One minute you’re fine, and the next minute you're not.
Diana M. Rojas-Soto, MDFor Dede Cummings, the signs of a stroke were subtle at first.
One morning, she noticed she was confused and had trouble finding the right words while talking to her son. After a hike a little later, her body suddenly leaned to one side. Soon, several symptoms showed up at once: her arm felt weak, her face drooped, and her speech became slurred.
“I called 911 and told the dispatcher, ‘I think I'm having a stroke. I need an ambulance,’” the Brattleboro resident says. “When the dispatcher said, ‘OK, where are you?’ Nothing could come out of my mouth except for this horrible, guttural sound.”
Each year, more than 795,000 people in the United States have a stroke, according to the U.S. Centers for Disease Control and Prevention. Most strokes affect people 65 or older, but about 10% happen to those under 45.
Here’s how doctors say you can minimize the effects of a stroke in yourself and in others by knowing the signs and the best ways to prevent and treat this sudden medical emergency.
What happens during a stroke?
“For most people, a stroke is something that happens all at once,” says Diana M. Rojas-Soto, MD, a neurologist at Dartmouth Hitchcock Medical Center. “One minute you’re fine, and the next minute you're not."
A stroke occurs when blood flow to your brain is blocked. If enough brain cells are affected, the damage can be permanent and may cause disabilities or changes in how you use your body.
“Stroke symptoms can come and go very fast,” Rojas-Soto says. “One of the big clues is that you feel something you’ve never experienced, and it’s something that takes away a very important function of the body.”
To recognize the warning signs, use the acronym BE FAST:
Balance. A sudden loss of balance.
Eyes. Sudden vision loss or changes in one or both eyes.
Face. Smile and look for a droop on one or both sides of the face.
Arms. Raise both arms. During a stroke, one arm will drop from weakness or paralysis.
Speech. Slurred speech or having trouble choosing the right words.
Time. Time is critical, so call 911 immediately.
Can the brain recover?
“There’s a saying that ‘time is brain.’ The earlier you restore that blood supply, the more healthy tissue you will be able to preserve.” says Anas Hannoun, MD, a neurologist at Dartmouth Health Clinics Concord and Bedford.
Research shows that after a stroke, the brain can rewire itself and recover through neuroplasticity. Healthy brain cells form new connections to take over for damaged ones, helping you regain abilities.
“The brain has an amazing capability of flexibility and plasticity. The neuroplasticity does an incredible job of recovering the functions,” Hannoun says.
How well someone recovers depends on how big the stroke was, where it happened, how quickly they got treatment, and how much rehab they do. Hannoun explains that not all lost brain tissue can be restored after a stroke.
“In an area where the tissues are already dead, there’s nothing we can do about it,” he says. “But the surrounding area of those tissues can still be saved if we act fast.”
What about therapy?
Recovering from a stroke can depend on where the stroke happened in the brain. If the left side is affected, speech and language may be harder. If the right side is affected, it might change how you pay attention or understand space.
After a stroke, several types of therapy can help. Physical therapy helps you get back strength and movement. Occupational therapy helps you relearn daily tasks. Speech therapy helps with language or swallowing problems.
Hannoun notes that progress can continue for months or even years after a stroke.
“Recovery is a team effort,” he says. “Physical therapy, occupational therapy, and speech therapy work together to help patients regain as much function as possible. The more intensive and early the rehab happens, the better the outcomes.”
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Can you have a minor stroke?
No. A stroke is a stroke, Rojas-Soto says.
She emphasizes that all strokes are serious, regardless of their size or your symptoms.
“We need our brain, every single inch of it, to function,” she says.
About 80% of strokes are called ischemic strokes, caused when a vessel supplying blood to the brain becomes blocked.
Another type is a hemorrhagic stroke, which happens when a blood vessel in the brain leaks or bursts. This type of stroke can show up with BE FAST warning signs, but also with a severe headache.
A "ministroke” might be used to describe a transient ischemic attack (TIA). A TIA is a temporary blockage of blood flow to part of the brain, the spinal cord, or the thin layer of tissue in the retina of the eye.
The blockage may cause brief symptoms similar to a stroke. But a TIA doesn’t cause permanent damage to brain cells or the brain.
“A TIA is like a warning shot,” Hannoun explains. “The symptoms might go away, but it means you’re at very high risk for a real stroke. It’s an emergency that needs immediate attention.”
Does aspirin help prevent stroke?
Aspirin can help some people prevent strokes, but experts say it should not replace managing other major risk factors.
Taking only aspirin is not enough to prevent a stroke. It is more important to control your blood pressure, cholesterol, and diabetes, and make healthy lifestyle choices.
“Aspirin is not a magic bullet,” Hannoun says.
What are the risk factors?
Your risk for stroke depends on both your health and your lifestyle. Some of the main factors are:
- High blood pressure
- Diabetes
- High cholesterol
- Obesity
- Smoking
- Sleep apnea
- Atrial fibrillation and other heart diseases
- Sedentary lifestyle
- Excessive alcohol use
- Family history of stroke
Research shows that responding quickly to a stroke is tied to a patient’s outcome.
Cummings, who is in her 70s, says noticing symptoms and calling 911 quickly made all the difference.
“So many people don’t know the signs of a stroke,” Cummings says. “But I’ve learned that if you get help within that first hour of having symptoms, you’re going to have a much better chance of recovery.”
Resources + Related Stories
Dartmouth Health Stroke Program
Dartmouth Health Neurology Services
