Updated on September 30, 2024.
More than 795,000 Americans have a stroke every year. Of those, more than 150,000 die, making stroke the fourth leading cause of death in the United States.
These are sobering facts, but here’s the most important fact of all: “A stroke is preventable, and key factors to that are controlling blood pressure and smoking cessation. Do that and the risk of stroke drops precipitously,” says Raul Guisado, MD, a neurologist at Regional Medical Center of San Jose in California.
Other stroke risk factors include diabetes, physical inactivity, obesity, and unhealthy blood cholesterol levels.
What is a stroke?
A stroke is when part of your brain dies due to a lack of oxygen-rich blood. There are two main types. An ischemic or “clot” stroke happens when a blood clot blocks blood flow to the brain, depriving it of oxygen and other nutrients. A hemorrhagic or “bleeding” stroke is when a blood vessel in the brain leaks or ruptures, causing blood to pool in or around the brain, depriving it of oxygen and other nutrients and leading to brain damage.
Stroke can lead to death or to disability. Stroke survivors may be left unable to:
- Move
- Talk
- Eat or swallow
- Think, remember, or control emotions
- Control bowel or bladder or other bodily functions
About 87 percent of all strokes are ischemic strokes. But “hemorrhagic strokes are much more disabling,” says Dr. Guisado. They are also more the deadly type of stroke, studies show. In a worrisome development, hemorrhagic strokes appear to be growing more common in the U.S., especially in younger and middle-aged adults and in Asian and Pacific Islander adults, recent research has found.
Then there is a transient ischemic attack (TIA), which occurs when blood flow to the brain is temporarily interrupted. Symptoms can last from a few minutes to a few hours, but there is no permanent damage or evidence of brain tissue death on imaging.
A TIA is often called a “warning stroke” because after having one, you’re at greater risk of having an actual stroke, especially if you have other risk factors. That’s why it’s critical to be evaluated as soon as possible, ideally within an hour of symptoms starting, since you can’t be sure if it’s a TIA or full stroke. A TIA may give you and your healthcare provider (HCP) time to help prevent a full-on stroke.
Recognize the signs of a stroke and remember to B.E. F.A.S.T.
Guisado says to look for “sudden changes that affect speech, the face, one side of the body, or neurological function.” The quicker a stroke is recognized and the quicker a person gets treatment, the more likely long-term damage will be avoided, he says.
That’s why it’s important to understand the elements of B.E. F.A.S.T. in your assessment if you think someone’s having a stroke. That means:
- Balance: Is there a sudden loss of balance or coordination?
- Eyes: Is there sudden vision loss, distorted vision, or blind spots in one eye?
- Face: Ask the person to smile and see if one side of the mouth droops.
- Arms: Ask the person to raise both arms over their head. Does one arm drift down?
- Speech: Does their speech sound slurred?
- Time: Note the time these symptoms began and call 911 right away.
Who is at risk of stroke?
Anyone can have a stroke, but factors that raise your risk—some of which are under your control—include the following:
- High blood pressure of 140/90 or higher
- Heart disease, especially atrial fibrillation (irregular heartbeat)
- Diabetes
- Smoking, which almost doubles your risk for clot stroke
- Unhealthy blood cholesterol
- Taking birth control pills
- Lack of exercise
- Obesity
- Excessive alcohol use—over two drinks a day, or binge drinking
- Using cocaine or other illicit drugs
- Older age. Your stroke risk approximately doubles every 10 years after age 55.
Stroke is also likelier among Black people, people with lower incomes, men, and people with a family history of stroke. It’s also likelier in certain regions of the country and during extreme temperatures.
Treating stroke is time-critical
Ischemic strokes can often be treated with powerful clot-busting drugs called thrombolytics. Acting quickly is critical. Getting a thrombolytic within three to four-and-a-half hours of having a stroke, and sooner if possible, can help limit long-term damage.
If the clot blocks one of the large arteries of the brain, surgically removing the clot is another option, but the procedure must ideally be performed within six hours of the stroke for optimal results. HCPs may also use aspirin to help prevent new clots from forming.
For a hemorrhagic stroke, once vital signs are stabilized, HCPs focus on ways to prevent blood clots and reduce pressure in the skull. You will likely get intravenous fluids, and if you take blood thinners, you may be given medications or even transfusions of blood products to counter their effects. You may also be given medications to lower your blood pressure, prevent seizures, and relieve pressure in your brain. Surgery to stop the bleeding or decrease pressure in the skull may be necessary as well.
Recovering from stroke
If you have a stroke, your recovery depends on many factors.
“The size of the stroke and location in the brain are most important,” says Guisado. “The next factor is the age of a person.”
The younger the patient, the more brain plasticity they have and the more likely they are to bounce back.
“The other factor is the general health of a person,” Guisado says. “Certain conditions like diabetes, congestive heart failure, and kidney disease can impair recovery.”
You may need formal stroke rehabilitation (rehab), which can help you regain muscle strength and coordination, learn to move an affected body part again, and/or recover thinking and memory skills.
After a stroke, you have a high risk of having another. In fact, nearly one in four strokes is a recurrent stroke.
To reduce your risk of a recurrent ischemic stroke, you may need to go on medication (often aspirin). And it’s crucial to get risk factors like high blood pressure under control, as well as to make lifestyle changes, like quitting smoking, cutting back on alcohol, eating a heart-healthy diet, and getting physically active. Stroke and TIA survivors who are able should try to get in at least 120 to 150 minutes per week of moderate- to vigorous-intensity aerobic exercise.
