Let's Talk About Stroke
Not all strokes can be prevented, there's a ton you can do to protect yourself. We cover everything you need to know.by Matt McMillen Health Writer
There’s a saying in stroke care: Time is brain. That means the faster you get medical attention when you’re having a stroke, the less brain damage the stroke will cause. It’s important to understand what can bring on this kind of brain attack and, more importantly, learn the right preventive measures to take now so you can lower your risk for ever having one. But perhaps most critical of all, you've got to know what to do in case one occurs: If you or someone you know shows the telltale signs of a stroke—facial drooping, slurred words, confusion, and weakness or even paralysis on one side of the body—don’t hesitate. Call 911. (And get to a hospital, stat!)
Our Pro Panel
We went to some of the nation’s top experts in stroke to bring you the most up-to-date information possible.
Rohan Arora, M.D.
Director, Stroke Program
Long Island Jewish Forest Hills
Ghulam Abbas Kharal, M.D.
The Cleveland Clinic
Vivien Lee, M.D.
The Ohio State University Wexner Medical Center’s Comprehensive Stroke Center
Do everything in your power to get risk factors involving heart disease under control. That might mean lowering your blood pressure, exercising at least 150 minutes a week, eating, a nutritious diet, maintaining a healthy weight, quitting smoking, and more. The earlier you start, the better, but no matter what your age, you’ll benefit from any and all of these positive changes.
Not necessarily. While it’s true that your risk of a stroke is much higher after age 65—this group accounts for nearly 75% of all cases—more and more young people are having strokes. Why? More are obese and have high blood pressure and/or diabetes—all of which puts them at higher risk of stroke.
More women than men have strokes each year, and more women die from them. That’s because women tend to live longer than men, and the older you get, the higher your stroke risk becomes. Older women are also much more likely to have atrial fibrillation, which increases risk of stroke by five times, no matter your age.
That depends on the size of the stroke, where in the brain it occurred, and how quickly treatment began. Part of rehabilitation will be training the undamaged parts of your brain to do jobs once performed by areas affected by your stroke. It could take months or years, and partial recovery may be all that’s possible. While that’s hard to read, scientists are learning more about the brain’s plasticity and its ability to “rewire” every day. So have hope.
What Is a Stroke, Anyway?
A stroke is underway when something interrupts the flow of blood and oxygen to the brain. There are a few ways that can happen, including through a blocked or ruptured blood vessel. Strokes occur suddenly and can quickly lead to disability—and sometimes even death. They’re also are quite common. The Centers for Disease Control and Prevention (CDC) estimates that a stroke occurs every 40 seconds in the U.S. In fact, stroke is the fifth-leading cause of death in this country.
For survivors, life after a stroke can present many challenges, some of them daunting, including problems with thinking and memory, speech, and mobility. In fact, stroke is the leading cause of serious disability for adults, according to the National Institute on Aging.
The good news? The CDC estimates that four out of five strokes can be prevented. That’s where we come in. Keep reading to learn what you can do now to avoid stroke from happening to you or someone you love.
What Are the Risk Factors for Stroke?
When you look at the list of things that up your odds of stroke, you’ll recognize plenty of usual suspects, many of which also contribute to heart disease. Most share an essential feature: You can do something about them if you’re willing to put in the work. Let’s take a look:
High Blood Pressure (HBP)
Hypertension, a.k.a. HBP, is the big one, so we’ll go into extra detail here. Your blood pressure is a measure of the force that presses against the walls of your blood vessels with each heartbeat. When it goes above normal and remains there, HBP can cause a whole host of problems, all of which contribute to stroke risk:
First, it damages your blood vessels and helps trigger the buildup of dangerous plaques.
Second, it weakens your blood vessels, making them prone to bursting.
Third, it increases your risk of atrial fibrillation, a dangerously erratic heartbeat that can cause clots to form inside the heart, which then travel to the brain.
Underlying Health Conditions
HBP isn't the only underlying condition that can lead to stroke. Sometimes other health issues, especially if they aren’t well-managed, can put you at higher risk for having one. They include:
Diabetes. Unchecked diabetes damages your blood vessels and heightens your risk of HBP. People with diabetes are also more likely to have other stroke risk factors, such as obesity and poor diet.
