How to recognize the signs of a stroke

There’s a good chance you know someone who has had a stroke, or you will in your lifetime—and that’s because strokes are prevalent. More than 795,000 Americans have a stroke every year, according to the Centers for Disease Control and Prevention (CDC). In other figures, someone in the United States has a stroke every 40 seconds. Every 3.5 minutes, someone dies of a stroke. And for those who survive, strokes are the leading cause of significant long-term disability.

Strokes are dangerous and common, but there is still a lot of questions about them—what is a stroke? What are the signs of a stroke? How can you prevent a stroke? Here, find the answers you need.

What is a stroke?

To put it as plainly as possible, “a stroke is damage to the brain caused by not enough blood getting to the brain,” says Stephen Devries, MD, a preventive cardiologist and executive director of the nonprofit Gaples Institute for Integrative Cardiology. “A stroke is caused by a problem with the blood vessels that go to the brain, which can happen either because the blood vessel becomes clogged from a cholesterol plaque or blood clot, or when a blood vessel in the brain bursts open due to high blood pressure or an inherited weakness in the artery.”

You often hear “stroke” in the same sentence as “heart attack” because they may have a related cause, but they are not the same thing. “Stroke occurs as a result of a blockage in the vessels that supply the brain with oxygenated blood, while a heart attack occurs due to a blockage that develops in the vessels that supply the heart muscle,” explains Regina S. Druz, MD, FACC, a cardiologist with Catholic Health Services of Long Island and Chief Medical Officer with the Holistic Heart Centers of America (HHCA). “While the organs are very different, the vascular and systemic events that involve stroke and heart attack are closely related, as are the underlying risk conditions.”

What are risk factors of a stroke?

According to the National Heart, Lung, and Blood Institute, some major risk factors that increase your chances of having a stroke include:

• High blood pressure
• Diabetes
• Heart disease
• Smoking (either current of a history of smoking)
• High LDL cholesterol levels
• Atrial fibrillation (abnormal heart rhythm)
• Brain aneurysms or arteriovenous malformations (AVMs)
• Viral Infections such as COVID-19  
• Autoimmune conditions (like lupus or rheumatoid arthritis) that cause inflammation
• Family history of stroke
• Female sex (women are more likely to have a stroke)
• Race (In the United States, African American, Alaska Native, American Indian, and Hispanic adults are more likely than white adults to have a stroke)
• Prior stroke or Transient Ischemic Attack (TIA) also known as a mini-stroke 

Other, lesser-known stroke risk factors include anxiety, depression, high stress levels, frequent illicit drug use, excessive drinking, being overweight or obese, getting too much sleep (more than nine hours regularly), not getting enough exercise, estrogen replacement, oral contraceptive pills, blood thinners, and living in areas with air pollution.

What are the first signs of a stroke?

“Face drooping, arm weakness, and speech difficulty are all indicators of a stroke,” Dr. Druz says. According to the CDC, early symptoms of a stroke also include:

• Sudden numbness or weakness in the face, arm, or leg, especially when it occurs on only one side of the body
• Sudden confusion, trouble speaking/word finding, or mumbled speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination
• Sudden severe headache with no known cause

Stroke symptoms can be different in women than they are in men. According to the American Stroke Association, women may report symptoms such as:

• General weakness
• Difficulty breathing or shortness of breath
• Confusion, unresponsiveness, or disorientation
• Sudden behavioral change
• Agitation
• Hallucination
• Nausea or vomiting
• Pain
• Seizures
• Loss of consciousness or fainting

How long do you have symptoms before a stroke?

Stroke warning signs may present several days, or up to a week before a stroke, according to research published in Neurology. “Warning signs of a stroke are the same as the stroke itself (like headache, difficulty with speech, numbness, and tingling)—but the difference is that, prior to the actual stroke, the warning symptoms resolve quickly, sometimes in a manner of a few minutes,” Dr. Devries explains. “Too often, these alarms are disregarded and people don’t seek the medical attention that could be life-saving.” Seeking immediate urgent medical help at the first hint of a symptom can help prevent brain damage.

What should you do if you recognize signs of a stroke?

“If these are new conditions then you should immediately call 911,” Dr. Druz explains. “This constellation of symptoms and signs is known as the acronym ‘FAST’—helping you to remember these three symptoms, with an added ‘T’ indicating that time is of the essence.” 

