Understanding Strokes: Recognizing and Responding to Symptoms

A stroke. It occurs quickly and without warning. It’s called the “silent killer” for a reason. The risk of having a stroke has increased by 50 percent over the past 20 years, according to the World Health Organization, with one of every four adults likely to experience a stroke. 

Adrienne Duke knows the implication of these rising numbers. As Legacy Health’s stroke program manager, Adrienne has witnessed firsthand the impact of strokes, physically and emotionally. Recently, she provided a comprehensive interview about the need to become better aware of strokes, including symptoms, how to respond when you or someone you know experiences one, and the importance of contacting an ambulance team (EMS) for transport to a hospital. The interview was edited for concision and space considerations.

Q: What is a stroke? 

A: A stroke happens when your brain doesn’t get the oxygen it needs to function. 

We breathe to bring oxygen into our blood, and our blood circulates to get that oxygen to the parts of our body that need it to survive. A stroke happens when blood vessels carrying oxygen to the brain either tear open or, more commonly, get blocked. In either case, blood can’t get to the part of the brain that needs it and causes brain damage. 

Different areas of your brain have different jobs. So, a stroke that happens in one area of the brain will look different than a stroke in another part of the brain; it all depends on which blood vessel is affected and where it’s supposed to be delivering blood. If blood is completely cut off to the area of your brain that is responsible for, say, understanding language, you will likely have problems understanding what people are saying to you, even though you may be able to hear just fine.

People don’t always realize that all strokes are not created equal, so to speak. Some strokes are very mild and have a minor impact on a person’s long-term functioning. But other strokes can be extremely severe, and they can cause a wide variety of symptoms. Most importantly, strokes can be deadly. But even when they aren’t, they can have such a profound impact on a person’s life. So often they can rob a person of their independence; you could lose the ability to do the kind of things that many of us take for granted daily, like getting in and out of bed without assistance, making our morning coffee and talking to our families over breakfast. 

The scary truth is that strokes can cause physical, emotional and communication changes that impact who we are and how we live our lives. And because of that, we should all strive to be aware of what makes us susceptible to strokes, and what we should do if we detect stroke symptoms. Not just in ourselves, but for people around us as well. 

Q: What makes someone vulnerable to a stroke?

A: A pretty good rule of thumb is that if something is bad for your heart health, it is probably also bad for your brain health. 

Health conditions like high blood pressure, high cholesterol and diabetes all make you more likely to have a stroke. If you are carrying extra weight and don’t get much exercise, chances are you may already have one or more of those problems, and sadly that means you are at risk. Smoking or using nicotine products is another risk factor; most doctors will tell you that quitting is one of the most meaningful things you can do to improve your health, and one of the many reasons why is that it will help lower your risk of having a stroke. Along similar lines, if you drink alcohol in excess or use illegal drugs, your stroke risk also goes up. 

Historically, a person’s stroke risk increases after the age of 65. But we are starting to see younger people having strokes more often these days. Oftentimes, that is due to lifestyle choices. The silver lining is that if we educate ourselves and make solid decisions about how to protect and preserve our health, we have the power to reverse that trend. 

Q: How do you know when you need stroke care?

A: We have an easy to remember acronym, BE FAST, to recognize stroke symptoms. It’s a great tool for the public because it’s also familiar to ambulance agencies and emergency rooms. BE FAST has become ubiquitous for stroke recognition across the country.

“B” stands for balance. If you have sudden balance changes or difficulty walking, you should get to the emergency room.

“E” is for eyes, specifically sudden vision changes in one or both eyes.

“F” stands for face. If someone develops a droop on one side of their face, it could be stroke. Watching someone make a few funny faces can help identify if there’s really an asymmetry in their face. Puffing out cheeks, raising eyebrows, or showing teeth are all good ways to see if both sides of a face are moving the same way. 

“A” stands for arms, or more specifically for arm weakness. Because of the way our brains are organized, strokes tend to cause symptoms on one side of the body rather than on both sides. So, weakness in one arm or leg, or in the arm and leg on the same side should get your attention.

“S” is for speech. This one can be a little tricky because a stroke can affect a person’s speech in a few different ways. Sometimes the speech is slurred or the words aren’t coming out clearly. In other cases, the words are clear but they don’t make sense. You sometimes hear people call this “word salad.” Sometimes a stroke will make it hard for a person to get the words out — they may know what they want to say, but they can’t make the words come. And in other cases, the person may be able to speak just fine, but they may not seem to be able to make sense of what is being said to them. In other words, their comprehension of language is affected. And in very severe cases, sometimes they can’t understand or produce speech. 

“T” stands for time. So, it’s not a symptom like the other letters, but it is a reminder to act immediately in hopes you can stop the stroke before it causes permanent harm.

Q:  What happens when a stroke is left undiagnosed and unchecked?

A:  Well, again, it depends on what part of the brain is affected by the stroke, and how much of the brain is deprived of oxygen and for how long. But it is no exaggeration to say that strokes can kill. A stroke is the number five cause of death nationwide, but that number shifts in certain demographics. For instance, strokes are the third leading cause of death in Hispanic women, and the fourth leading cause in Hispanic men. Now, even though most strokes are not deadly, they can really wreak havoc on the life of the person having a stroke and those around them. Imagine a 55-year-old man who has a stroke that impacts his ability to use his dominant arm, and therefore he is no longer able to work. He is likely to miss those years of his career when he had the highest earning potential, when he still relies on his job for insurance benefits, and when his family likely still relies on him for income. And suddenly, he needs help just to get dressed every morning. The most devastating thing about a stroke is that it can take away our independence and our autonomy, and when that happens, we see increased rates of depression and a reported decrease in quality of life. 

Q:  Why is it important to go to a hospital when you have a stroke?

A: I like to think of it like this: if I wrap string around the tip of my finger for a few minutes, it won’t do me any long-term harm. But if I leave that string in place for very long, it will start to cause problems. The tip of my finger will start to feel different and it probably won’t move or work as well as it should. If I just never took the string off, eventually I would do permanent damage to my finger. 

That’s kind of how things are early in a stroke. If you get to the hospital quickly, we may be able to get blood flowing where it needs to go before long-term damage happens. But I can’t stress enough how important the element of time is: after a certain point, the damage may already be done, and our options may be limited. 

Q: Why is an ambulance the best way to transport someone to the hospital when they are having a stroke?

A: Calling an ambulance is so important because they help save time. Granted, if you walk into a hospital with stroke symptoms, we are going to notice that and get you treated fast, but we still must figure out who you are and why you are there. If you come in an ambulance, they have already passed that information along to us before you get to the emergency room. And since we know you’re coming, we get the entire stroke team together so we can make a diagnosis and initiate treatment quickly. Those minutes truly matter, especially with big strokes, when you’re losing millions of brain cells as the minutes pass. 

The ambulance agencies also know which hospitals provide specialized stroke care. They know where to bring a person based on their symptoms. This helps us provide the right treatment without delay; that’s just not something the public knows. They are a huge asset in getting people to the right place at the right time.