Atherosclerosis. The buildup of plaque on the walls of the arteries leads to decreased blood flow and increases your risk of developing artery-blocking clots.
Heart attack. Similar to an ischemic stroke, a heart attack occurs when the heart’s supply of blood and oxygen gets cut off. If the heart attack damages the heart in such a way that it can no longer beat normally, clots become likelier to form.
Atrial fibrillation. We mentioned it above, but it's worth repeating: Afib is a major risk factor for stroke. The most common type of arrhythmia, or irregular heartbeat, it causes dangerous blood clots to form when left untreated.
Sleep apnea. This sleep disorder causes brief but repeated interruptions of breathing during sleep, which strains the heart. It’s a worry for stroke because it raises the risk of HPB and atrial fibrillation (and other arrhythmias).
The more unhealthy blood fats you have floating through your arteries, the more likely the excess will get deposited as plaque. The main offenders? High LDL cholesterol and high triglycerides. Having low HDL cholesterol is risky too: HDL is the good kind. It’s main job is to sweep up bad LDL and move it on to the liver for processing. When you don’t have enough HDL, your LDL levels can rise. Plaque buildups can block your arteries and encourage clots to form (or even rupture), increasing your risk for stroke.
Smoking cigarettes (and vaping, too, the evidence increasingly suggests) harms your blood vessels and promotes the unhealthy buildup of plaque. It also ups your blood pressure. (Need help quitting smoking forever? Visit the American Heart Association.)
Lack of Exercise
Being sedentary can lead to both high cholesterol and HBP, plus contribute to weight gain.
Regularly overindulging elevates your blood pressure, leads to weight gain, and puts you at risk of atrial fibrillation.
A diet that features lots of saturated fat, added sugars, and other sodium is bad for your waist line, your blood pressure, and your arteries.
Are Some Risk Factors for Stroke Beyond Your Control?
We wish we could say you can control, or at least try to control, all risk factors, but some, like aging and genetics, simply come with the territory of being alive. Here’s what you can’t prevent, avoid, treat, quit, or diet away:
You can have a stroke at any age, but the risk gets higher the older you get. Two out of three strokes occur after age 65. In fact, once you turn 55, your risk of a stroke will double every 10 years, according to the National Institute of Neurological Disorders and Stroke.
If a close relative, such as a parent or sibling, had a stroke before age 65, your stroke risk may be higher than normal. One reason is genetics. Certain genes can make you more likely to have HBP or high cholesterol, for example.
About a quarter of people who have a stroke will go on to have a second one, often within days of the first event, because your blood vessels remain vulnerable for up to three months to one year after a first stroke, according to the Cleveland Clinic.
What Are the Types and Causes of Stroke?
When most people think of a stroke, they immediately think “blood clot to the brain,” often forgetting that hemorrhagic strokes (caused by bleeding the brain) happen, too. Let’s break down the differences between these two types of stroke now:
This type of stroke is caused by a blocked artery. It’s by far the most common, accounting for nearly nine out of 10 strokes.
Ischemic strokes vary in size and severity, depending on the size of the blockage and where it occurs. It could occur in a small artery, or it could happen in one of the large carotid arteries in the neck, disrupting blood flow to greater portion of the brain. The brain demands about 20% of your body’s total oxygen requirements, according to the CDC, so any interruption can do real damage in a short amount of time.
So, how do blockages occur? Blood travels to and through the brain in a branching network of arteries. Arteries sometimes narrow, often due to plaque buildup (a.k.a. atherosclerois). When such narrowing occurs, a few things can happen—all of them leading to a stroke:
The plaque can continue to build up until it narrows an artery so severely, blood flow becomes blocked and part of your brain is starved of oxygen.
A blood clot may form in the slow-moving blood around the plaque buildup, blocking the flow of blood.
Plaque may rupture, or break apart, triggering the formation of an artery-blocking clot, which, again, starves your brain of oxygen.
