Know the Signs and Symptoms of Stroke with Emergency Medicine Physician Kurt Schmidt, DO

May is National Stroke Awareness Month. We recognize this month each year because, for many people, stroke awareness can be truly lifesaving. According to the Centers for Disease Control (CDC), someone in the US suffers a stroke every 40 seconds. For these patients, timely treatment can mean the difference between successful recovery and long-term disability.

UP Health System – Portage Emergency Medicine Physician Kurt Schmidt, DO, shares information on the different types of stroke, common warning signs, risk factors, what to do if experiencing stroke symptoms and recovery. 

Q: What is a stroke? Can you explain the different types?

A: A stroke is caused by a lack of blood flow to cells of the brain, which causes damage to those cells. The damage causes the symptoms of the stroke and the location and function of the brain cells being damaged lead to the specific symptoms of that particular stroke. There are two main types of stroke—both lead to a lack of blood flow to the brain but in different ways.

Imagine a river in a desert feeding an oasis of plants and trees. If the river becomes clogged, such as by a dam, the water flow stops going downstream leading to a lack of water supply to the plants, starving them of nutrients, leading to plant injury and possibly death. This is similar to an ischemic stroke. The artery becomes "clogged," the downstream cells do not get enough nutrients and oxygen delivered by the blood, and there is cell injury. The longer the lack of blood flow persists, the more likely it is to progress to cell death. This can then lead to permanent problems, and the affected area of cells potentially can grow, causing more extensive symptoms.

Treatment of ischemic strokes is highly time-dependent and focuses on trying to ‘clear’ the clog and re-establish blood flow and nutrients to the downstream cells to minimize the extent of damage and therefore maximize the chance of recovery. The treatments that work the best for ischemic stroke must be given within four hours of symptom onset, meaning the patient has four hours from the start of symptoms to recognize the stroke, get to the hospital, have the type of stroke diagnosed, ensure eligibility for the treatment, and undergo treat.

Say the banks of the river burst and the water escapes and goes elsewhere. There is still a lack of adequate water supply to the plants, starving them of nutrients. This type of situation, comparable to a hemorrhagic stroke, can lead to injury and possibly death. It's a ‘brain bleed,’ in essence.

Treatment is different in hemorrhagic strokes but is still time-dependent. The focus is reversing any blood thinners the patient may be on, monitoring for increased pressures within the brain and getting the patient to a hospital with neurosurgery. 

Q: What are the common symptoms that go along with having a stroke? 

A: Stroke symptoms vary depending on the location in the brain of the cells that are starving of nutrients. Common symptoms include:

• Face: Drooping of one side of the face. Ask the patient to smile and watch the corners of the mouth. Does one side seem to droop? This can also sometimes cause a sip of water to dribble out of that corner of the mouth.
• Arms and legs: Weakness or decreased sense of touch on one side of the body in the arms and/or legs. Ask the patient to raise both arms. Is one side weak? You can ask them to raise their legs as well (if they are seated or lying down). Leg weakness can also make it seem difficult or clumsy to walk.
• Speech: Stroke can cause slurred speech (from the drooping mouth), or difficulty speaking. Ask the patient to repeat a simple phrase. Is the speech slurred or strange?
• Time: If you see any of these signs call 911 immediately or have someone drive you to the emergency room.

Q: Who is the most at risk of having a stroke?

A: There are two general categories of risk factors for stroke—those you can control and those you cannot control.

Factors you can control (which account for 82-90 percent of all strokes):

• Atrial fibrillation/Atrial flutter (approximately five times increase in risk of ischemic stroke)
• High blood pressure
• Heart disease (strokes and heart disease share many of the same risk factors)
• Diabetes
• Smoking (smoking almost doubles your risk of ischemic stroke)
• Obesity
• Lack of exercise/physical inactivity
• Excessive alcohol use (more than two drinks per day), illicit drug use

Factors you CANNOT control:

• Age (for each decade of life after age 55 your stroke risk more than doubles)
• Race
• Gender (strokes occur more often in men but more women die from strokes than men)
• History of prior stroke
• Genetics (family history of stroke)

Q: If you or someone you're with are experiencing stroke symptoms, what should you do first?

A: Call 911 for an ambulance or have someone drive you to the emergency room immediately. The faster a stroke is treated, the more likely the patient is to recover.

Even if these symptoms disappear quickly, the danger isn’t over. Every stroke can cause lasting damage, and every stroke patient should seek emergency care right away. If you think that you or a loved one has suffered a stroke, don’t hesitate to find help at an emergency room near you.

Q: What does stroke recovery look like?

A: Stroke recovery varies widely—some may recover within hours, others take weeks to months and some may have long-lasting or permanent damage. The long-term effects of a stroke depend upon the area of cells affected. They can include memory problems, difficulty speaking, difficulty swallowing, weakness, depression, and fatigue.

Physical therapy, occupational therapy and speech therapy can help with rehabilitation. The goal of rehabilitation is to initially focus on the activities of daily living (walking, getting dressed, bathing, eating, etc.). Beyond this, there are specialists to help with challenges of cognitive function (speaking, memory problems, etc.) and help with permanent lifestyle changes if needed.

The first three months after a stroke are the most important for recovery and when patients will see the most improvement.

If you would like to speak to a primary care provider about your risk of stroke, UP Health System – Portage can help. Visit the “Find a Provider” tab at UPHealthSystem.com to schedule an appointment today. In the event of a stroke-related emergency, call 9-1-1. Minutes matter, and acting quickly may save a life, including your own.