Column: What Is A Stroke & How To Recognise It

March 15, 2023

Dr. Lee Schwamm Column March 2023

[Column written by Dr. Lee Schwamm]

In 2020, King Edward VII Memorial saw 4-5 patients a week presenting with stroke symptoms and with the island’s aging population, it’s likely these numbers will only go up. As such, we wanted to take the opportunity to share some information about this serious illness.

What is a stroke?

A stroke, or brain attack, happens when blood flow to your brain is stopped. It’s an emergency situation so call 911 if you think you might be having a stroke or stroke symptoms.

The brain needs a constant supply of oxygen and nutrients to work well. If the blood supply is stopped even for a short time, this can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen.

When brain cells die, brain function is lost. You may not be able to do things that are controlled by that part of the brain. For example, a stroke may affect your ability to:

  • Move
  • Speak
  • Eat, drink, and swallow
  • See clearly
  • Think and remember
  • Solve problems
  • Control your bowel and bladder
  • Control your emotions
  • Control other vital body functions

A stroke can happen to anyone of any age at any time.

What causes a stroke?

A stroke is caused when blood flow to your brain is stopped or disrupted.

There are 2 kinds of stroke, ischemic and haemorrhagic:

  • Ischemic stroke. This is the most common type of stroke. It happens when a blood vessel in the brain is blocked. It may be blocked by a blood clot. Or it may be blocked by a build-up of fatty deposits and cholesterol. This build-up is called plaque.
  • Haemorrhagic stroke. This occurs when a blood vessel in your brain bursts, spilling blood into nearby tissues. With a haemorrhagic stroke, pressure builds up in the nearby brain tissue. This causes even more damage and irritation.

Who is at risk for a stroke?

Anyone can have a stroke at any age. But your chance of having a stroke increases if you have certain risk factors. Some risk factors for stroke can be changed or managed, while others can’t.

Risk factors for stroke that can be changed, treated, or medically managed:

  • High blood pressure
  • Heart disease
  • Diabetes
  • Smoking
  • Birth control pills [oral contraceptives] or hormone replacement therapy
  • History of TIAs [transient ischemic attacks]
  • High blood cholesterol [lipids]
  • Lack of exercise or inactivity
  • Obesity
  • Excessive alcohol use
  • Illegal drugs
  • Abnormal heart rhythm
  • Cardiac structural abnormalities

Risk factors for stroke that can’t be changed:

  • Older age. For each decade of life after age 55, your chance of having a stroke more than doubles.
  • Race. African Americans have a much higher risk for death and disability from a stroke than whites. This is partly because the African-American population has a greater incidence of high blood pressure.
  • Gender. Stroke occurs more often in men, but more women than men die from stroke each year.
  • History of prior stroke. You are at higher risk for having a subsequent stroke if you have already had a stroke.
  • Heredity or genetics. The chance of stroke is greater in people with a family history of stroke.

What are the symptoms of a stroke?

Stroke symptoms may happen suddenly and may vary from person to person. Symptoms may include:

  • Weakness, drooping, or numbness of the face, arm, or leg, usually on one side of the body
  • Having trouble reading, speaking or understanding
  • Problems with vision, such as dimness or loss of vision in one or both eyes
  • Dizziness or problems with balance or coordination
  • Problems with movement or walking
  • Fainting [loss of consciousness] or seizure
  • Severe headaches with no known cause, especially if they happen suddenly

Other less common symptoms of stroke may include:

Sudden nausea or vomiting not caused by a viral illness
Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma

B.E. F.A.S.T. is an easy way to remember the signs of a stroke:

  • B – Balance. Sudden loss of balance or coordination.
  • E – Eyes. Vision changes in one or both eyes.
  • F – Face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.
  • A – Arm weakness. One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward.
  • S – Speech difficulty. You may hear slurred speech or difficulty speaking. The person can’t repeat a simple sentence correctly when asked.
  • T – Time to call 911. If someone shows any of these symptoms, call 911 right away. Call even if the symptom goes away. Make note of the time the symptoms first appeared.

*Please note that this information should not be taken as medical advice; if you have concerns about a stroke or any other medical condition, please consult your doctor.

- Dr. Lee Schwamm is a C. Miller Fisher Chair in Vascular Neurology and Director, MGH Center for TeleHealth at Massachusetts General Hospital and Chief Digital Advisor, Mass General Brigham

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