Stroke

There’s Good News About Treating a Bleed-Type Stroke with Today’s Medication

As strokes go, there are good things to be said about treating a bleed-type stroke with the modern medical/surgical techniques available today. By “bleed-type”, we mean a hemorrhagic stroke, one in which a blood vessel inside the brain or it’s covering layers bursts and bleeds. First, these strokes are less common than blockage-type strokes. Only 13% of strokes are from a bleeding vessel inside the head. Second, our understanding of the brain injury result from a bleed has improved tremendously during the past 20 years. Basic science research on brain cell damage after injury from this type of stroke is one source of this better understanding. Another source is better worldwide information sharing. To give an example, the first ever worldwide meeting on hemorrhagic strokes was held as recently as 2005, at the University of Michigan.

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The Symptoms from Bleeding Inside the Brain or It’s Covering Layers

Here is both the good thing and the problem with symptoms of strokes. The good part is that the first obvious symptoms are the same for all strokes, whether from bleeding or from a vessel blockage. So, there’s no need to memorize new symptom checklists. They all look the same. Check out our main page on stroke for the symptoms. The problem is that no one, not even a stroke doctor, can tell the difference just by looking at the person. This point is really important. These 2 major types of stroke look the same but must be treated very differently. Because the treatments are so different, a brain CT scan is needed to see the stroke before a stroke can be treated.

One of our Montgomery, Alabama Readers Wrote to Us to Ask:

But it’s still got to be in the four hours. Right? I mean, if not even the doctors know which type of stroke it is no one can know it’s the kind of stroke where you can wait up to 72 hours. Right?

Yes, the reader is right.  You might have to read the rest of the article below to understand. If someone is having a blockage-type stroke the window for the best outcome of treatment is extremely short, less than four hours. For a bleed-type stroke the time is longer, up to 72 hours. But the symptoms for all strokes are the same, so if you see someone with symptoms of a stroke you can’t know which type it is. So, you have to assume the worse, that it’s a blockage-type stroke, and call 911 immediately. Even skilled stroke physicians need an MRI scan to tell the difference, so there’s no way anyone can know just by watching the person’s symptoms.

Completely Different Treatments for the Two Types of Strokes

Here’s why we need that brain scan. A clogged blood vessel needs the medication tPA to dissolve the clot. The tPA is designed to make bleeding easier. So if the doctor gives tPA to make the blood flow more easily and the stroke is caused by bleeding, the bleeding gets worse, much worse. To treat a stroke caused by a bleeding vessel a doctor needs to repair the break in the vessel. The situations are very different, one using a medication to make blood flow easily and the other a medication to lower blood pressure and maybe surgery to stop the bleeding. The wrong choice will make the person worse, possibly with a fatal result. So, a CT scan is absolutely needed before treatment can be started. That’s why there are now ambulances that have a scanner right in the ambulance (see our page for subscribers on Mobile Stroke Units).

Also Good News: Preventing Burst Blood Vessel Type Strokes

There are things you can do to lessen the chance of having a stroke, including a burst blood vessel in the brain. They are simple things that you can do and you’ve heard them all before. A big one is to stop smoking. Another big one is to get your blood pressure checked and, if it’s high, get it treated so that it’s normal. In addition, get your blood sugar level checked and, if that’s high, you might have type-2 diabetes. See your doctor and get the medications you need to treat it. Then there the prevention tip of eating right, less unhealthy fats and less salt. It’s great that there are these things that you can change to prevent strokes. It’s great because there are things you can’t change, like your family history of stroke and any blood vessel quirks that were there when you were born.

Types of Strokes That Are Bleed-Type Strokes

There are two main types of these bleeding strokes. One type has the bleeding actually in the brain itself. In the other type the bleeding is not directly in the brain but in the coverings that surround the brain. The area of bleeding is “sandwiched” inside the covering of the brain but outside the brain itself. This bleeding outside the brain is further divided into types depending on where exactly the bleeding occurs.

Explaining a Bleeding-Type Stroke

Whether a cut on your hand or a weak blood vessel in your head, if you break the wall of a blood vessel, it bleeds. On your hand it’s simple. You apply pressure until the bleeding stops. Inside your head it’s a bigger problem. There’s no easy way to apply pressure to get it to stop. One needs a skilled physician to do it, as we explain below.

Why a Blood Vessel in Your Head Would Burst

Why would a blood vessel inside your brain burst? Because of a weak spot in the vessel wall or because of high pressure, or, more likely, a combination of the two. It’s just a burst pipe. Think of the blood vessel as a tube, like a bicycle tire inner tube. If you pump in too much air, too much pressure, it will burst, split open with a big hole. The newer the rubber and the thicker the inner tube walls, the more pressure it can hold before it bursts. The same with blood vessels. Healthy, young, elastic blood vessels do better with higher pressure. Older, stiff vessels full of cholesterol, not so much. A bit of high blood pressure and the old stiff vessel bursts and bleeds.

