain is blocked. This is usually due to a blood clot obstructing a blood vessel that supplies blood to the brain. Ischemia is when cells don't get enough blood flow and, as a result, oxygen. Without oxygen, brain cells can die within minutes. There are two main types of ischemic strokes: thrombotic and embolic. Thrombotic strokes are caused by a blood clot that forms in an artery supplying blood to the brain, while embolic strokes happen when a clot forms elsewhere in the body and travels to the brain.

Hemorrhagic strokes, on the other hand, are caused by bleeding in or around the brain. They can occur when a weakened blood vessel, often due to uncontrolled high blood pressure, ruptures. There are two types of hemorrhagic strokes: subarachnoid hemorrhage and intracerebral hemorrhage. Subarachnoid hemorrhage occurs in the space between the brain and its outer covering, while intracerebral hemorrhage is bleeding inside the brain.

Both types of strokes require immediate medical attention to prevent permanent damage or death. The faster a person receives treatment for a stroke, the more likely they are to recover without disability.

Risk factors

While a stroke can happen to anyone, some people are at a greater risk than others. Here are some key risk factors for stroke:

Age

Strokes are more common in older people, with about two-thirds of strokes occurring in individuals over the age of 65. However, it is important to note that strokes can and do occur at any age, even in children.

Medical Conditions

Certain medical conditions can increase the risk of experiencing a stroke. These include:

• High blood pressure (hypertension): This is a significant risk factor for all types of strokes, as it can contribute to blood vessel damage.
• High cholesterol (hyperlipidemia): High cholesterol levels can lead to plaque buildup in the arteries, potentially blocking blood flow and causing a stroke.
• Type 2 diabetes: Diabetes can damage blood vessels and lead to narrowed arteries, increasing the risk of stroke.
• Heart conditions: Conditions such as atrial fibrillation, heart defects, and abnormal heart rhythms can increase the risk of stroke.
• Migraines: People who experience migraines, especially with auras, have a higher risk of stroke.
• Previous stroke or heart attack: If you have had a stroke or heart attack in the past, your risk of having another stroke is higher.

Lifestyle Choices

Some lifestyle choices can also increase the risk of stroke:

• Smoking: Smoking increases the risk of stroke and should be avoided.
• Alcohol and drug use: Alcohol use disorder and recreational drug use, including prescription and non-prescription drugs, can contribute to stroke risk.
• Diet and exercise: A healthy diet and regular exercise can help lower the risk of stroke, while unhealthy dietary choices and a sedentary lifestyle can increase risk.

Gender and Ethnicity

According to the American Stroke Association, women, Hispanics, and African Americans in the United States have a higher risk of stroke. Additionally, hormonal changes during menopause and pregnancy, as well as certain types of birth control medications, can put women at a higher risk.

Preventative measures

While strokes can happen to anyone, from children to adults, they are more common in people over 65, with about two-thirds of strokes occurring in this age group. There are also certain medical conditions that increase the risk of stroke, such as high blood pressure, high cholesterol, Type 2 diabetes, and a history of heart attack or irregular heart rhythms. However, the good news is that up to 80% of strokes can be prevented through healthy lifestyle changes and working with healthcare professionals to control risk factors. Here are some preventative measures you can take to lower your risk of having a stroke:

Lower Blood Pressure

High blood pressure is the biggest contributor to stroke risk, so monitoring and treating it is crucial. Your goal should be to maintain a blood pressure of less than 120/80, but consult with your doctor to determine the appropriate target for you. To lower blood pressure, reduce your salt intake to no more than 1,500 milligrams per day and limit high-cholesterol foods like burgers, cheese, and ice cream. Eat plenty of fruits and vegetables, and consider the DASH or Mediterranean diets, which emphasize these food groups while reducing saturated fats and cholesterol.

Maintain a Healthy Weight

Obesity increases the risk of stroke, so maintaining a healthy weight is important. Work with your doctor to develop a weight loss strategy that is realistic for you. Aim for a calorie-controlled diet, with a general guideline of 1,500 to 2,000 calories per day, depending on your activity level and current BMI.

