What Are the Warning Signs of a Stroke?

In the time it takes to read this article, at least one person in the U.S. will die from a stroke. Depending on how fast you read, 10 or more will suffer a stroke before you reach the last sentence. Stroke, obviously, is nothing to take lightly.

The Centers for Disease Control and Prevention estimate that stroke kills about 140,000 Americans each year. That is about 1 of every 20 deaths that occur annually in the country. Someone in the U.S. has a stroke every 40 seconds, and someone dies from it every four minutes. Although stroke risk increases with age, about one-third of people hospitalized for stroke are under 65 years old.

The CDC estimates that stroke costs the U.S. $34 billion each year in health care services, medicines to treat stroke and missed days of work. Stroke is a leading cause of serious long-term disability.

Yet, despite these dire statistics, the American Stroke Association says that stroke "is preventable, treatable and beatable." The treatment part, however, depends the most on one important factor: speed. The faster you recognize the signs and symptoms of a stroke and begin treatment, the more likely you are to prevent long-term disability and death.

Types of Stroke

First, it's important to understand what a stroke is. The most common type is called ischemic stroke. This is when a blood vessel supplying blood to the brain is obstructed by fatty deposits in the vessel lining, which is known as atherosclerosis. The ASA says about 87% of all strokes are ischemic in nature.

Hemorrhagic strokes, which comprise about 13% of stroke cases, result when a weakened blood vessel ruptures – most often the result of untreated or poorly treated high blood pressure – causing bleeding into the brain. The blood builds up and compresses the surrounding brain tissue, causing tissue damage and cell death.

In each case, the longer the condition lasts, the more damage occurs. Stroke specialists use the phrase "time is brain" – every second the stroke lasts, more brain cells are damaged and die.

Another important type of stroke to know about is called a transient ischemic attack, or TIA. Also called a ministroke, a TIA is a temporary blockage of blood flow to the brain. It doesn't cause permanent damage, may not cause noticeable or long-lasting symptoms and is often ignored. But the ASA warns that TIAs may signal that a full-blown stroke is soon to come, so symptom awareness is critical.

Symptoms

There is an easy way to remember the symptoms of stroke: Just use the acronym FAST, for face, arm, speech and time. And because time is of the essence, it's the perfect term to use.

"FAST is a very simple tool that even a nonmedical person can employ for timely recognition and treatment of stroke, and can save brain tissue during the critical time period when you have the opportunity to do so," says Dr. Dhanunjaya Lakkireddy, a cardiologist specializing in electrophysiology and the medical director for the Kansas City Heart Rhythm Institute at HCA Midwest Health.

The ASA describes FAST like this:

Those aren't the only symptoms, however. Especially among women. "Women tend to have a little bit different symptoms. It is more common in women to have dizziness, disequilibrium, overwhelming fatigue and nausea or vomiting," says Dr. Karol Watson, a cardiologist, professor of medicine/cardiology at the David Geffen School of Medicine at UCLA and director of the UCLA Women's Cardiovascular Health Center and the UCLA-Barbra Streisand Women's Heart Health Program.

So it's also important to act fast if any of the following occur:

Again, if any of these symptoms present themselves, get to a hospital or call 911 immediately.

Treatment

For many types of ischemic stroke, doctors or first responders administer a medication called tPA intravenously , which quickly dissolves the blood clot and restores blood flow to the brain. It works best when given within three hours of the onset of stroke, but can also be given after that in some cases to reduce long-term damage from the stroke. Surgeons can also remove a blood clot surgically by going into the blocked vessel and pulling it out with a corkscrew-like instrument.

For hemorrhagic stroke, surgery is necessary to close off the bleeding vessel and relieve pressure on the brain. The surgeon can insert a catheter to see the rupture and, sometimes, insert a mechanical device to block the opening. Other cases may require more extensive surgery to open the skull and repair the rupture.

Prevention

The ASA says that up to 80% of strokes can be prevented by simple lifestyle choices and appropriate medical care.

High blood pressure is the leading cause of stroke, so controlling blood pressure is No. 1on the list. That requires maintaining a healthy weight, making smart food choices, staying active and not smoking. For some, it may also require medication to keep blood pressure at or below the recommended level of 120/80 mmHg.

Diabetes more than doubles the risk for stroke, so the ASA suggests those with the disease work closely with their doctors to manage blood sugar and reduce that risk.

Atrial fibrillation, or an irregular heartbeat, is a very common cause of stroke, Lakkireddy says. In fact, many blood clots that cause strokes come from a small structure in the upper left chamber of the heart, where atrial fibrillation typically starts, that can trap blood, which then clots, when it doesn't work right. "We can remove that structure like removing an appendix," he says. "If that is corrected, it stops the problem."

FAST Is Best

The FAST system of symptom recognition has been studied extensively, and "nothing better has been validated," Watson says.

And if you have to give anyone the test, grade them hard. "Even one suspicious thing – if they speak slowly, or can hold up both arms but one drifts a little," Watson says. "You don't have to get an F, but you should get an A or B." Anything less should be met with a call to 911 or a swift trip to an emergency room.