Transferring Blood Pressure into Brain Pressure: Not Good

If a blood vessel has high pressure inside it, and it breaks, that high pressure flows out along with a lot of blood. And, inside someone’s head there’s no place for the high pressure to be relieved. It’s high pressure in a closed box, the skull. So not only is the person losing blood into the brain (so it’s not nourishing nerve cells) but it’s building up pressure in the skull, squeezing the brain. Not good! First, doctors need to get the person’s blood pressure down, way down, fast. Then, to get the high pressure off the soft brain a surgeon might need to open a window into the skull and relieve the pressure. Then a 3rd problem creeps in. With all this happening to the brain, it gets inflamed and starts to swell, adding to the pressure. You see the dilemma.

Treating a Small Bleed-Type Stroke

Another piece of good news is that some strokes caused by vessel bleeds are small. In the Emergency Department the doctors will be able to see how bad the bleeding is. If the blood vessel breaks and the amount of bleeding is small, and if the pressure that builds up in the skull is also small, standard good medical care will be enough to treat the stroke. This care would include getting fluids in by an IV line, having the person lie still and rest, and treating any other medical problems the person has. If there are longer-term losses or problems, a course of speech therapy, and/or physical therapy, and/or occupational therapy might be necessary and would help a lot.

When The Doctor Takes a Look at How to Repair the Bleeding Blood Vessel

Some breaks in a blood vessel can be fixed without a full surgery. If the vessel can be reached by a tiny catheter, doctors can take a look and maybe fix it. The catheter, a tiny tube, can sometimes be threaded up through a major artery in an arm or leg and guided into the brain tissue, allowing a doctor to use cameras to see the problem. Once the catheter is at the place where the vessel is broken the doctor can use it to put in place a metal coil that will seal the leak and strengthen the vessel wall to prevent further bleeding.

There Are Times When Treating a Bleeding Stroke Needs a Good Surgeon

If there’s a lot of bleeding, surgery is the way to treat it. A surgeon must go in and repair the burst blood vessel and stop the bleeding. If there’s an abnormal area of the vessel that caused it to break the surgeon will need to remove that part of the vessel. Despite the comment above about opening a window in the skull to lower the pressure on the brain, if the bleeding vessel is deep in the brain, a window might not be enough. So it’s even more important for the doctors to get the blood pressure down to normal quickly. It’s also important to get into the skull just enough, that is, with a small hole, to remove the blood that has been pooling in the brain.

Urgent Treatment Needed But Less Urgent

Timing is important with treating any stroke. And though the timing to treat a bleeding stroke still needs to be fast, it’s not as urgent as with a blockage-type stroke. The “time window” is perhaps as long as 72 hours, plenty of time to realize someone is having a stroke, call an ambulance, and get him/her to the nearest Stroke Treatment Center. If the blood pressure can be brought down quickly, maybe even in the ambulance (see our page for subscribers on Mobile Stroke Units), the time window might stretch a bit to slightly more than 72 hours.

How It’s Done If the Bleeding is Deep In The Brain

One might think that if the bleeding is somewhere deep in the brain it’s an impossible problem. Not so. The surgeons have invented a way to image the head in real time and see right were the blood is pooling. They go in with just a small hole in the skull, put the tip of a long tube right in the middle of the pool of blood, and draw the blood out. This works really well and quickly lowers the pressure on the brain so the stroke victim does much better. The whole process is not quite that simple, as you might imagine, but it’s not a problem for a skilled surgeon.

But Along the Way Brain Inflammation Is A Problem

All of this activity, bleeding, high pressure, and surgery, inflame the tissues involved. The inflammation lets loose many types of substances that try to repair the damage and start the healing. Unfortunately, it’s often the case that the body overshoots and produces too much of too many substances. Too much can cause damage even as the body is trying to repair itself. There’s a protective barrier between the brain and the rest of the body, the blood-brain barrier. The barrier can be damaged by these products of inflammation, letting body substances into the brain that shouldn’t be there. This set of events can create problems that might continue for weeks. Getting the blood pressure down quickly and relieving the pressure in the head can lessen this damage caused by inflamed tissues.

Treating a Bleed-Type Stroke – The Road to Recovery

Once all the emergency and urgent medical and surgical care has been done, the path forward for the person who had the hemorrhagic stroke is rehabilitation and recovery. This path is the same for blockage and bleeding strokes. See our page on for subscribers Stroke Rehabilitation for a discussion of that part of stroke recovery.