The American Stroke Association breaks down FAST with the symptoms and the action you should take to confirm a possible stroke patient’s condition like this:

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward? Is either arm weak or numb?
S—Speech: Ask the person to repeat a simple phrase. Is speech slurred or hard to understand, or are they unable to speak?
T—Time: If you observe any of these signs, call 9-1-1 right away. Early treatment is essential.

If you think you or someone else is having a transient ischemic attack (TIA) or stroke, don’t drive to the hospital or let someone else drive you. Call an ambulance. Medical personnel often begin life-saving treatment en-route to the emergency room. During a stroke, every minute counts.

Can a stroke go unnoticed?

There is such a thing as a mini stroke—or a TIA—which can go unnoticed by both the person experiencing it and bystanders. A TIA is a problem in the blood vessels of the brain that causes a temporary decrease in blood flow to a certain brain region, according to Harvard Health. Dr. Louis Caplan, professor of neurology at Harvard-affiliated Beth Israel Deaconess Medical Center says that these episodes are very brief, lasting less than an hour to up to 24 hours. 

In fact, most TIAs have neurologic symptoms that resolve spontaneously within a few minutes. The chain of events that leads to a TIA is the same that leads to a stroke, but on a smaller scale. This is dangerous because a TIA is very likely to cause a stroke in the near future.

What conditions can mimic a stroke?

According to research published in 2017, there are many medical conditions that can mimic the signs and symptoms of a stroke, such as: brain tumors, metabolic disorders (like hypoglycemia or hyperthyroidism), brain infections (like meningoencephalitis), and neurologic disorders (like migraine, muscular sclerosis, or seizures).

This makes recognizing a stroke even more difficult, but waiting on treatment can cause irreversible deficits. If you think there’s any chance it could be a stroke, call 911. Go to the hospital. Even if it is not a stroke, it’s better to be safe than sorry.

How to prevent a stroke

While there are many risk factors that are out of our control (such as family history and genetics), there are many ways to significantly reduce your risk of stroke. “People have much more power over their health with diet and lifestyle than they often realize,” Dr. Devries says. 

Patients who have diabetes, atrial fibrillation, high cholesterol, and hypertension are at increased risk of developing a stroke. Controlling these underlying conditions will decrease the chance of a stroke. 

These eight steps can help to prevent a stroke:

1. Control your blood sugar. Keeping your blood glucose levels in the normal range can help reduce your risk of stroke. Make sure your physician checks your hemoglobin A1c blood work every three months to confirm that your diabetes is well controlled. 
2. Quit smoking. “Smoking is a big risk factor, and nothing could be a more positive step toward better health than to quit,” says Dr. Devries. There are medications and nicotine replacement and free hotlines to help you quit and stay quit.
3. Reduce salt in your diet, and consume less processed foods. “High blood pressure is also one of the strongest risk factors for stroke,” says Dr. Devries. “Dietary changes can go a long way to help with blood pressure—especially limiting the salt in your diet (found in many packaged processed foods, as well as in bread, processed meats like bacon and sausage, and pizza).”
4. Eat fruits, beans, and greens. “On the positive side, foods high in potassium, like many fruits, beans, and greens, actually help to lower blood pressure,” says Dr. Devries.
5. Limit alcohol. “Excess alcohol can also raise blood pressure—a fact that many people are not aware of,” notes Dr. Devries.
6. Treat heart disease. People with coronary heart disease, problems with a heart valve, or irregular heartbeat are at increased risk of stroke.
7. Get regular exercise. “Other lifestyle changes that can help prevent stroke include regular exercise, including sustained walking, and stress management with tools like meditation,” says Dr. Devries. Thirty minutes of moderate exercise daily is the goal.
8. Maintain a healthy weight. Keep your weight under a BMI of 25. Being overweight or obese is associated with an increased risk of stroke. 

If you’ve already had a TIA or heart attack or stroke, your doctor may prescribe aspirin, clopidogrel (Plavix), and cholesterol-lowering medications to help prevent a second stroke. 

“The two-pronged approach to avoiding a recurrence of stroke is to get regular medical checkups and to do all you can to optimize your lifestyle opportunities,” Dr. Devries says. “Regular medical checkups are essential to keep blood pressure, cholesterol, and sugar levels in check. But even with the right medicine, making lifestyle changes remains essential.” Stroke patients are treated with aspirin, clopidogrel (Plavix) as well as statin medications to prevent a second stroke.