A stroke is a medical emergency in which part of the brain suddenly loses its blood supply. Brain cells begin to die within minutes, so the faster someone gets treatment, the more of their brain, speech and movement can be saved. Learning to recognize the signs takes a few minutes and can change the outcome for someone you love.
What happens in a stroke
There are two main types:
- Ischemic stroke, the most common type, happens when a blood clot blocks an artery supplying the brain.
- Hemorrhagic stroke happens when a blood vessel in or around the brain bursts and bleeds.
Both cause sudden symptoms, and only a brain scan can tell them apart. That matters because the treatments are very different, which is why every suspected stroke needs a hospital immediately.
The BE FAST warning signs
Doctors and emergency services use the letters BE FAST to help people recognize a stroke:
- B – Balance: sudden loss of balance, dizziness or trouble walking
- E – Eyes: sudden blurred vision, double vision or loss of vision in one or both eyes
- F – Face: one side of the face droops or feels numb. Ask the person to smile and look for an uneven smile
- A – Arms: weakness or numbness in one arm or leg. Ask them to raise both arms and see if one drifts down
- S – Speech: slurred speech, trouble finding words, or difficulty understanding what others say
- T – Time: call 911 immediately and note the time symptoms started
A sudden, severe headache unlike any before, especially with vomiting or a stiff neck, can be a sign of bleeding in the brain and is also an emergency.
Why the time symptoms started matters
For ischemic strokes, a clot-dissolving medicine can be given through a vein, usually within 4.5 hours of when symptoms began. For strokes caused by a large blocked artery, a procedure called thrombectomy, in which a doctor removes the clot with a catheter, can help some patients up to 24 hours after onset.
Hospitals need to know exactly when the person was last seen normal. If someone wakes up with symptoms, the clock starts from when they went to bed. Write the time down or tell the paramedics.
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What to do while waiting for help
- Call 911 straight away. Do not wait to see if symptoms improve, and do not drive the person to hospital yourself. Paramedics can alert the stroke team so treatment starts sooner.
- Note the time symptoms began.
- Keep the person safe and comfortable. If they are drowsy or vomiting, lay them on their side.
- Do not give food, drink or medicine, including aspirin. Aspirin can make a bleeding stroke worse, and stroke can affect swallowing.
- Gather information about their medicines, especially blood thinners, for the paramedics.
Mini-strokes (TIAs)
A transient ischemic attack, or TIA, causes the same symptoms as a stroke but they disappear, often within minutes. A TIA is a serious warning sign. A significant share of people who have one go on to have a full stroke, and the risk is highest in the first few days. Treat a TIA as an emergency and get assessed the same day, even if you feel completely fine afterward.
Who is at risk
The biggest risk factor is high blood pressure. Others include:
- Atrial fibrillation, an irregular heart rhythm that can cause clots
- Smoking
- Diabetes
- High LDL cholesterol
- Obesity and physical inactivity
- Heavy alcohol use
- A previous stroke or TIA
- Age, family history and sickle cell disease
Women face some extra risks, including pregnancy-related high blood pressure, migraine with aura combined with smoking, and certain birth control pills in women who smoke.
Life after a stroke
Recovery depends on which part of the brain was affected and how quickly treatment started. Rehabilitation usually begins in the hospital and may include physical therapy, occupational therapy and speech therapy. The fastest gains often happen in the first few months, but many people keep improving for a year or longer. Depression after stroke is common and treatable, so mention changes in mood to the care team.
Preventing a second stroke is a major focus. It usually involves medicines to control blood pressure and cholesterol, antiplatelet drugs or anticoagulants, and treating conditions such as atrial fibrillation or a narrowed carotid artery.
How to lower your risk
- Know and control your blood pressure. Get it checked regularly and take treatment if prescribed.
- Stop smoking. Stroke risk falls steadily after quitting.
- Stay active. Aim for about 150 minutes of moderate activity a week.
- Eat well. More vegetables, fruit, whole grains and fish, and less salt and processed food.
- Limit alcohol.
- Manage diabetes and cholesterol.
- Ask about irregular heartbeat, especially if you feel palpitations or a smartwatch flags one.
The bottom line
Stroke symptoms come on suddenly: a drooping face, a weak arm, slurred speech, loss of balance or vision. If you see them, call 911 immediately and note the time. Fast treatment saves brain tissue, and most strokes can be prevented by controlling blood pressure and other risk factors.
This article is for general information only. If you think someone is having a stroke, call 911 now.