Helpful links:

The Mayo Clinic on Hemorrhagic Stroke (halfway down the page)

American Stroke Association on Stopping the Bleeding in a Hemorrhagic Stroke

The journal Stroke on Hemorrhagic Stroke

CNS Neuroscience & Therapeutics on Hemorrhagic Stroke Mechanisms

Neurocritical Care on Deep Intracerebral Hemorrhage

Treating a Blockage-Type Stroke – What YOU Can Do

We’re pleased but surprised at how many readers go to this page and spend a lot of time reading it. A lot of interest in stroke! Treating a blockage-type stroke is the topic of this page, but first, what can you do as “just a person”? You can do everything if you’re observant and quick. If someone has a stroke but no one notices for a while, the physicians in the special Stroke Treatment Centers can’t help much. If you see someone having a stroke and you call 911 (or 999 in the UK, other numbers below) immediately you can save a big piece of the person’s brain and probably even save their life. Stroke treatment cannot begin until someone sees the stroke, calls 911, and an ambulance arrives and takes the patient to the hospital Emergency Department. Even better if the hospital has a specific Stroke Treatment Center.

(In Australia dial 000; in Ireland dial 112 or 999; in New Zealand dial 111)

Here’s What A Stroke Looks Like – FAST

FAST. The reminder acronym most often given to recognize a stroke is FAST.

• The “F” is for face. Does the person’s face look wrong, like a face or a mouth that droops on one side?
• The “A” is for arm. Is the person’s arm not working right? Have them hold up both arms. If one arm won’t go up, or keeps drooping down quickly, it could be a stroke.
• The “S” is for speaking. Has the person’s speech become garbled, not make sense?
• The “T” is for time. If you think someone is having a stroke, note the time, write down the clock time. Treatment decisions in the ambulance, in the Emergency Department, and in the Stroke Treatment Center depend greatly on how much time has gone by from the first signs of a stroke.

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So, Here’s What You Can Do To Treat a Stroke

Use the letters in “F-A-S-T” to spot stroke signs and know when to call 911. If someone is having a stroke, call 911 immediately. Even a few minutes delay in calling 911 can make a huge difference. Those few minutes can mean the death of, rather than the rescue of, a part of the person’s brain. When part of the brain dies the person will be disabled permanently. If too much of the brain dies, the individual dies.

One of our Readers in Nashville, Tennessee (USA) Asked:

Don’t strokes only happen in old people in poor health and they feel like a bad heart? Why can’t they just use a nitro pill and see how they feel later?

This question is wonderful in that it illustrates a few of the common misunderstandings that many of us have about stroke. While the percentage of people at risk for a stroke is higher for older individuals, a person can have a stroke at any age. About 40% of strokes occur in people under age 65. In younger individuals, ages 18 to 44, stroke is more common in women. Smoking, poor diet, little exercise, and obesity do increase one’s risk for stroke, but stroke can and does occur in people who don’t smoke, eat well, exercise, and are thin. Heart pain, a gripping chest pain, is not a symptom of stroke. Heart problems and stroke symptoms don’t look at all alike. And as we say in many other parts of these pages, even a delay of a few minutes can make a huge difference in the medical outcome of a stroke.

BEFAST Is Another Acronym for Recognizing a Stroke

The BEFAST acronym adds a couple of letters/items to the warning signs.

• B is for Balance – has the person lost their balance, are their arms and legs not working right, or are they having trouble walking?
• E is for Eyes – Are they having trouble seeing out of one or both eyes?
• F is for Face – As with FAST above, does the person’s face or mouth droop on one side? Have the person try to smile. Does their smile look right?
• A is for Arms – Does one arm drift down? Does one arm not go up if the person tries to raise both arms? Is one side of their body suddenly weak or numb?
• S is for Speech – Can he/she understand and say simple sentences? When they talk does it make sense?
• T is for Time – First, if any of these signs are present, time to call 911 right away. Also, time, note the clock time and write it down. The ambulance attendants and the Emergency Department physicians will need to know the time the symptoms started.

“STR” is a Third Reminder to Recognize a Stroke

Stroke is such huge medical emergency, like a heart attack or a limb amputation, that there have been several ideas to help with knowing what’s a stroke.  Some people have called this one “the three steps” to recognize a stroke. S-T-R stands for three questions you can ask the person who might be having a stroke.

• The “S” is for Smile. Ask the person to smile for you.
• The “T” is for Talk. Have the person say something, some simple sentence.
• Finally, the “R” is for Raise. Have him/her raise both arms into the air.

