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What You Need to Know About Stroke

Get the facts on the different types of strokes, what puts you at risk for having a stroke and the latest treatments.

About 795,000 Americans suffer a stroke every year and of those, 130,000 die, making stroke the fifth leading cause of death in the U.S.

These are sobering facts, but here’s the most important fact of all: “A stroke is preventable, and the key factors to that are controlling blood pressure and smoking cessation. Do that and the risk of stroke drops precipitously,” says Raul Guisado, MD, a neurologist at Regional Medical Center of San Jose in California.

What is a stroke?
A stroke is when part of your brain dies due to a lack of oxygen-rich blood. There are two main types. An ischemic stroke happens when a blood clot blocks blood flow to the brain, depriving it of oxygen and other nutrients. A hemorrhagic stroke is when a blood vessel in the brain leaks or ruptures, causing blood to pool in or around the brain, which can lead to brain damage.

About 87% of all strokes are ischemic strokes, according to the Centers for Disease Control and Prevention (CDC), but “hemorrhagic strokes are much more disabling,” says Dr. Guisado. A 2009 study from Denmark that followed nearly 40,000 people for six years, published in the journal Stroke, showed that hemorrhagic strokes are 56% more likely overall to cause death than ischemic strokes.

There is another sub-type, often referred to as a “mini-stroke,” called a transient ischemic attack (TIA), which occurs when blood flow to the brain is temporarily interrupted. Its symptoms, which can last from a few minutes to a few hours, don’t usually cause permanent damage. While that may seem like good news, a TIA should be considered a warning sign. You’re at greater risk of having an actual stroke in the first few hours to days after a TIA, especially if you have other risk factors. A full one-third of TIA patients will have a stroke within the next year. That’s why it’s critical to be evaluated as soon as possible, ideally within an hour of symptoms starting, since you can’t be sure if it’s a TIA or full stroke.

Symptoms
Guisado says to look for “sudden changes that affect speech, the face, one side of the body or neurological function.” The quicker a stroke is recognized and the quicker a person gets treatment, the more likely long-term damage will be avoided, according to Guisado. That’s why it’s important to B.E. F.A.S.T. in your assessment if you think someone’s having a stroke. That means:

  • Balance -- is there a sudden loss of balance or coordination?
  • Eyes -- is there sudden vision loss, distorted vision or blind spots in one eye?
  • Face -- ask the person to smile and see if one side of the mouth droops.
  • Arms -- ask the person to raise both arms over their head; does one arm drift down?
  • Speech -- does the speech sound slurred?
  • Time -- if you notice any of these symptoms, call 911 right away.

Who Is At Risk?
Major risk factors of stroke include high blood pressure, high LDL cholesterol, smoking, diabetes and heart disease. Age is another important risk factor. According to the CDC, your risk approximately doubles every 10 years after age 55. Some risk factors are genetic, but your chance of having a stroke rises even more when you combine genetics and family history with unhealthy lifestyles such as smoking, poor diet and physical inactivity.  

Treatment
One of the biggest advances in ischemic stroke treatment in the last decade, according to Guisado, is the use of powerful clot-busting drugs called thrombolytics. Acting quickly is critical; getting a thrombolytic within three hours of having a stroke can help limit long-term damage. If the clot blocks one of the large arteries of the brain, surgically removing it is another option, but the procedure must be performed within six hours of the stroke for optimal results. Doctors may also use aspirin to stop new clots from forming.

For a hemorrhagic stroke, once vital signs are stabilized, doctors focus on ways to prevent blood clots and reduce pressure in the skull. You may be given medications or even transfusions of blood products to counter the effect of blood thinners, if you take any. You may also be given medications to lower your blood pressure, prevent seizures and relieve pressure in your brain. Surgery to stop the bleeding or decrease pressure in the skull may be necessary as well.

Recovery
Recovery depends on many factors. “The size [of the stroke] and location [in the brain] are most important,” says Guisado. “The next factor is the age of a person.” The younger the patient, the more brain plasticity they have and the more likely they are to bounce back. “The other factor is the general health of a person,” Guisado says. “Certain conditions like diabetes, congestive heart failure and kidney disease can impair recovery.”

A small December 2016 study published in Neurology suggests that lifestyle changes can have a major impact on your recovery after a stroke. Getting your cholesterol and blood pressure under control and being physically active can reduce your risk of another stroke or a heart attack three years after your stroke. Physical activity was especially important—people in the study who were physically inactive were at a five times greater risk of a stroke, heart attack or vascular death than people who exercised weekly.

See More from Dr. Guisado:
How soon after stroke should treatment start?
What are the warning signs of a stroke?
Are there new devices available to treat stroke?