A Basic Run Down of Stroke
In my work in neuro rehab, I see many patients who have had a stroke; and, in discussing their medical history with them at bedside, I am still surprised to hear many of them express confusion about how to prevent a stroke and how to take care of themselves after having one. Given the many times I have had this conversation with patients, I felt it important to provide readers with the basics of stroke, what you can do to reduce your risk and what you cant.
Understanding Stroke: Types, Risks, Prevention, and the Warning Signs
A stroke is a medical emergency that occurs when blood flow to the brain is disrupted. When this happens, brain cells are deprived of oxygen and due to the limited reserves of oxygen storage in the brain, the brain cells begin to die within minutes.
There are Two Main Types of Stroke:
Ischemic Stroke: This is the most common type, accounting for the vast majority of all strokes. An ischemic stroke occurs when a blood clot blocks an artery that supplies blood to the brain. These are often categorized as thrombotic (clots forming directly in the brain's blood vessels) or embolic (clots forming elsewhere in the body, like the heart, and traveling to the brain).
Hemorrhagic Stroke: This type occurs when a blood vessel inside the brain bursts or leaks. The spilled blood creates high pressure and swelling, damaging the surrounding brain cells. This is the most damaging type of stroke due to the large surface area that can be impacted and has a high mortality rate.
Then we have a TIA:
Transient Ischemic Attack (TIA): Often called a "mini-stroke," a TIA is caused by a temporary blockage. The acute symptoms appear like a stroke, but tend to disappear within minutes or hours without causing permanent damage. Additionally, there is no evidence of a stroke on brain imaging after having a TIA. A TIA is a serious warning sign that a major stroke could occur in the future and is something to take seriously.
Major Stroke Risk Factors
There are many risk factors that increase your risk for stroke, some of which you can control and some that you can’t.
Uncontrollable Risk Factors
Age: Risk increases proportionally with age, particularly after age 55.
Family History: A history of stroke in your immediate family can raise your risk.
Race and Ethnicity: In the United States, stroke occurs more frequently among Black, Hispanic, Alaska Native, and American Indian adults.
Sex: While younger men are more likely to have a stroke than younger women, women live longer on average, making their lifetime risk of stroke higher.
Controllable Risk Factors
High Blood Pressure: The single leading manageable cause of stroke.
Smoking and Vaping: Nicotine and tobacco smoke damage blood vessels and increase clotting.
High Cholesterol: Contributes to fatty plaque buildup in the arteries.
Diabetes: High blood sugar damages blood vessels over time.
Obesity and Poor Diet: Diets heavy in saturated fats, trans fats, and excess sodium increase strain on the cardiovascular system.
Lack of Exercise: Physical inactivity exacerbates blood pressure, weight, and cholesterol issues.
Excessive Alcohol Use: Drinking large amounts of alcohol raises blood pressure and stroke risk.
So what can we do about the controllable risk factors?
Actionable Steps to Prevent a Stroke
Up to 80% of strokes are preventable through healthy lifestyle adjustments and medical management.
Manage Your Blood Pressure: Monitor your numbers and work with a doctor to keep blood pressure under control, ideally aiming for a target below 130/80 mm Hg.
Adopt a Heart-Healthy Diet: Eat a diet rich in fruits, vegetables, whole grains, and lean plant or animal proteins. Limit foods high in saturated fats and minimize salt intake. The MIND or Mediterranean diet which is high in low fat proteins, nuts, healthy oils and vegetables has an overwhelming amount of data in the literature documenting the benefits for cognitive health.
Exercise Regularly: Aim for at least 150 minutes of moderate aerobic exercise per week, such as brisk walking, cycling, or swimming. Of all of the controllable risk factors, this one has the most potential for positive impact on reducing risk.
Quit Tobacco Use: Quitting smoking or vaping significantly reduces blood vessel damage.
Limit Alcohol Consumption: If you choose to drink, limit intake to no more than one drink per day for women and two for men.
Treat Underlying Health Conditions: Work closely with healthcare providers to properly manage conditions like diabetes, sleep apnea, high cholesterol, or irregular heart rhythms like Atrial Fibrillation (AFib).
How to Recognize a Stroke: Think "B.E. F.A.S.T."
When a stroke occurs, every second counts. Memorizing the B.E. F.A.S.T. acronym from the American Stroke Association can help you quickly identify the warning signs:
B = Balance: Look for a sudden loss of balance, dizziness, or coordination trouble.
E = Eyes: Watch for sudden vision changes, double vision, or loss of sight in one or both eyes.
F = Face Drooping: Check if one side of the face droops or feels numb. Ask the person to smile to see if it is uneven.
A = Arm Weakness: Check if one arm feels weak or numb. Ask the person to raise both arms; look to see if one arm drifts downward.
S = Speech Difficulty: Listen for slurred speech or difficulty repeating a simple sentence.
T = Time to Call 911: If you notice any of these signs—even if they go away—call emergency services immediately. Note the time the symptoms first appeared, as some treatments must be administered within a strict timeframe.
Cognitive Consequences:
Depending on the location of a stroke, patients can experience both slight or profound changes to their cognitive and emotional functioning. While some patients are surprised to learn they had a stroke in the past, others may struggle to walk or talk. This is where a neuropsychologist can be helpful. Through cognitive testing, an evaluation will reveal the areas of weakness post stroke in order to help the patient capitalize on their strengths, accomodate their weaknesses, support the patient’s family and normalize the experience identifying goals for care and expectations for recovery and independence following the injury.
A stroke can be a scary experience and while we can’t go back in time and undo the choices we have made in the past, we can do things now to make sure we improve our health and reduce our chances of having a stroke, negatively impacting our cognitive functioning and reducing our independence/quality of life.