If the smile is crooked or the person can’t smile, or, if they can’t talk right, or, if they can’t get both arms in the air, it’s time to call 911.

There’s actually a fourth way to recognize a stroke that we’ll add here. We don’t know whether to call it “S”, or “T”, or even “ST”, because it’s for having the person stick out their tongue.

• So, ST, for stick out your tongue.

If, when they stick out their tongue, it goes crooked (points to one side, not straight out) that’s a stroke sign. Time to call 911.

Now On to How Physicians Treat a Blockage-Type Stroke

To Get More Technical We Need Some Definitions

We know definitions are boring. But to get more into the technical parts of talking to physicians and of treating a blockage-type stroke we do need first to define some words. The first word we’re defining, because it is often misunderstood and misused, is “acute”. Acute means fast, or sudden. Acute does not mean severe.

Treating a Blockage-Type Stroke – The Acute Stroke

A stroke is acute if it occurs suddenly, it strikes out of the blue, it’s a complete surprise. For treatment of an acute stroke to be successful, the treatment also needs to be “acute”, that is, fast. That is, treatment right now. Not “soon”, but NOW.

What the Emergency Department Physician Means by “Acute”

As we said above, “acute” is about time. It means fast, sudden. It’s not about how bad it is or severity, not about how severe a medical situation is. Many people say acute to mean severe. Here’s an example to show what we mean. If just now you cut your finger (minor cut) you have an acute cut. It was quick and it just happened. A minor cut on a finger is not severe, but in this case it is “acute”. On the other hand, if you’ve had cancer for five years and you’re dying, and you’ll die in the next month, clearly your cancer is severe. But it’s not “acute”. It’s the opposite of acute, it’s “chronic”. Your cancer is awful but it’s been going on for a long time, five years. So your cancer is chronic and severe, but it’s not acute.

Acute Treatment (Fast Treatment Right Now) for an Acute Stroke (a Stroke that Just Happened) Caused by a Blockage (Thrombus or Embolism)

(On our main Stroke page we define thrombus and embolus. Also, defined below.)

Making sure that a stroke is an “acute stroke” is really important to the Emergency Department and Stroke Treatment Center physicians because there are different treatments for an acute stroke and a stroke that is not acute, that is, that occurred hours or days ago.

tPA – An Almost Magic Medicine Given by Vein

At least, almost magic if it’s given acutely for an acute stroke. One of the three tPAs has to be given by vein during the first four hours after an acute blockage (thrombotic or embolic) stroke. But, we’re getting ahead of ourselves.

tPA is “tissue plasminogen activator”. tPA is known as a “clot buster” drug. It’s able to dissolve a clot, melt it away, and reopen the blocked artery. A thrombus is a clot that forms right there, where the artery is blocked. A thrombus is usually caused by local hardening of the artery (atherosclerosis) in a brain artery. An embolus is a clot that forms somewhere else in the body in an artery that leads to the brain. And again, hardening of the artery is the likely cause. A piece of this distant-from-the-brain clot breaks loose, travels through the artery to the brain, and gets stuck in a brain artery. The place where it gets stuck in the artery in the brain is the location of the stroke. No blood flow, no oxygen, brain tissue death.

Unfortunately, tPA can’t be given by mouth. It has to be given by infusing it into a blood vessel. An infusion of tPA can melt away a thrombus or embolus in an hour or two.

The Emergency Department / Stroke Treatment Center Physician Will Decide Which tPA to Use

There are three tPAs: alteplase (Activase), tenecteplase (TNKase), and reteplase (Retavase, Rapilysin). Usually alteplase is used for blockage type strokes; it’s FDA-approved for this. But in some situations tenecteplase might be better. So the Emergency Department / Stroke Treatment Center Physicians will know what to do.

Another Type of Clot-Buster: Local Intra-Arterial Thrombolysis

This is like a roto-rooter on a clot in a blood vessel. It’s a mechanical device, not a drug, that breaks up the clot. It’s called local intra-arterial thrombolysis (IAT). As with tPA, this device method can save brain tissue from dying.

Remember That “T” Part? The Length of Time That Has Passed

Time. Clock time, minutes that have passed. That’s how Emergency Department Physicians will decide on using the drug, tPA, or the device, IAT. And here’s the time problem. (1) First, someone is having a stroke. (2) Then, someone else needs to see that the person might be having a stroke. (3) The person does the above quick stroke tests (FAST, BEFAST, STR). (4) Yes, the person is having a stroke, call 911. (5) The ambulance arrives and gets the stroke victim. (6) The ambulance gets to the Emergency Department. As the minutes in each step add up it can equal a long time, too long a time.