Once an ischemic stroke begins, brain cells begin to die. Fast. This can cause permanent damage in all sorts of ways because the brain controls our ability to move, speak, think, and feel, leading to all manner of disability. The specific type of disability can be related to the part of the brain that’s being starved of oxygen.
There are two types of ischemic stroke:
Thrombotic stroke, which occurs when a blood clot develops inside the brain’s system of arteries
Embolic stroke, which occurs when a blood clot forms elsewhere in the body, often the heart, and then travels to the brain
Far less common, a hemorrhagic stroke is caused by a blood vessel in the brain that bursts or begins to leak. This does more than prevent the brain from getting the blood and oxygen it needs. Pooling blood—think of it like water pouring from a hose—puts added pressure on the brain, which further deprives the tissue of oxygen, according to the Cleveland Clinic.
There are two types of hemorrhagic stroke:
Intracerebral Hemorrhage. The more common of the two, these strokes can lead to permanent brain damage and can sometimes be life-threatening; they're caused by the rupture of a blood vessel inside the brain.
Subarachnoid Hemorrhage. This life-threatening type of stroke causes bleeding on the surface of the brain, creating damaging pressure between the brain and skull. Often, this type of hemorrhage is the result of a ruptured aneurysm, traumatic head injury, or arteriovenous malformation (AVM), which is an abnormal tangle of arteries. To be considered a stroke, however, it must be caused by the bursting of a blood vessel. This is usually due to a cerebral aneurysm, a bulging area where a brain artery’s wall has become weakened, making it prone to rupture. There’s no soft-pedaling this type of stroke: Roughly 35% of those who have one die within three months, and 50% make an incomplete recovery, according to 2019 research published in The Lancet.
There’s also a third, related category called transient ischemic attack (TIA). Also known as mini-strokes, these generally last less than an hour. They often keep reoccurring until they’re treated. Symptoms resemble that of an actual stroke—which we’ll detail in short order—but they are usually temporary and don’t do permanent harm. However, they are considered to be a medical emergency because they often indicate a full-blown stroke is just around the corner.
What Are the Symptoms of Stroke?
OK: Let’s talk about what happens when a stroke is underway. Symptoms can be very sudden and severe, and they can progress very quickly. Get to know them so you recognize them right away, either in yourself or in others. An easy way to do this is to memorize the acronym FAST. It stands for:
Time to call 911!
Remember: Early treatment saves the brain. If you suspect a stroke, don’t wait—get help.
Here’s some more detail about specific symptoms and how they can present themselves:
Weakness, numbness, or paralysis on one side of the body. Which side and what part of the body will depend on where in the brain the stroke occurs. Drooping, weakness, and other symptoms will strike suddenly in your face, arm, or leg. Often, strokes only cause damage to one side and not the other. If the stroke occurs in the left side of your brain, your right side will be affected (because your brain’s nerves cross from one side of the brain to the opposite side of your body), and vice versa.
Sudden movement difficulties. You may have trouble with your balance or sense of physical coordination. You might even experience paralysis to parts of your face, or in an arm or a leg.
Difficulty speaking or comprehending others. You may feel confused, experience slurred speech, or find it difficult to understand what someone else is saying.
Vision problems. You might have trouble seeing due to blurred, blackened, or double vision. This can occur in one or both eyes.
Severe headache. Every bit as painful as your worst migraine—and often worse—you’ll know it’s stroke and not a migraine if your head pain comes on suddenly (regular migraines tend to build) and is accompanied by other stroke symptoms (see above). According to the American Heart Association (AHA), if you have a history of migraine with aura, you are 2.4 times more likely to have an ischemic stroke.
Delirium or loss of consciousness. According to data pulled from stroke registries, up to 38% of people lost some level of consciousness from ischemic stroke, ranging from delirium all the way to coma.
How Do Doctors Diagnose a Stroke?
First—and this is important!—don’t attempt to get yourself to the hospital. Call an ambulance. EMTs are trained to recognize the signs of stroke and can begin prepping you on the way to the emergency room. They also will alert the hospital, so the medical staff is ready for you and a neurologist, or brain specialist, is on deck, if necessary. Ideally, someone who can speak for you will accompany you, in the event you are not able to fully communicate.
