For the brain to work properly, it needs a constant supply of blood.
If the blood supply is stopped, even for a brief moment, brain cells die, which can result in temporary or permanent disabilities including paralysis, difficulty talking and memory loss.
While brain cells can be damaged by concussions, drug and alcohol use, and even dehydration, strokes are among the leading causes of brain injury.
When it comes to the top diseases, incidents and conditions that kill Americans each year, strokes rank No. 5 on the list. Heart disease is No. 1, followed by cancer, unintentional injuries and chronic lower respiratory disease, respectively.
Just as keeping cholesterol down and maintaining healthy blood pressure levels are vital to our heart health, it’s equally important to help prevent strokes.
A stroke is when blood flow to the brain stops or is disrupted. This stop of blood flow could be caused by a blockage in a blood vessel or by a blood vessel bursting.
“A stroke is literally a brain attack. Either there is a plug in your pipes, or your pipes have burst. Regardless, your brain tissue isn’t getting blood flow,” explained Amanda Werner, a registered nurse and manager of UCHealth’s stroke program in northern Colorado. “And when your brain doesn’t get blood, it dies.”
There are two different types of strokes: ischemic and hemorrhagic.
Ischemic strokes, the most common type of stroke, happen when a major blood vessel in the brain is blocked. This blockage can be caused by a blood clot or the build-up of fatty deposits and cholesterol, also known as plaque. No matter the cause of the blockage, they both disrupt blood flow to brain cells.
A hemorrhagic stroke is when a blood vessel in the brain bursts and blood spills into surrounding brain tissue. The spillage of blood into surrounding tissue causes pressure to build and can result in additional damage and irritation.
“A hemorrhagic stroke is like when you kink a hose too long and it bursts. That’s exactly what happens: your brain’s blood vessels just can’t take that pressure, so they burst,” Werner said. “Hemorrhagic strokes are almost always related to high blood pressure.”
The brain is designed with two sets of blood flow, Werner said. So if there is a problem in one area, the second set of blood flow can compensate and feed the affected area for a short time.
“But if you have cruddy vessels, as soon as you have a problem on one side, the other side doesn’t even have time to get over there to fix it,” she said. “So it’s very dependent on your vessel status.”
Every 40 seconds, someone in the U.S. has a stroke, and strokes kill someone every 3 1/2 minutes, according to the Centers for Disease Control and Prevention.
Every year, nearly 800,000 people in the U.S. have a stroke, with 1 in 4 people having had a previous stroke.
Celebrities such as Sharon Stone, Tim Curry, Emilia Clarke and Frankie Muniz have all suffered strokes. Most recently, comedian Sinbad shared that he is learning to walk again two years after having a stroke. The comedian was just 66 years old when he had an ischemic stroke in 2020 that left him hooked up to a ventilator and in a medically induced coma. Sinbad’s doctors gave him a 30% survival rate at the time, according to CBS News. After being in several acute care facilities, Sinbad got the OK from doctors to continue his recovery at home.
Actors Luke Perry, 52, and Bill Paxton, 61, and director John Singleton, 51, all died from strokes at fairly young ages.
Strokes are also the leading cause of serious long-term disability in the U.S., according to the CDC.
While anyone can have a stroke, some high-risk factors include:
- High blood pressure
- Heart disease
- High red blood cell count
- Excessive alcohol or drug use
- History of mini-strokes
- Birth control pills
- High cholesterol
- Family history of strokes
Additional risk factors for strokes that can’t be controlled are genetics, race, age and gender.
If you or your family has a history of strokes, your chance of having a stroke is increased. When it comes to race, African Americans have a higher risk of strokes. Men have strokes more often, but women are more likely to die from a stroke. The chance of having a stroke more than doubles for every 10 years of life after age 55, according to HealthPartners.
How to identify stroke signs and symptoms
Remembering the acronyms “FAST” or “BEFAST” can help quickly identify stroke symptoms, recommends Dr. Sean Pauzauskie, a neurohospitalist with UCHealth’s Greeley Hospital, Medical Center of the Rockies and Poudre Valley Hospital.
B — Balance problems. Is the person stumbling or having a hard time staying balanced?
E — Eyesight issues. Does the person have blurry or blackened vision, double vision or other eyesight problems?