Four Hours Goes By Quickly – Treating a Blockage-Type Stroke

For all these six steps to happen in under four hours needs quickness. One has to be fast. Unfortunately, it also needs some luck. A lot can go wrong. If it all happens in four hours or less the Emergency Department Physicians can use tPA. If it’s too late to use tPA they can use IAT if it’s been less than 24 hours. And some physicians like the mechanical device better anyway. They like grabbing the clot instead of melting it with tPA. Here’s why. While tPA does break up the clot, it also thins the blood and makes the person more likely to bleed. More easy bleeding can set the stage for bleeding into the brain, the bleeding type of stroke that is much harder to treat.

Using tPA vs. IAT – Treating a Blockage-Type Stroke

Using tPA has that four-hour time limit, while the “rotor rooter” IAT way can be done up to 24 hours after the stroke. The IAT device can clear the artery of the clot quickly, maybe in just a few minutes. On the other hand, tPA might take two hours for melt away the clot.

More About Mechanical Clot Busting

There are different ways to get the clot out of the way and different devices to do it. Here we mention a few.

Really, Really Small Tubes – “Microcatheters” for IAT

This first type of IAT clot grabbing is easy to understand. A microcatheter, a really tiny long tube with a grabbing coil on the end, is slid into the artery. Like a corkscrew into a wine bottle cork, the coil at the end is screwed into the clot. Once the far end of the coil pokes out the other side of the clot, like the corkscrew going all the way through the wine cork, it gets fatter. By getting fatter/bigger in the artery the coil grabs a tight hold on the clot so that, when the microcatheter is pulled back and pulled out of the artery, the clot comes out too, snagged by the coil. The artery is clear and the blood flows freely again.

A Coiled Wire IAT Called a Stent – A Second Type of IAT

This second type of IAT, a stent, is a different way to deal with a clot. Stents are small wire coils that are tightly wound, tightly coiled up, at the start. Since they are wrapped really tightly the coil is quite skinny. This tight coil of wire is pushed into and all the way through the clot. It’s pushed in until the far end sticks out the far end of the clot while the near end of the coil is still sticking out of the near end of the clot.

Then The Physician Hits a Button to Unwind the Coiled Stent

Then the physician hits a button that lets the coil unwind and get bigger. It goes from a thin coil to a fat coil, smashing the clot against the vessel wall. This opens a hole through the middle of the clot so the blood can flow freely through it. It works great right then, but there might be problems down the road. The hole though the middle of the clot could fill up again with a new clot and close off the artery again.

Vacuum Out the Clot – a Third Type of IAT

Last of all, there’s this third IAT. It uses suction through the small catheter to vacuum out the clot, like a tiny clot vacuum cleaner. Early models had problems. The sucking vacuum tip would get clogged with little pieces of clot. New models have fixed this problem so the catheter tip won’t get plugged. In this way, the vacuum cleaner catheter just sucks the clot right out of the artery.

We’ll Stop There with the Preachy Lectures

We actually had written another whole set of paragraphs, similar to the ones at the top of the page, about calling 911 right away. Our page editor made us take them out. Sound advice is one thing, she said, preaching is another

Helpful links:

ClinicalTrials.gov for a listing of recruiting and not-yet-recruiting studies of acute stroke.

National Heart, Lung, and Blood Institute on Stroke

Centers for Disease Control and Prevention on Stroke Treatment

American Stroke Association – American Heart Association on Stroke Treatment

The Mayo Clinic on Stroke Diagnosis and Treatment

The Good News About Stroke Prevention and Treatment

The good news about stroke these days is in the areas of prevention and treatment. You can read about what to do to prevent stroke at the bottom of this page (hypertension, smoking, cholesterol, diabetes) and we have two entire free pages on treating both types of stroke, bleeding-type and blockage-type stroke. In short, there are several things you can do to minimize your risk of having a stroke. And, if you have one and someone calls 911 right away, you have a great chance of not only surviving the stroke but also having minimal damage from the stroke. (Call 911 in the US. See a list of emergency medical phone numbers for other English-speaking countries at the bottom of the page.) And stroke rehabilitation care has evolved to be better than ever to restore function and get people back to their usual lives.

Welcome to the Neuroscience Research and Development Consultancy website. Have a question or a comment? Send it to us at: Comment@NeuroSciRandD.com

What’s A Stroke?