Increase Physical Activity

Exercise is a powerful tool for stroke prevention. Aim for at least 30 minutes of moderate-intensity activity per day, and try to incorporate activities like walking, golfing, or playing tennis into your routine. Breaking up the exercise into shorter sessions throughout the day is also beneficial if you don't have a longer block of time available.

Moderate Alcohol Consumption

Drinking alcohol in moderation is important, as excessive consumption can raise blood pressure. Limit yourself to no more than one drink per day, and remember that alcohol can interact with certain medications.

Treat Atrial Fibrillation

Atrial fibrillation, or irregular heartbeat, increases the risk of stroke by causing clots to form in the heart that can travel to the brain. If you experience symptoms like heart palpitations or shortness of breath, consult your doctor for an examination. They may prescribe anticoagulant medication to reduce your stroke risk.

Control Blood Sugar

High blood sugar can damage blood vessels over time, making clot formation more likely. Monitor your blood sugar levels as directed by your doctor, and use diet, exercise, and medication to keep them within the recommended range.

Quit Smoking

Smoking is a significant risk factor for stroke, as it accelerates clot formation and increases plaque buildup in the arteries. Ask your doctor for advice on quitting, and consider using quit-smoking aids and counseling to increase your chances of success.

Treatment options

Stroke is a life-threatening condition that requires immediate medical attention. Treatment options depend on the type of stroke, the location and severity of the bleeding, and whether the patient has any other medical conditions. Here are some of the treatment options available:

Ischemic Stroke Treatment

Ischemic strokes are caused by blocked blood vessels in the brain, cutting off blood flow. This is the most common type of stroke, accounting for about 80% of all strokes. Treatment for ischemic strokes focuses on restoring blood circulation to the affected areas of the brain. This can be done through medication or medical procedures.

Medication

The main medication used for ischemic strokes is tissue plasminogen activator (tPA), which breaks up blood clots. tPA must be administered within 3 hours of the onset of stroke symptoms, and sometimes up to 4.5 hours if large parts of the brain are still viable. Other medications, such as anticoagulants or blood-thinning medicines like aspirin or clopidogrel, can also be used to stop blood clots from forming or growing larger.

Procedures

A thrombectomy is a procedure used to remove blood clots from blocked arteries in the neck or brain. A long, flexible tube called a catheter is inserted into the upper thigh and guided to the blockage. Angioplasty and stenting procedures involve inserting a balloon or small mesh tube into the artery to clear space for improved blood flow. A stent retriever can also be used to trap and remove the clot.

Hemorrhagic Stroke Treatment

Hemorrhagic strokes are caused by bleeding in or around the brain and require urgent treatment to prevent further damage. Treatment options depend on the location and severity of the bleeding.

Medication

For hemorrhagic strokes, the focus is on reducing blood pressure to minimise bleeding and strain on blood vessels in the brain. Blood pressure medications are often used, and any anticoagulant or blood-thinning medications that may have contributed to the bleeding are discontinued. Vitamin K may be administered to aid in stopping the bleeding.

Procedures

Several procedures can be used to treat hemorrhagic strokes, including:

• Aneurysm clipping: A tiny clamp is placed at the base of an aneurysm to stop bleeding and prevent it from bursting again.
• Coil embolization: A catheter is inserted into an artery in the upper thigh and guided to the aneurysm in the brain. A tiny coil is pushed through the catheter, causing a blood clot to form and block blood flow to the aneurysm.
• Draining excess fluid: If fluid has built up in the brain after a stroke, it can be drained to relieve pressure and reduce damage.
• Surgery: In cases of significant swelling, surgery may be performed to temporarily remove part of the skull to give the brain room to swell without pressure building up. Surgery can also be used to remove pooled blood or to address an arteriovenous malformation (AVM), a tangle of arteries and veins that can break open in the brain.

Frequently asked questions