F— Face drooping. Is one side of a person’s face drooping or numb? Ask the person to smile to see if one side of the mouth is drooping.
A — Arm weakness. Is one arm weaker than the other or numb? Can the person raise both arms at the same time, or does one arm slouch or sag below the other?
S — Speech difficulty. Is the person experiencing slurring speech, confused or hard to understand?
T — Time to call 911. If you are someone you know is experiencing one or more of these signs or symptoms, call 911 immediately. Getting professionals involved as quickly as possible is important for certain types of treatment options.
Other less common symptoms of a stroke include sudden nausea or vomiting not caused by an illness, fainting, confusion, seizures or coma and a mini-stroke.
“Basically any kind of sensory changes, those are the big ones,” Pauzauskie said. “It can come and go.”
As with any medical issue, when in doubt, it’s best to seek medical care immediately — especially in the emergency room of a hospital.
“They need to go to the emergency room. Don’t go to primary care. Don’t go to urgent care. We need to be able to take a picture of their brain, and that can only happen in the ER,” Werner said.
Diagnosis and treatment for strokes
While maintaining a healthy diet and getting in at least 30 minutes of exercise a day can help lower your risk of strokes, anyone can have a stroke at any age.
If you are admitted to the emergency room for a possible stroke, be prepared to undergo a variety of tests. Some of the tests used to help diagnose a stroke include:
- CT scan, which uses X-rays to take detailed images of the brain
- MRI, which uses magnetic fields to find small changes in the brain tissue to help locate and diagnose strokes
- CTA, computed tomographic angiography, an X-ray image of the blood vessels in the brain
- MRA, magnetic resonance angiography, which uses MRI technology to check blood flow through the arteries
- Doppler sonography, a test that uses sound waves to create pictures of the inside of the carotid arteries.
You may also undergo heart tests, such as an electrocardiogram and echocardiogram, to help identify heart problems that could have led to a stroke.
Once the medical team has confirmed that a patient has suffered a stroke, they will create a treatment plan based on the patient’s age, overall health and past health, the type of stroke they suffered, how severe the stroke was, where the stroke took place and other factors.
Currently, there is no cure for a stroke once it has taken place, but medical and surgical options are available.
When it comes to treating a stroke, time is of the utmost importance. The more time between the stroke and treatment, the more brain cells that can be affected.
“The ‘time is brain’ adage has been around forever because it has always been a struggle for us to get the community to act very quickly,” Werner said. “The time of onset, the time of symptoms, the time since your last ‘normal’ is really what drives your treatment eligibility.”
“We are talking millions of neurons a minute that you can lose, so every minute counts,” Pauzauskie added.
Once those brain cells have lost their oxygen supply, they cannot recover and are gone forever.
With the pandemic causing people to hesitate to go to the emergency room or even deciding to skip it altogether, UCHealth saw a 15-20% decrease in hospitalized stroke patients across its facilities.
“Most people would say, ‘Hey, that’s great,’ but no, it’s not. People just don’t stop having strokes, and strokes don’t go away,” Werner said.
One treatment option for strokes includes administering thrombolytic or fibrinolytic medications to patients, which dissolve blood clots that are associated with ischemic strokes. The medications are given to patients through an IV line or catheter.
Despite being highly effective in helping reduce damage to brain cells caused by a stroke, thrombolytics or fibrinolytics are only successful if given to a patient within a certain amount of time after the stroke.
Tissue plasminogen activator, or tPA, is an IV medication that can be used in stroke treatments.
“It is a heavy-duty blood thinner that essentially prevents clots from forming and reduces the size of the clot by blocking a certain component of clot formation,” Pauzauskie said. “The clot-buster is the terminology the public should know.”
Patients must receive tPA within 4 1/2 hours of their stroke for the medication to be effective, and there is a list of criteria the patient must meet to receive tPA. Patients already on blood thinners, for example, may not be eligible.
Neuroprotective medications protect the brain from damage and lack of oxygen, while a craniotomy surgery can remove blood clots, relieve pressure or repair bleeding in the brain.
A thrombectomy is an innovative surgical procedure to remove blood clots from arteries and veins in the brain. During the procedure, a catheter is threaded up into the brain through blood vessels to where there is a clot. The clot is then physically removed using the catheter.