A stroke is death or near-death of brain tissue. That’s why strokes are so serious. We live in our brains, so if our brain dies, we die. Stroke is caused by a blockage of blood vessels bringing oxygen-carrying-blood to our brain. The blockade of blood flow can be from an actual blockage in the blood vessel, or from bleeding such that the body’s blood pressure falls too low to push the blood up to the brain. Without oxygen, brain cells die. Most strokes are from blockage, not bleeding. And most blockages occur when there is “hardening of the arteries” or atherosclerosis. That’s why preventing atherosclerosis is a huge step toward lowering risk of a stroke. Bleeding strokes are from bleeding inside the brain, almost always from too high blood pressure. That’s why lowering high blood pressure is another huge step in preventing stroke.

How to Tell if a Person Is Having a Stroke

Since the important part of limiting permanent damage and disability for a person who is or might be having a stroke is knowing right away whether or not they really are having a stroke, an important question is, how to you know? At the top of the list when starting to talk about stroke is how to know one when you see one. And when you know you are seeing a real stroke, call 911.

Stroke Signs You Can See

There are signs that a person is having a stroke that you can see. For example:

• Or, they suddenly have trouble talking, or seem not to understand what people are saying, or they are suddenly confused and can’t recover.
• The limb, an arm or a leg, might just going limp, not working.
• If the individual falls, passes out, and has an arm or a leg or other body part jerking or twitching. On the one hand, this one is dramatic and easy to spot. On the other hand, this could be a seizure and not a stroke.
• If they have a sudden loss of balance or trouble walking, or appear dizzy.

Stroke Signs You Can’t See

Then there are stoke signs you can’t see until the person complains about them. For example:

• If he/she suddenly has trouble seeing out of one or both eyes.
• Is stricken with a sudden severe headache.
• Or, complains of numbness or weakness somewhere, such as in the face, or with an arm or a leg, or maybe on one whole side of the body.

With these three examples, unless the person says something, you can’t see what’s happening. Except maybe the part about weakness in an arm, a leg, or one side of the body. This problem would likely be obvious because of a change in their behavior, as in, they might fall down.

A Clever, Easy to Remember, and Often Quoted Acronym: FAST

Doctors in England made up the FAST reminder acronym in 1998. It’s an easy way to remember the symptoms of a stoke as the stroke is happening. The first three letters of FAST are each a reminder of a stroke sign.

• The “F” stands for face drooping on one side. If one side of a person’s face suddenly looks limp and is not right, or if the person complains that half their face feels numb, it’s a problem. Ask them to force a smile. If only half their mouth smiles, call 911.
• The “A” is for arm It also reminds you to ask about arm numbness, which you might not know unless the person tells you. Ask him/her to raise both arms in the air. Can they do it? Does one arm only go up a bit, or go up and then drift down and they can’t keep it up? Call 911.
• The “S” stands for speech. Has their talking suddenly changed, for example, gotten hard to understand or slurred? Or maybe they’re not able to talk at all. Ask them to say some short sentence and see if they can do it. Can they speak clearly? If not, call 911.
• The “T” gets us back to the hard fact that the clock is ticking. T is for time. Don’t wait and wonder what to do to help the person. Time is brain. If you think someone is having a stroke, call 911.

Call 911 Right Away, As In, Right Now, If Someone is Having a Stroke

The most important “take-away” of this page is to call 911. Get that ambulance rolling. Remember the “about stroke” TV ads showing a snake wrapping around a woman’s leg or a woman’s hair on fire. These ads were useful to show stroke as a “right now”, immediate-action-needed emergency. If stroke treatment is going to work it has to be started quickly, as soon as is possible after the stroke starts. This 911 call needs to be as immediate as possible, with no hesitation, no lost time. Then the person is whisked away by ambulance to the nearest Specialized Stroke Center Emergency Department. Stroke Centers have the motto, “Time is brain.” Those first minutes are super important to keep all parts of the brain alive. As we mentioned above, if too much brain dies, the person dies.

One of our readers asked:                                                                                         

Why do you keep saying call 911? Doesn’t everyone just call 911?

Well, no, oddly enough. One-third to two-third of stroke victims don’t call 911. They drive themselves to the Emergency Department. About one-third of the time people fear the ambulance will not take them to the hospital of their choice, so they drive themselves or have someone take them. One out of five didn’t know it was an emergency! About 10% of people say a family member preferred to drive them, or someone thought it would be faster to drive, or they were close to a hospital anyway or already in their car. Three out of 100 feared the ambulance would be too expensive. (Here’s a link to a little study about this question.) We who treat stroke victims try to do a lot of community education on stroke and calling the emergency medical number.

