How to spot and respond to the signs of a stroke

A stroke happens when the blood supply to part of the brain is reduced or interrupted, which deprives it of nutrients and oxygen, often leading to brain damage.stock.adobe.com

Eric Morris had no idea what was happening. As he was getting ready for work one morning in 2016, he felt weakness on his right side and then fell over while getting dressed. With a single pant leg on, he crawled on the floor back to bed.

“I couldn’t really talk,” said Morris, who was then 41 and living in Brookline, N.H. “I was just on the bed freaking out.”

His wife, Kristen, soon found him and called 911.

When he was treated at the Lahey Hospital in Burlington, doctors told him he had a stroke, due to carotid dissection, a tear in one of the arteries in his neck. “I learned that I have these weird arteries that kind of twist and turn while most people’s are more straight,” Morris said.

Morris, now almost fully recovered, shares his story to create awareness that stroke can affect men and women of all ages. “After seeing what happened to me, the young guys I work with have all started saying, ‘We’ve got to go to the doctor to make sure everything’s OK,’ ” said Morris, now 44 and living in Hudson, N.H.

Over the last few months, Morris has had more conversations about the topic than usual, prompted by the recent deaths of actor Luke Perry, 52, and director John Singleton, 51, due to stroke. In March, “Game of Thrones” actress Emilia Clarke, 32, shared her story about having two life-threatening hemorrhagic strokes in 2011 and 2013, while in her mid-20s.

“Many people can identify with a celebrity who has had a stroke because they’ve often experienced it in their own life or know somebody who has,” said Dr. Gioacchino Curiale, director of Stroke Services at Boston Medical Center. “It highlights the issue and can hopefully highlight prevention.”

What is stroke?

Think of it as a “brain attack.” A stroke happens when the blood supply to part of the brain is reduced or interrupted, which deprives it of nutrients and oxygen, often leading to brain damage. There are two main types of stroke: ischemic and hemorrhagic. Ischemic strokes are the most common, accounting for about 80 percent, and occur when arteries become narrowed or blocked due to blood clots. A TIA, or transient ischemic attack, is caused by a temporary clot and is often referred to as a “mini stroke.”

Less common hemorrhagic strokes happen when a blood vessel in the brain leaks or ruptures, and are often characterized by a sudden, severe headache.

What are the risk factors of an ischemic stroke?

Women are affected at greater rates than men. Stroke is the fourth-leading cause of death for females and the fifth-leading cause of death for males, according to the Centers for Disease Control and Prevention. Risk increases with age, but about 10 percent occur in people who are 18 to 50 years old.

“It can really happen at any age,” said Curiale, who noted that May is National Stroke Awareness Month.

There are modifiable and non-modifiable risk factors for stroke, said Dr. Barbara Voetsch, co-director of the Comprehensive Stroke Center at Lahey Hospital & Medical Center. Non-modifiable risk factors include advanced age and a family history of stroke. Those who have had a stroke or a TIA in the past are more likely to have another one, she said.

The most significant modifiable risk factors — those you can do something about — include high blood pressure, physical inactivity, obesity, smoking, high alcohol intake, drug use, diabetes, and stress.

“This is often not talked about as much because it is difficult to measure objectively and prove, but depression and stress are risk factors,” Voetsch said. “There is evidence in the literature to support this and we see it in our daily practice.”

Managing risk factors through healthy lifestyle choices and working with a primary care doctor to address areas of concern are the best ways to reduce your risk, Voetsch added.

“It doesn’t mean that if you have high blood pressure you will have a stroke, but it’s a risk factor and the more risk factors you have, the more the risk is potentiated,” she said. “Young women also have risk factors that are very particular to them, like contraceptive use, so if you say, take a contraceptive and you smoke, suddenly your risk is a lot higher.”

Pregnant and postpartum women also have an increased risk due to possible elevated blood pressure, gestational diabetes, the complication preeclampsia, and blood clots.

What are the signs of an ischemic stroke?

Signs and symptoms can be either dramatic or subtle. “If someone is having a big stroke, it’s obvious, but if someone is having a small stroke, it may not be that obvious,” Voetsch said. “Symptoms can be mild and can be transient.”

The FAST mnemonic is a good place to start to detect stroke, said Dr. Ali Aziz-Sultan, co-director of the Comprehensive Stroke Center at Brigham and Women’s Hospital. It stands for Facial drooping, Arm weakness, Speech difficulties, and the fact that Time is of the essence.

“If you are unable to speak, if you have neurological symptoms, if you have a vision deficit, or numbness on one side of the body, that requires immediate attention,” he said.

How to respond

If you witness someone having what appears to be stroke symptoms or are experiencing them yourself, the advice is straightforward: Call 911.

“A little over half of patients who are having a stroke actually go to the emergency department by ambulance, which surprises me because the first thing I would think to do is to call 911 and get to the hospital as soon as possible,” Curiale said.

Voetsch has seen cases where people have said “Oh, my arm isn’t moving — let me just sleep it off and see if it’s better in the morning” or have tried to Google their symptoms or call a friend to see if it might be stroke.

Don’t do that, experts urge. “The sooner you get treatment, the more likely you are to have a good outcome,” Curiale said.

From the moment the stroke occurs, doctors have a limited time period during which they can administer treatments, including the clot-busting intravenous injection tPA and mechanical thrombectomy, by which clots are physically removed from the brain using a catheter.

“It’s essentially that your brain is sort of choking, and the longer you have it on choke, the more cells die,” said Aziz-Sultan. “It’s important that we don’t waste time because every minute that goes by, millions of brain cells die.”

Fortunately, stroke treatment has improved significantly in the last decade, Aziz-Sultan added.

“Now we’re able to, in 20 minutes, take a catheter from the vessel of the leg and go up and physically pull the clot out using X-rays and a small incision,” he said. “Just get to us and the results can be profound.”

Often it’s not the person having the stroke — or even a family member — who calls 911, but a random bystander, Curiale said. “That’s why awareness of stroke symptoms by the general public is important,” he said.

Eric Morris said he believes his wife’s quick response on the day he suffered a stroke — and the immediate medical attention he received by EMS and at the hospital because of it — is the reason why he’s still alive.

“Good thing I wasn’t at work,” he said. “If I was sitting in the corner office, people probably wouldn’t have checked on me for a couple hours, and who knows where I’d be now.”