Once at the hospital, the medical team will review your health history, check your vitals (including pulse and blood pressure), draw blood, and ask you (or the person speaking for you) about your symptoms. You’ll also undergo a neurological exam, which includes testing your reflexes, strength, and coordination, as well as asking you questions to help identify problems with memory, speech, and thinking. Based on all of that, the doctor will be able to confirm a stroke.
Still, further testing is needed to determine the type of stroke, its location in your brain, and its size. Generally, as soon as you are stabilized, you’ll undergo one or more scans of your brain, and also of your blood vessels and arteries that feed the brain with blood and oxygen to determine where, and how much, they’ve been damaged. These scans include:
Computed Tomography (CT) Scan
This creates a 3D image of your brain that will reveal whether you’re having an ischemic or hemorrhagic stroke.
Your doctor will insert a thin and flexible tube called a catheter, usually into your groin, and maneuver it through your blood vessels to the major arteries in your brain and neck (the carotid and vertebral arteries, respectively). Once there, the doctor will inject a dye that enables an X-ray to provide images of any blockages, narrowing, or other abnormalities.
CT Perfusion Study
A CT perfusion study of the head takes about 25 minutes. Contrast dye is injected through an I.V., which enables images to be taken of your brain. It detects the size of the stroke and how much of the brain is at risk but has not yet suffered permanent damage.
Magnetic Resonance Imaging (MRI)
Not everyone can do a CT scan—some people have an allergy to iodine contrast and must instead get an MRI, which uses a different kind of contrast (called gadolinium) that most people tolerate well. This type of imaging test can identify the type of stroke and help locate areas of the brain damaged by ischemic stroke.
Sound waves create a picture of the arteries in your neck that lead to your brain. It will show any narrowing, blockages, or damage.
Sound waves create images of your heart and help locate the source of clots that may have caused your stroke. If you have afib, for instance, you might have additional clots in your heart’s upper chambers.
What Are the Best Treatments for Stroke?
Treatment depends on the type of stroke. For an ischemic stroke, the priority is to restore normal blood flow to the brain. If you’re having a hemorrhagic stroke, doctors will get the bleeding under control if it has not yet stopped on its own and relieve any pressure on the brain caused by the bleeding.
Treatment for Ischemic Stroke
When you have an ischemic stroke, an artery in the brain has been blocked, starving the brain of blood and oxygen. Removing that blockage must be done quickly.
The primary treatment is a medication called tPA (short for tissue plasminogen activator). Administered intravenously, tPA breaks up blood clots in order to get your blood moving freely through your brain again. However, tPA must be used within 9 hours of the start of your symptoms. After that point, the risk that this powerful blood thinner may actually cause dangerous bleeding in the brain has climbed too high for it to be deemed safe. (In other words, after this window of time closes, more people with stroke are shown to be worse off than improved when using thrombolytic medications.) Some doctors use emergency endovascular procedures to break up clots, delivering clot-dissolving tPA directly to the brain where the clot has formed. They do this via a catheter that is threaded through your blood vessels, starting in your groin and moving up to the clot.
A procedure called a thrombectomy may be recommended within the first 24 hours from the start of symptoms if you have a blockage in one of your brain’s larger blood vessels. A doctor threads a catheter through your groin to your brain via your blood vessels. Once it reaches the clot that’s causing the blockage, the catheter can be used to surgically remove it.
Antiplatelet drugs like aspirin may help prevent the formation of clots—but only take aspirin if your doctor tells you to do so. There is some evidence that taking aspirin after a first stroke may prevent a second one from occurring, according to the AHA. Anticoagulants like Eliquis (apixaban) are another option to prevent clots.
