By Dr. Faraz Javed , Performance Improvement Coordinator for Stroke and Chest Pain at Memorial Hermann Pearland Hospital
Forty seconds. What does it mean to you? How long is it? Is it how often you check your phone for social media updates? Is it how frequently you refresh your patient list? Or, is it how frequently you check your phone on the eve of your favorite sports team’s trade deadline? While it may be just one or all of the above for you, 40 seconds also has a more serious meaning. Every 40 seconds, someone in the United States is affected by a stroke, making stroke the leading cause of long-term disability and the fifth leading cause of mortality (only behind heart disease, cancer, accidents and chronic lower respiratory diseases, in that order).
May is National Stroke Awareness Month, and an opportunity for us to share information and resources about risk factors, warning signs, and treatment. Every four minutes, someone dies from stroke, and more than 800,000 Americans will suffer from one, so it is critical that you and your loved ones learn how to identify a stroke and how to seek out appropriate medical attention promptly.
What is stroke, also known as a cerebrovascular accident, or CVA? To put it bluntly, it is damage to the brain that happens by a multitude of mechanisms. Just like the heart can experience a heart attack, a stroke is like a brain attack—in fact, it was once referred to as a brain attack. The two major types of stroke are ischemic and hemorrhagic. While there are plenty of risk factors for stroke, some of the more common causes include:
- Prior TIA (commonly called “mini stroke”) or prior stroke
- Alcohol abuse
- Drug abuse
- A. fib (irregular rate and rhythm of the heart)
- Sickle Cell disease
- Obesity and lack of exercise
- High cholesterol
- Having COVID-19
- Females have a higher risk than males
- Older age
- Poor sleeping patterns
- Living in the Southeastern United States
- Lower socioeconomic status
Ischemic strokes are due to a lack of oxygenated blood going to the brain, thus starving the brain of oxygen, causing tissue damage. I liken it to if you were watering your garden but had a rock stuck in your hose—you would have less water getting to your plants causing them to get damaged and die—and pretty much the same thing happens to our brain during an ischemic stroke. When most people think of a stroke, they think of a blood clot, which is a form of an ischemic stroke.
On the other hand, hemorrhagic strokes are due to blood escaping vessels in our brain and coming in direct contact with the brain, and even compressing the brain, causing damage. So now you’re thinking, if ischemic strokes are due to a lack of blood, why is blood in the brain a problem? Great question! My best analogy is that your phone needs electricity, but it gets that through a series of wires connected to computer chips. If the wire was frayed and the electricity came into contact with the computer chip directly, that would cause a short circuit. A similar mechanism of damage occurs to the brain when blood interacts directly with it rather than through vasculature.
Now that you know how common stroke is, what it is, and how it damages the brain, let’s talk about what a stroke looks like. Depending on where the damage occurs in the brain, there can be a wide variety of effects on the body, but the best way to remember the signs are through the acronym BE FAST.
- B – stands for a change or loss in balance
- E – stands for sudden changes affecting your eyes and vision
- F – stands for having changes in the face such as a facial droop or uneven facial muscle tone on either side of the face
- A – stands for one-sided arm or leg weakness. Grip strength or arm strength may be significantly affected, or you may feel even numbness in the area
- S – stands for speech. Those affected can exhibit aphasia, which means the patient is unable to converse as easily or has slurred speech
- T – stands for time. Every minute someone has a stroke, they lose approximately 1.9 million neurons (brain cells), 13.8 million synapses and over 7 miles of axons.
So, what can you and your loved ones do after identifying a stroke, other than keeping the patient safe from environmental hazards to prevent falling and choking? The answer is calling 911 and identifying what time the symptoms began. You will need to provide that information to the health providers and EMS, as that can dictate care, especially for our ischemic stroke patients. Those with ischemic strokes can be given a medication that can break down a clot, helping restore oxygenated blood to the brain, if the medication is given within 4 ½ hours after symptoms began. In some cases, surgical management may be required for specific types of ischemic strokes. For our hemorrhagic stroke patients, strict blood pressure management and neurosurgery may be needed.
I hope this information helps you and those you hold dear be prepared should you ever come across someone experiencing stroke-like symptoms. Remember: time is brain, and quick identification can be the difference between a long-term disability and the ability for the patient to regain most of their loss of neurological functions.