Why the Signs of a Stroke Look the Way They Do

Each area of your brain connects to a specific part of your body. For example, one small area in your brain makes your right leg move. Another little part is the feeling in your left hand. Every part of your body is “electrically” connected by nerves into some area of your brain. So, what a stroke looks like or feels like depends on which areas of the brain are at risk of dying. That’s why the person might feel a sudden weakness in one arm or leg. Or they can’t talk or they get confused. It means the connected part of the brain is at risk of dying.

Strokes Are Common

Strokes are common. In fact, and sadly, they are too common. There’s nothing unusual or rare about a stroke. In every country around the world stroke is a major cause of disability. And a major cause of death. Of the millions of people worldwide who have a stroke, a one out of three die and another one out of three are left permanently disabled.

Are Strokes Just Bad Luck?

This is a common belief. But it’s not true. Most people believe that strokes come as a surprise, that they occur “out of the blue”, strike with no warning. You’re fine one day, and boom, the next day you’ve had a stroke and you’re in the hospital. People tend to think it’s just bad luck. And the same with getting better. Maybe you’ll be lucky and get completely well, perhaps with some physical therapy help. Or, sadly, luck of the draw, you could be permanently disabled. Or worse yet, dead.

The Truth Is, Strokes Are Rarely a Surprise

In 2022 it’s rarely really true that strokes come out of the blue. A stroke only surprises you if you’ve not been watching. Well, maybe at times a stroke is a surprise. For example, if it’s from a little blood vessel bulge that burst. But it’s seldom a real surprise. Long-term smoldering health problems are usually behind the “sudden” stroke, with 85% of strokes due to high blood pressure that has gone on for many, many years. Get your blood pressure checked and, if it’s high, get it treated. Get the pressure down, and you’ll dodge 85% of the risk of a stroke. Same story with cholesterol and other blood fats, and with smoking, and with diabetes. More on how to prevent strokes below.

A Personal Life’s Story About Us

We at the Neuroscience Research and Development Consultancy care a lot, maybe even worry a lot, about stroke. Let us tell you why. Stroke is very personal for one of our company officers. Both of his grandfathers died of a stroke at age 73. His uncle was severely and permanently disabled by a stroke at age 47, and when he died years later he had been deaf and blind for a decade. His aunt and cousin also died of strokes at young ages. These occurred in an era before medicine knew about the link between high blood pressure and stroke. And, it was before doctors could easily catch high blood pressure early and treat it. Our company officer’s father started a successful battle with high blood pressure at age 40. He lived to be 96, a healthy, clear-minded, and happy 96. Treating high blood pressure really does make a huge difference.

The Two Main Kinds of Strokes

There are two main kinds of strokes. At least for now let’s stay with two main kinds. One kind is when a blood vessel to or in the brain gets blocked by a clot. With the vessel blocked the blood can’t flow. The other main kind of stroke is a bleed. A blood vessel breaks open and bleeds inside the brain. Blood flows out of the vessel and into the brain tissue. You see, our brain only stays alive because blood constantly brings oxygen. Whether a clot or a bleed, some part of the brain does not get the oxygen it needs to stay alive. All brain areas need oxygen every minute to stay alive. Just few minutes without oxygen kills brain cells. That’s why Stroke Treatment Centers have the motto, “Time is brain.”

Well, Actually, There Are a Couple More Types of Strokes

The strokes caused by a clot blocking the blood vessel can be one of two types. One type is a block where the blood clotted right in the vessel in the brain. The other type of block happens when the blood clot occurs in a blood vessel in a more distant part of the body, far from the brain, but a piece of this distant clot breaks off and travels through the blood vessel until it wedges in a small blood vessel in the brain and blocks the blood vessel.

In addition, there are two types of bleeding strokes, but for now we’ll stop adding types of strokes.

What Causes Strokes and How to Prevent Them

Preventing strokes is far, far better than letting them happen and treating them. A half-ounce of prevention in this case is worth many pounds of cure. This is true because strokes are too often hard to treat. And, sadly, some just can’t be treated. Once some strokes occur the brain damage is done. The disability (or death) is there. Strokes that can be treated have to be treated immediately. And, bad news again, luck does come into play when treating strokes. Who wants Lady Luck involved at a time like this? How many minutes away is the nearest Specialized Stroke Center Emergency Department? How fast can the Emergency Medical Services ambulance get to the stroke victim? Then, how quickly can EMS get the stroke victim to the best emergency department? How soon after the start of the stroke did someone call 911? It gets complicated.

While getting a stroke treated in time needs some luck, preventing a stroke is much more of a sure thing.