Treatment for Hemorrhagic Stroke
The goal here is to stop the bleeding and to relieve pressure on the brain. You may receive drugs that actually help clots to form—up until now, the very thing you’ve been trying to avoid, right? But in the case of a brain bleed, you’ll want to do everything possible to relieve pressure on the brain and prevent further tissue damage. Medications to help lower your blood pressure can also help do this. Depending on the size and severity of the stroke, you may require surgery to remove the blood that has leaked from the burst blood vessel, and to repair the blood vessel. Surgical procedures, including temporarily removing a part of the skull, may also be performed to relieve life-threatening pressure.
What’s Life Like for People Who Have Had a Stroke?
Not everyone who has a stroke or mini-stroke experiences permanent disability. When treated in time, symptoms can be stopped and reversed—which is great news. However, it’s important to know that stroke is a leading cause of long-term disability in the U.S. Its impact can’t be understated—complications of stroke can be life-changing. They include:
Weakness on one side of the body
Permanent speech problems
Cognitive problems that affect your judgment, memory, your ability to pay attention, and to think clearly
Aphasia, or difficulty finding words (though, generally, there’s little difficulty saying them)
Difficulty walking due to balance problems
Paralysis or drooping in the face
Permanent difficulty with swallowing, as well as ongoing double vision, from strokes occurring at the back of the brain
Can Rehabilitation Reverse the Effects of Stroke?
A stroke rehabilitation program that involves both physical and occupational therapy will help you adapt to your post-stroke life. PT will help you relearn the basics of movement: walking, sitting, standing, and lying down. OT trains you to do the daily activities that may be a real challenge, such as getting dressed, cooking, taking a shower or bath, and going to the bathroom. You also may require speech therapy, which helps you relearn speech and language skills or find new ways to communicate.
Your biggest priority after a stroke? Preventing another one. That means doubling down on managing any underlying health conditions (like diabetes) and living a healthier lifestyle in order to minimize the risk factors discussed above (like lack of exercise and poor diet). Often tough to do in the best of circumstances, making positive changes to your lifestyle habits can be hampered by your disability. But don’t give up—work with your team of doctors and specialists so you get all the support you need. You don’t have to navigate this new normal alone.
You might also feel “down” after having a stroke—in fact, depression is pretty common. If you’re experiencing a continuous low mood, talk to your doctor about how to recognize the symptoms of depression—and if you need additional help (like talk therapy), ask for it. Depression can make it much more difficult to stick with your treatment plan, participate in rehab, or do the work necessary to make positive changes, such as eating and sleeping well, socializing with others, and getting into better shape.
Life after stroke can be challenging—but remember: You’ve survived one. That's a first victory. Here's to many more along the way as you recover from one, too.
- Stroke (1): Mayo Clinic. (2020). “Stroke.” mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113
- Stroke (2): Merck Manuals. (2018). “Overview of Stroke.” merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/stroke-cva/overview-of-stroke
- Stroke (3): American Association of Neurological Surgeons. (n.d.). “Stroke.” aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Stroke
- Stroke Prevention: National Institute of Neurological Disorders and Stroke. (2020). “Brain Basics: Preventing Stroke.” ninds.nih.gov/Disorders/Patient-Caregiver-Education/Preventing-Stroke
- Ischemic Stroke: Merck Manuals. (2018). “Ischemic Stroke.” merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/stroke-cva/ischemic-stroke
- Hemorrhagic Stroke (1): Harvard Medical School. (2019). “Hemorrhagic Stroke.” health.harvard.edu/a_to_z/hemorrhagic-stroke-a-to-z
- Hemorrhagic Stroke (2): The Lancet. (2019.) Core Outcomes for Subarachnoid Hemorrhage.” thelancet.com/journals/laneur/article/PIIS1474-4422(19)30412-0/fulltext
- Stroke Diagnosis: Internet Stroke Center. (n.d.). “How a Stroke is Diagnosed.” strokecenter.org/patients/stroke-diagnosis/how-a-stroke-is-diagnosed/
- Stroke Rehab and Recovery: National Institute of Neurological Disorders and Stroke. (2020). “Post-Stroke Rehabilitation Fact Sheet.” ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/post-stroke-rehabilitation-fact-sheet
- Stroke Treatment: American Stroke Association. (n.d.). “Stroke Treatment.” stroke.org/en/about-stroke/treatment