Time is critical when a stroke occurs. Knowing the warning signs and what to do can mean the difference between life and death or permanent disability.
In this video, Mary Kalafut, MD, a neurologist at Scripps Clinic and stroke medical director for Scripps Health, and San Diego Health host Susan Taylor discuss the causes, symptoms and treatments for stroke — one of the leading causes of death in the United States.
“Knowing how to reduce the risk for stroke can really help prevent them,” says Dr. Kalafut.
A stroke is a medical emergency that requires immediate attention to minimize brain damage and potential long-term health problems, such as paralysis or loss of muscle movement.
“Time is brain,” Dr. Kalafut says, emphasizing the importance of knowing the signs and symptoms of a stroke, also known as a brain attack.
Nearly 800,000 people suffer a stroke each year in the United States, according to the Centers for Disease Control and Prevention (CDC). About 140,000 people die from stroke each year.
Stroke occurs when blood supply to the brain is interrupted or reduced.
“A stroke is a lack of blood flow to the brain, just like a heart attack is a lack of blood flow to the heart,” Dr. Kalafut explains. “This causes neurologic problems and problems with people being able to function.”
Time is of the essence whether you are the one experiencing a stroke or witness someone showing the warning signs of a stroke.
“If you have signs of a stroke, you should immediately call 911 and go to your nearest emergency room for treatment,” Dr. Kalafut says.
Treatment for stroke depends on the type and severity of the problem.
There are two types of stroke. Ischemic stroke occurs when a blood clot prevents blood and oxygen from reaching the brain. The artery in the brain can be blocked in a couple of ways. An embolic stroke is a type of ischemic stroke where the blood clot travels to the brain from another part of the body. A thrombotic stroke happens when a blood clot forms inside one of the brain’s arteries. About 87 percent of all strokes are ischemic strokes, according to the CDC.
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and blood spills into the brain tissue, causing damage to brain cells.
Some people can experience a transient ischemic attack (TIA), which is a short-lived or mini-stroke that does not cause permanent brain damage.
“The thing about a transient ischemic attack is it's a warning sign that you could have a stroke in the near future. So, it's important to get to your doctor and make sure that your risk factors are under control,” Dr. Kalafut says.
A cryptogenic stroke is a stroke that has occurred without a known cause. It tends to occur more often in younger people — generally under the age of 60.
Symptoms of stroke vary and typically arise suddenly.
“The hallmark of a stroke is that it happens acutely. It's not something that gradually comes on, but comes on all at once,” Dr. Kalafut says.
The most common symptoms are:
- Sudden numbness or weakness of the face, arm, or leg—especially on one side of the body
- Sudden confusion, difficulty speaking or trouble understanding speech
- Sudden vision loss or changes in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
People at risk of stroke include smokers, and those who have high blood pressure, high cholesterol or diabetes. People with heart conditions, such as atrial fibrillation, patent foramen ovale (a hole in the heart that didn't close the way it should after birth) and heart valve disease are also at risk.
”Controlling your risk factors can really help prevent a lot of strokes,” Dr. Kalafut says. “Make sure you’re treating your high blood pressure if you have it. Make sure your blood sugars are under control. Make sure you don’t drink to excess or smoke. Those are all very important risk factors.”
Tissue plasminogen activator (tPA) is an FDA-approved, clot-dissolving medication that is given, under several conditions, for treatment of ischemic stroke. The medication is used to improve blood flow in the part of the brain affected and to limit damage to brain tissue.
Clot-busting drugs must be used within four and a half hours after the onset of symptoms.
“That's why it's very important if you have stroke-like symptoms to call 911 and get to your nearest emergency room,” Dr. Kalafut says.
Certain patients can undergo a thrombectomy, where a catheter is threaded into the blocked artery and the clot is removed.
“Blood flow is restored and hopefully there's no damage to the brain,” Dr. Kalafut says.
One tool for remembering the signs and symptoms of a stroke and what to do is the acronym F.A.S.T.
“If you're with someone you think may be having a stroke, ask them to smile and look at how their face moves. Your face should be symmetric and there should not be any weakness on one side. If there is, that's a reason for concern,” Dr. Kalafut says.
“Ask the person to extend their arm. If they can't do it or one arm kind of drifts down, then you know that there's a problem.”
“Ask them to say a sentence and if it's slurred or it doesn't come out correctly, then you know that there's a problem.”
“Make sure that people understand that you have to get to your nearest emergency room if you have any of these types of symptoms,” Dr. Kalafut says.
Guidelines for stroke care call for taking the patient to the nearest hospital designated as a stroke center. All Scripps hospitals with emergency rooms have a Primary Stroke Center designation, meaning they are certified to take care of patients with acute stroke.
Scripps La Jolla is a Comprehensive Stroke Center, “which is one level higher as far as taking care of complex stroke patients,” says Dr. Kalafut, who is medical director of the stroke center at Scripps La Jolla.
“If you have significant need for long-term monitoring for your stroke or other types of procedures, you would be taken to the comprehensive center,” Dr. Kalafut says.