Beating the Main Stroke Devil – High Blood Pressure

High blood pressure causes 85% of strokes. So, it’s easy. See your doctor and have your blood pressure checked. If you don’t have a doctor, find one! If you use the blood pressure machines in your grocery or drug store, okay, but don’t rely on them. Store machines are rarely checked for being right. Your doctor will get the right number. If she says your blood pressure is high, get a prescription from her for the medicine to treat it. And, get the prescription filled and take the medicine. It’s amazing how many people buy the medicine for high blood pressure but don’t take it. Don’t think you don’t need the medicine because you feel fine. You don’t feel high blood pressure. It’s called a silent killer. There are no symptoms. You feel fine until you have a stroke. No warning. And about one-third die. Sudden death.

Come On, People, Quit Smoking Already!

Don’t smoke. It really is that simple. Smoking cigarettes, cigars, or a pipe damages blood vessels. Your inside plumbing goes from nice, solid, like-new pipes to rusty, corroded pipes ready to burst at any time. We don’t yet know about vaping (electronic “cigarettes”). However, it does much less damage than any kind of burning-tobacco smoking. Inhaled nicotine is probably not the problem with vaping. If you have other junk in your vape juice/e-liquid, especially oils, it can kill you. Smoking, in addition to aging your plumbing, also gives a person high blood pressure. Double whammy.

Nicotine Helps Stop Depression – Take a Depression Medicine Instead

But here’s the problem. The nicotine from smoking feels good. It treats a down mood. And, nicotine is addictive. If you get depressed, angry, and irritable if you don’t smoke, ask your doctor for a medicine for depression. If you’re really not depressed but you can’t stop smoking, you’re addicted to the nicotine. So, find a safer source for your nicotine hit. Smoking is the most dangerous way to get nicotine. Stop smoking and use nicotine patches. Or, stop smoking and chew nicotine gum.  Maybe even stop smoking and start vaping (just no junk or oil vape juice). Do whatever, but stop smoking. It might not feel like the best answer to you right now, but you’ve got to stop smoking.

Shortened Lives – A Case Example

When our CEO was the head of a Division in the Dept. of Medicine at Scripps Clinic (La Jolla, CA, USA), an older guy from Montana came to see him. He said that it was so obvious that smoking was shortening the lifespan of his brothers and sisters. His mom and dad, and his aunts and uncles, all lived into their mid-90s, ranchers in Montana. None of them smoked. But, his brothers and sisters (and cousins) were all cigarette smokers. And they were all, one by one, dying in their early 70s. From the old guy’s point of view, this information told the story. And, the message was clear. Smoke and you die 25 years too soon. He had stopped smoking.

Those Fats in Your Blood

LDL cholesterol and triglycerides, the fatty lumps floating in your blood. While your doctor is checking your blood pressure, have her draw some blood to measure your cholesterol. High cholesterol is another way to ruin your body’s plumbing. It weakens the walls of your blood vessels and sets the stage for a stroke. If your cholesterol is high, there are now great medicines to treat it, to lower the level. Get a prescription, get the medicine, take it, and live ten extra years. That’s ten extra good years, healthy, clear minded.

The Sugar in Your Blood

Too much sugar in your blood, that is, high blood sugar, called Type II diabetes. Maybe “lifestyle changes” will help. Healthy foods, exercise. Maybe not. If not, get back to your doctor again and get the right medicine to treat it. There are great, easy-to-take medicines for diabetes. Your doctor can also check for early diabetes, or “pre-diabetes”. She has tests and will get your medical history, and can tell you whether you might become diabetic. Diabetes is much easier to prevent than to treat. You might be able to “dodge the diabetes bullet” altogether.

Are You Healthy?

If you’re healthy now, great. If not, do whatever you need to do to become healthier to help prevent strokes. Eat healthy foods. Things like vegetables, fruits, and nuts, whole grain breads and cereals, chicken and especially fish, and healthy oils like olive oil and canola oil.

And exercise. Get yourself moving. Any exercise! Physically getting in gear and getting going is much, much better than sitting. Walk. When going up two or down three floors in a building, take stairs rather than just hopping on an elevator and pushing a button. Swim. Bicycle. If you can and want to do more, go for it. But while you’re sitting there and thinking about it, about what exercise to do, about how to get started, take a walk. The best exercise for you is the exercise that you’ll keep doing for years.

Medical Emergency Telephone Numbers

Australia – 000

Ireland – 112 or 999

New Zealand – 111

United Kingdom – 999 or 112

United States – 911

Helpful links:

The National Institute on Aging on stroke

National Institute of Neurological Disease and Stroke – Stroke Information Page

Or, try the National Institutes of Health, National Heart, Lung, and Blood Institute on stroke

National Library of Medicine’s Medline Plus on stroke

Center for Disease Control and Prevention (CDC) on stroke

The National Stroke Association – About Stroke

The Mayo Clinic on stroke