Your biggest questions about strokes, answered

You probably hear more about heart attacks than strokes. A stroke is like the brain’s version of a heart attack — and is also life-threatening. When the blood flow to the heart is blocked, we call it a heart attack. And when blood flow to the brain gets blocked, we call it a stroke. Strokes are the fifth most common cause of death in the United States, according to the American Stroke Association. And your risk goes up as you age: About two-thirds of strokes happen in people over 65.

“Someone has a stroke every 40 seconds, and someone dies every 3.5 minutes,” says Carlos S. Ince Jr., M.D. He is a cardiologist at the Heart Center at Mercy Medical Center in Baltimore.

Your brain controls your movement, speech, behavior, and emotions. It stores your memories, controls your breathing and heart rate, and much more. That’s why damage from a stroke can be so serious.

The good news: Early treatment can minimize the brain damage of a stroke and save someone’s life. Here are answers to some common questions about the causes, symptoms, and treatment of a stroke.

What happens when you have a stroke?

When someone has a stroke, a blood vessel to the brain bursts or is blocked by a clot. The result: Part of the brain cannot get the oxygen and nutrients it needs from blood, so brain cells die.

“It’s a brain attack,” says Dr. Ince. “When there is a disruption of blood flow to a specific area of the brain, it damages the brain tissue. It disrupts the functioning of what that part of the brain controls.”

The brain damage caused by a stroke can lead to serious problem such as:

• Cognitive issues (memory lapses, difficulty solving problems)
• Difficulty swallowing and eating
• Muscle weakness or paralysis, often on one side of the body
• Problems with speech, reading, and writing
• Vision changes

Because one side of your brain controls the opposite side of your body, a stroke on the right side of your brain will affect the left side of your body, and vice versa.

There are two types of strokes, according to the National Institutes of Health:

1. Ischemic stroke happens when blood clots or plaque block blood vessels to the brain. About 87% of strokes are ischemic, says the Centers for Disease Control and Prevention (CDC).
2. Hemorrhagic stroke happens when an artery in the brain leaks blood or breaks open. The leaked blood puts pressure on brain cells and damages them.

You can also have a “mini stroke,” called a transient ischemic attack, or TIA. This happens when there is a blockage, but it breaks up before causing any damage to the brain.

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How do I know if I’m at risk of having a stroke?

Risk factors for stroke are similar to those for a heart attack, says Dr. Ince. They include:

• Age: You can have a stroke at any age, but your chances go up as you get older. According to the CDC, your risk of stroke doubles every decade after you turn 55.
• Genetics and family history: You may have a higher risk if someone in your family has had a stroke, especially if they had it at a young age. Genetics can also up the chances you’ll have issues linked to stroke. These include high blood pressure, high cholesterol, and diabetes.
• High blood pressure: According to the CDC, this is a leading cause of stroke. And many people don’t know they have high blood pressure. That’s why it’s important to get your blood pressure checked regularly — and get on medication and make lifestyle changes to bring your levels down, if necessary.
• High cholesterol: In particular, elevated LDL (low-density lipoprotein) cholesterol can build up your arteries, increasing your stroke risk.
• Heart disease: Problems with your heart and arteries can increase your risk of plaque buildup or blood clots that can cause a stroke.
• Diabetes: High blood sugar can cause damage to blood vessels, which can increase your risk of stroke.

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How can I tell if I’m having a stroke, or if someone else is?

Time matters when it comes to strokes. The sooner a stroke victim gets treated, the less brain damage is likely to happen. So, it’s important to recognize the signs of a stroke.

