Your brain needs a continuous supply of blood to survive. Fortunately, the human brain is supported by 400 miles of blood vessels providing oxygen and nutrients.
A stroke is an immediate threat to this most important organ.
“When something cuts off the blood supply, like a clot in the vessel, the tissue that depends on that blood vessel doesn’t have what it needs and starts to die,” says UNC Health stroke neurologist and neurointerventionalist James Pham Ho, MD.
About 85 percent of strokes are ischemic strokes, meaning that a blood clot has stopped the flow of nutrient-rich blood to the brain; the remaining 15 percent are hemorrhagic strokes, caused by uncontrolled bleeding in the brain after a vessel bursts.
Once blood supply to any portion of the brain is cut off, brain tissue starts to die, so it’s critical to call 911 and get to the hospital.
“Every minute that the brain doesn’t have that blood supply, 1.9 million brain cells die, so you need to be seen as quickly as you can,” Dr. Ho says. “A stroke can happen to anyone—man, woman, young, old—at any time, day or night.”
That’s why it’s so important for everyone to know the signs of a stroke. Here’s what to look for.
Signs of a Stroke
Strokes can look a bit different from person to person, depending on where the blood flow to the brain is interrupted.
“If the vessel that’s blocked feeds the part of the brain that controls speech, and that part of the brain gets no oxygen or nutrients, then you won’t understand speech,” Dr. Ho says. “One half of your brain controls the opposite half, so if the clot is in a vessel on the left side that affects movement, it will affect your ability to move your right arm or leg.”
The acronym BE FAST can help you remember the signs of stroke and how important it is to act quickly.
“We all need to be fast at recognizing stroke symptoms,” Dr. Ho says. “The larger the clot or the longer it’s there, the more brain tissue that dies.”
B – Balance. You may have difficulty maintaining your balance or feel off on one side as you move.
E – Eyes. You may experience sudden vision changes, such as blurred or double vision, or be unable to see at all.
F – Face. Your face may droop or become numb on one side.
A – Arm. Your arm—or your leg—will feel weak on one side, or you may feel like you can’t control one side of your body.
S – Speech. You may slur your words or have difficulty speaking, and you may not be able to understand others. If you’re by yourself, you may notice you can’t understand what you’re reading or hearing on the television.
T – Time. If you have any one of these symptoms, it’s time to call an ambulance and go to the hospital.
Don’t drive yourself or someone else to the hospital, and don’t go to urgent care.
“If there’s any symptom, call 911,” Dr. Ho says. “If you think you have a symptom but you’re still on the fence, go ahead and call 911 and have an evaluation by the stroke team.”
Do’s and Don’ts When Someone Has a Stroke
Remember that once a stroke starts, brain cells are dying, so it’s important to seek care right away.
“The biggest mistake that people can make is waiting to see if symptoms improve,” Dr. Ho says. “Symptoms can fluctuate, but a stroke does not get better on its own. Don’t wait.”
If one of these symptoms occurs and does go away, it’s still important to call 911 and be seen in a hospital. You may have had a transient ischemic attack (TIA), sometimes referred to as a “ministroke.”
“With a transient ischemic attack, a clot may have gone into a vessel, caused symptoms and then dissolved on its own, so that you feel back to normal,” Dr. Ho says. “But now you’re at high risk for another stroke, so it’s still important to come to the hospital as quickly as possible so we can reduce that risk.”
While waiting for emergency transport, don’t eat or drink anything, including water. Strokes can affect the muscles that help us swallow, so choking is a risk.
Don’t take aspirin or any other blood thinner.
“With a hemorrhagic stroke, a blood thinner like aspirin will make that bleeding worse, and you won’t know which type of stroke it is until you’re seen at the hospital,” Dr. Ho says.
Care starts the moment you call 911. First, emergency medical services can determine the best place to take you for a stroke; ideally, you’ll go to a hospital that has a certified Comprehensive Stroke Center. Then, they can alert the stroke team that you’re on the way, so that you get an evaluation for your symptoms as soon as possible.
“It’s helpful to tell emergency medical services the last time the patient was seen without symptoms, because knowing when they were last seen normal can affect the treatments we provide,” Dr. Ho says.
The two main treatments for stroke—IV medications called thrombolytics and a minimally invasive surgery known as a thrombectomy—are most effective within a window of a few hours. Fortunately, that window has become larger in recent years, but it’s still important not to wait.
“The longer that clot is there, the more tissue that dies, and all of our treatments are time-sensitive,” Dr. Ho says. “Stroke can be devastating, but there is real hope. With early treatment and rehabilitation, many patients regain independence and return to meaningful lives. If you remember one thing, remember this: stroke is treatable, but only if we act quickly. Recognize the signs, call 911 and don’t delay.”
If you think you or someone you’re with is experiencing a stroke, call 911. If you’re concerned about your risk for stroke, talk to your doctor or find one near you.