Slurred speech, an impaired gait, paralysis on one side of the face, arm, and/or leg—these are all signs of a stroke, especially if they appear suddenly. If you believe you or someone else is experiencing a stroke, call 911 immediately. Strokes are an emergency, and waiting can result in serious brain injury and even death.
Carolyn Brockington, MD
In this Q&A, Carolyn Brockington, MD, Director of the Stroke Center at Mount Sinai West and Mount Sinai Morningside, and Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, discusses the signs and symptoms of a stroke, the difference between a stroke and a mini stroke, and why you must act fast.
What is a stroke?
Simply put, stroke is an injury to the brain caused by a reduction of blood flow—for example, a blood vessel is blocked by a blood clot. Strokes are an emergency because there is a restricted time period—just a few hours—for people to come in for treatment, where doctors can try to administer certain therapies to improve blood flow in order for the affected part of the brain not to be injured.
What are the signs and symptoms?
The signs and symptoms from stroke have to do with how the brain is organized. Primarily, the left side of the brain controls the right side of the body, and the right side controls the left. Let’s say somebody is not getting enough blood flow on the left side of the brain, depending on the part of the brain affected, they might develop right-sided weakness or right-sided numbness, or difficulty speaking, or difficulty understanding speech, etc. If someone has a stroke on the left side of the brain in the back, they may have vision problems but they’ll be able to walk around and speak. If they have a stroke towards the front of the brain, they might have more of a language problem but no vision disturbance. While it’s very hard to tell people exactly what type of symptoms they would have, the appropriate thing is to understand that the symptoms are sudden, like turning off a light switch. Pay attention to balance, eyesight, face asymmetry, arm or leg movement, speech or language.
Who is most at risk?
Everyone is at risk for stroke. Most people think you only have to worry about stroke when you are old. The truth is that the incidence of stroke increases as we get older, because some of the risk factors or the medical conditions that we know that increase stroke increase over time—high blood pressure (hypertension), diabetes, heart disease, elevated cholesterol, etc. However, the most important thing to understand is that anybody can have a stroke at any age. The fact that stroke risks increase with age doesn’t mean it can only happen when you get older. There are different reasons people might have a stroke at different ages.
If I think I or someone else is having a stroke, what should I do?
If you or someone else is having a stroke, time is ticking, so call 911. As doctors, we say “time is brain,” meaning every minute that goes by it has been estimated that approximately 1.9 million brain cells are potentially dying. Emergency Medical Services will dispatch the ambulance, which will take you to the closest designated stroke center that has the ability to assess you in a timely fashion and provide the appropriate treatments. At the Mount Sinai Health System, all of our eight hospitals have been designated as certified stroke centers, meaning that we all have multidisciplinary teams to provide the appropriate therapy within the clinical guidelines for the acute treatment of stroke.
How will I be treated for an acute stroke?
Once you are in the emergency room, there is a lot that needs to be done in a very short period of time to make sure you are eligible for acute stoke treatment, including brain imaging and blood tests, etc. Afterwards, we may be able to administer certain therapies, for selected patients, within what we call the “therapeutic window.”
For example, for acute stroke, there’s treatment we give intravenously through the IV in the emergency department. If there is a big blockage of a blood vessel, we might be able go in and pull that clot out. The time period for the intravenous therapy is within three hours of symptom onset, and for some people we can extend it to four and a half hours. People who receive treatment earlier typically do better.
Am I having a stroke?
It’s important for everyone of all ages to know the signs and symptoms of a stroke. F.A.S.T and B.E.F.A.S.T, acronyms used by many medical and health organizations, including the American Heart Association and the American Stroke Association, can help you quickly spot the common signs and symptoms of stroke.
B is for sudden loss of balance. Your gait is suddenly off balance, as if drunk or suddenly dizzy.
E is for sudden loss of vision in one or both eyes. You may also see double.
F is for an uneven face. You are experiencing sudden facial weakness or numbness on one side.
A is for arms or leg weakness. You can’t outstretch your arm or leg or keep it up, and there is a sudden weakness and/or numbness on one side of your body.
S is for slurred speech. Aside from slurred speech, you may not be able find the right words, or may have trouble understanding others.
T is for time. “Time is brain.” Don’t wait and hope symptoms go away—call 911.
Want to learn more about the warning signs of a stroke? Check out this interactive F.A.S.T. guide from the American Stroke Association.
Hispanohablantes: ¿Crees que alguien está sufriendo un derrame cerebral? Sea R.Á.P.I.D.O.
What’s the difference between a stroke and a mini stroke?
When people say “mini stroke,” they mean a transient ischemic attack, or TIA. “Transient” means brief; “ischemia” means reduction in blood flow; and “attack” means an event that is a shorter period of time where not enough blood gets to the brain and causes symptoms. An example might be that somebody is walking down the street, and suddenly, they feel their left arm and leg is heavy. They are having difficulty moving, they may have some difficulty walking, and then a few minutes later it goes away. Both stroke and TIAs are caused by an interruption of blood flow to the brain. The big distinction is that the TIA is a shorter period of time where not enough blood gets to the brain, so it doesn’t cause a permanent injury.
What should I do if I think I had a TIA?
Even if the symptoms resolve, a TIA is an emergency. Even though a TIA doesn’t result in an injury to your brain, we need to identify the cause. TIAs are warning signs that a stroke may be looming. If we can find that you have an artery narrowing or problems with your heart or your blood or blood pressure etc, that gives us the opportunity to try to address the issue before you have a stroke. TIAs and stroke are both considered emergencies and require fast treatment.
How can I decrease my risk for having a stroke?
There are a lot of risk factors for stroke, both modifiable and nonmodifiable. Nonmodifiable risk factors include age and family history of stroke. Modifiable risk factors include high blood pressure, heart disease, and diabetes. Hypertension (high blood pressure) is the number one reason why people have stroke and heart disease. The identification of high blood pressure, and modifying it, usually through adopting a healthier diet, regular activity, and sometimes medication, is important. Speaking to your doctor about your risks provides an opportunity to modify or control risks better long-term to reduce your chances of having a stroke.
How to tell if someone could be having a stroke
Remember the B.E.F.A.S.T. acronym:
- You notice they are suddenly acting or walking as if drunk or dizzy, but they have not had anything to drink
- You ask them to smile, and their face is asymmetrical
- Their speech is slurred or they are unable to find the right words, or they seem confused and have trouble understanding you
- They have difficulty maintaining or are unable to lift their arms or legs
- They have double or blurred vision
If you notice any of the above, call 911 immediately.
How will having a stroke affect me?
Many individuals recover well after a stroke, and enjoy a good quality of life. The challenge is that certain types of stroke have the potential of causing significant neurological impairment, which highlights the need for prompt identification of stroke symptoms and treatment. If you think having a stroke is inevitable, you are wrong—there are many things you can do to reduce the chance of it happening. However, it starts with partnering with your primary care physician to discuss your particular risk factors and determine what you can do to modify your risks—not just today, but long-term—to reduce your risk of stroke and maintain good brain health.