“That procedure is a game changer because it is focused on these patients with large vessel occlusions, or LVOs. Those are those vessels that are feeding a third of your brain. Those kinds of clots can kill a 30-year-old (or) land you in a nursing home, best-case scenario. These are awful strokes,” Werner said. “For specific patients, we can do that procedure up to 24 hours since their last-known well-time.”
Life support measures may also be administered such as a ventilator for breathing, controlling blood pressure and making sure the patient receives proper nutrition.
The effects of a stroke
When it comes to how a stroke can affect a person, there are a few contributing factors. The type of stroke, severity, location and number of strokes all play a part in how a person’s body is affected by the episode, Johns Hopkins Medicine reports.
The brain is comprised of three main areas: the cerebrum, cerebellum and brainstem.
The cerebrum is the right and left sides of the brain, while the cerebellum is the top and front. The brainstem is the base of the brain, above the spinal cord.
Depending on where in the brain a stroke strikes, the effects can vary. Strokes in the cerebrum typically affect functions like movement, speech, vision, emotional control, eating and cognitive ability, or thinking, reasoning and memory.
Strokes in the cerebellum can cause dizziness, nausea and vomiting, headaches, and coordination and balance issues.
When a person suffers a stroke in the brainstem, it can cause issues with breathing, body temperature control, heart functions, vision, chewing, swallowing and speaking as well as balance and coordination. Strokes in the brainstem may also cause death.
“You could have someone with a microscopic stroke in the brainstem and have them be basically brain dead. The brainstem controls your blood pressure, your heart rate regulation, your respiratory rate,” Werner said. “You could have someone who has a pretty sizable stroke in the front portion of their brain, and they might just have some facial weakness and grip weakness.”
While each area of the brain controls different functions, some of the effects of strokes can overlap across the different areas. Effects of a stroke can also include other issues not listed above.
The effects of a stroke will determine what treatment plan a patient will need. Treatment plans can include physical and speech therapy as well as medications.
“Once everything is all said and done, a blood thinner is given, the name of the game is rehabilitation and prevention,” Pauzauskie said. “We have physical therapists, occupational therapists and speech therapists who evaluate the patient.”
Depending on the severity of the stroke, some patients will be admitted into an in-patient rehab facility, while others may get the green light to go home.
Patients admitted to a rehab facility will work with therapists in different programs to help them recover movement and speech functions, working to regain as much independence as they can. The facility also works with family members and caregivers to help educate them on how they can best care for the patient — now and into the future.
“The most recovery happens in the first three to four months for most people. Up to a year or longer is the plateau point,” Pauzauskie said. “The bottom line is that you don’t have to cram it all in, you can continue to work on it the rest of your life.”
Tips for lowering stroke risks
As with most diseases or medical issues, a healthy lifestyle is key to keeping yourself and your family members out of the emergency room.
Many of the tips associated with lowering a person’s risk of having a stroke also pertain to preventing other health risks such as heart disease, diabetes and high cholesterol.
Some of the things you can do to ensure a healthy brain and body are:
- If you smoke, stop
- Maintain a healthy weight
- Limit alcohol use
- Incorporate fruits, vegetables and whole grains into your diet.
- Limit your intake of sugar, salt, saturated and trans fats, and cholesterol
Your doctor may also prescribe certain medications or over-the-counter pills to help lower stroke risks.
Things like low-dose aspirin and blood-thinning medicine and help prevent blood clots from forming. Blood pressure and cholesterol-lowering medications can help reduce plaque buildup in blood vessels, which can hinder the flow of blood.
If your risk of stroke is exceptionally high, your medical provider may suggest certain surgeries to remove plaque and clots from arteries in the neck or the placement of a stent to help prevent blood clots.
“The brain can be so tricky. I’ve been in this job for four years, and I’ve worked with stroke patients for my whole career,” Werner said. “We are seeing so many more young people. Our average stroke age has decreased in the last couple of years, and there has been more debilitating and even fatal strokes in 40-year-olds than I have ever seen in my career.”
This increase in younger stroke patients circles back to lifestyle and choices.
“We like things easy; we like things quick, and it’s usually not very healthy,” Werner said.
For more information about strokes, how to prevent a stroke or resources for caregivers to stroke patients, go to:
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