Symptoms depend on the type of stroke and what part of the brain is being affected. According to Dr. Ince and the CDC, common signs include:

• Sudden weakness or numbness on one side of the body and/or face
• Sudden confusion, trouble speaking or difficulty understanding what others are saying
• Problems with coordination or walking
• Trouble seeing in one or both eyes
• Sudden severe headaches with no known cause

If you’re a woman, you’ll also want to look out for these additional symptoms:

• Disorientation and confusion or memory problems
• Fatigue
• General weakness
• Nausea or vomiting

If you think someone might be having a stroke, remember the FAST test:

• Face: Ask the person to smile and notice if one side of the face droops.
• Arms: Ask the person to raise both arms and notice if one arm drifts downward.
• Speech: Ask the person to repeat a simple phrase and notice if their speech is slurred.
• Time: If you notice any of these signs, call 911 right away.

It’s best to call an ambulance so that emergency workers can begin life-saving treatment on the way to the hospital, says Dr. Ince. “Do not hesitate. Earlier attention and treatment usually result in better outcomes.”

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How are strokes treated in the short term?

At the ER, your care team will decide on a treatment plan. That will depend on whether the stroke was ischemic or hemorrhagic, how much time has passed since symptoms began, and if you have other medical conditions.

The most common treatment for ischemic stroke is injecting a medicine into a vein in your arm that breaks up blood clots. You must get to hospital within the first three hours of noticing symptoms to get clot-busting drugs.

Some strokes may also require surgery to open or repair blood vessels.

What are the long-term effects of a stroke?

There are many health issues that can emerge after a stroke, depending on the region of the brain affected by the stroke.

• If the stroke affects the parts of your brain that control movement, then you can have problems with movement — like partial paralysis or difficulty walking.
• If the stroke affects parts of your brain involved with speech and language, you might have problems speaking or understanding speech.
• If the stroke affects the parts of your brain involved in vision, that can lead to problems noticing things in parts of your visual field, or figuring out exactly what you are looking at.

And most of the time when you’re recovering from a stroke, you’ll notice that your brain speed, attention, and memory aren’t what they used to be. These broad cognitive issues don’t necessarily relate to the exact area of the brain damaged by the stroke. They seem to emerge because the overall health of the brain, including the network that connects brain regions to one another, isn’t as good after a stroke.

How can my brain recover after a stroke?

There’s a wide spectrum of success in recovery. “Some people never recover and have permanent deficits, and some recover fully,” says Dr. Ince. “A lot depends on the size and location of the stroke and how quickly you get medical attention.”

Recovery also depends on rehabilitation. With help from the right rehabilitation specialist, you can work on — and improve — many of these issues. For example:

• Working with a physical therapist can help improve challenges with walking, by intensive practice with balance and movement
• Working with a speech therapist can help with speech issues, by helping you relearn how to produce speech sounds and find words
• Working with an occupational therapist can help you with day-to-day tasks, such as dressing and bathing, by breaking those tasks down into elemental parts and then helping you relearn how to put them together into complete actions

Rehabilitation works through brain plasticity — the intensive practice, breaking down tasks into elemental parts, and relearning all drive brain rewiring. A stroke damages the brain. Rehabilitation can help the brain relearn how to do a real-world task. How? By training a nearby part of the brain to take over the work that the damaged part of the brain used to do.

New research also shows a role for computerized cognitive training. The American Heart Association’s most recent guidelines for stroke rehabilitation show promising results from using a brain training program under the guidance of a clinician as part of a comprehensive rehabilitation program.

Clinician-guided rehabilitation works by helping you relearn how to do specific tasks that were affected by the damaged region of your brain. And computerized cognitive training may help with stroke recovery by improving the broad functional networks in your brain that contribute to the building blocks of cognitive skills. These include brain speed, attention, and memory.

Stroke recovery can be a long journey, but it is possible to live a long and independent life after stroke. Talk with your care team about your treatment and therapy options.

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Additional sources:
Stroke statistics: American Stroke Association
Stroke over 65: Cleveland Clinic
Types of strokes: National Institutes of Health
Age and stroke: Centers for Disease Control and Prevention
Symptoms of a stroke: American Heart Association
Ischemic stroke statistic: Centers for Disease Control and Prevention
Study on BrainHQ training and stroke recovery: Neurology