Understanding stroke

Stroke is the fifth leading cause of death among adults in the United States, according to the National Stroke Association. It’s also the leading cause of disability. Yet, since many people don’t know the symptoms of a stroke, they may ignore them and delay seeking treatment.

An average adult’s heart beats 100,000 times a day. With each beat, your heart pumps out blood that is rich in oxygen and nutrients that are vital for your cells. The blood travels through a network of vessels that deliver the oxygen and nutrients to every cell in your body.

Sometimes, a blockage or break occurs in a blood vessel. This can cut off the blood supply to an area of your body. When this happens to the vessels that supply blood to your heart muscle, it’s called a heart attack. When this happens to vessels in your brain, it’s called a “brain attack,” or stroke.

How to recognize whether you’re having a stroke

If you think that you’re having a stroke, there are classic symptoms that you should look for. These happen suddenly, and include:

It’s important to note that the symptoms of stroke aren’t associated with pain. This may cause you to disregard your symptoms. You may not realize that you’re experiencing a life-threatening medical emergency.

A characteristic of all stroke symptoms is that they begin suddenly and are severe. If you notice a sudden or pronounced onset of any stroke symptoms, you should call 911 or your local emergency services immediately.

A PRESENTING SYMPTOM "My presenting symptom was falling backwards onto my bed while trying to apply eye makeup. As an occupational therapist who specialized in stroke rehab, I knew that a sudden loss of balance was not normal." – Rebecca Dutton, occupational therapist, had a stroke in 2004

How to recognize whether someone else is having a stroke

The National Stroke Association recommends an easy strategy to help you assess if someone is experiencing a stroke. If you think that someone in your presence is having a stroke, remember to Act FAST.

FFACEAsk the person to smile. Does one side of their face droop?
AARMSAsk the person to raise both arms. Does one arm drift downward?
SSPEECHAsk the person to repeat a simple phrase. Is their speech slurred or strange?
TTIMEIf you observe any of these symptoms, it’s time to call 911 or your local emergency services immediately.

What happens to the body during a stroke?

There are two major types of stroke: hemorrhagic stroke and ischemic stroke. There’s also a subset of stroke known as transient ischemic attack (TIA), or “ministroke.”

Hemorrhagic stroke

Hemorrhagic stroke occurs when a weak blood vessel in the brain ruptures. It’s the least common form of stroke and is considered to be the deadliest. According to the National Stroke Association, hemorrhagic stroke accounts for about 15 percent of cases, but about 40 percent of all stroke deaths.

The amount of time that passes before receiving treatment is critical. Your doctors will need to stop any bleeding in the brain, seizures, or brain swelling. If your doctors are unable to stop the bleeding from the ruptured blood vessel, you may need surgery to repair the vessel.

Ischemic stroke

Ischemic stroke occurs when a blood clot blocks a blood vessel in the brain. This is the most common type of stroke, accounting for 87 percent of all cases.

In most cases, your doctor can give you potent medications to dissolve the blood clot. This can restore blood flow to your brain. But this type of treatment is time-sensitive. You must receive the medications within four and a half hours of the start of your symptoms, according to new guidelines from the American Heart Association (AHA) and American Stroke Association (ASA). However, mechanical clot removals can be performed up to 24 hours after the onset of stroke symptoms.

An ischemic stroke is also known as cerebral ischemia.

Transient ischemic attack

Transient ischemic attack (TIA) is identical to ischemic stroke. This is because it’s also caused by a blood clot. TIA also has similar symptoms. The primary difference between the two is that TIA is self-limiting. The clot dissolves on its own and all symptoms resolve within 24 hours.

Although TIA isn’t a stroke, the condition should be treated just as seriously. Experiencing TIA is a warning that you may be at high risk for a stroke. To address this risk, it should be treated immediately. One out of every three people who experience TIA end up having an ischemic stroke within one year of the TIA. Often, the stroke occurs within a few days or weeks following the TIA.

When to see your doctor

It’s important that you seek emergency care as soon as possible, regardless of the type of stroke. According to the American Stroke Association, for every minute that the brain is deprived of blood, approximately 2 million brain cells die from lack of oxygen and nutrients. When your brain cells die, the bodily functions controlled by those cells are also lost. This includes functions such as walking or speaking.

What to expect after a stroke

Dealing with the aftermath of a stroke can be physically and emotionally stressful. Depending on the severity of the stroke, you may lose some of your mental and physical abilities. Some of your abilities may return over time, while others may not.

FINDING A COMMUNITY "An unexpected source of support has been blogging with other stroke survivors. I share photographs of my recovery and receive words of encouragement on my blog homeafterstroke.blogspot.com. I do not like to think about how my long-term recovery would be different without this online stroke community." – Rebecca Dutton, occupational therapist, had a stroke in 2004

Your doctors and care team will focus on stabilizing your condition immediately after a stroke. They’ll also treat any underlying conditions that may have caused your stroke. Otherwise, your risk of having a repeat stroke can increase.

Your doctors will also assist you in regaining your strength. And they’ll help you with basic functions such as breathing and swallowing.

Your doctors will either send you home or to an in-patient rehabilitation facility once your condition has stabilized. Once you enter the rehabilitation phase, the focus of your care will shift to regaining any lost functions and becoming as independent as your condition will allow. Learn more about stroke recovery.

IN-PATIENT REHAB“In-patient rehabilitation is the hardest thing I have ever had to do. My hemiplegic leg felt as heavy as a car. It took three physical therapists to help me walk in the beginning… Thankfully, when I left the rehab hospital I could walk with a quad cane and a leg brace and was independent in my self-care.”Rebecca Dutton, occupational therapist, had a stroke in 2004

Outlook

Experiencing stroke can be a frightening experience. But your ability to recognize symptoms and seek emergency care for yourself — or others — can significantly improve the outcome. Your long-term outlook will depend on the type and severity of the stroke that you’ve had.

ROAD TO RECOVERY“A common myth is that recovery from a stroke happens only in the first 6 months, but research has proven that this is not true. Fortunately, I had a talented out-patient occupational therapist. My hand was completely flaccid when I left the rehab hospital.”Rebecca Dutton, occupational therapist, had a stroke in 2004