En español | Spotting the warning signs and early symptoms of a stroke is key to reducing the risk of permanent disability or death when the disease strikes. But do you know what to look for?
Often, a stroke is mistaken for an event that takes place in the heart. But it happens in the brain when blood flow is disrupted either by a blockage or bleeding. Deprived of the oxygen it needs, that part of the brain starts to die.
"If you think about it, the brain is really responsible for everything that you do. It's responsible for your ability to move, your ability to speak, your ability to think, your ability to see, your ability to feel, to hear, etc. So really, a loss of any of those things can be a sign of a stroke,” says Mitchell Elkind, M.D., professor of neurology and epidemiology at Columbia University and president-elect of the American Heart Association.
A quick and easy way to remember the most common signs of a stroke is with the acronym FAST. It stands for “face drooping, arm weakness, speech difficulty and time to call 911.” Elkind, however, likes to tack on two additional letters ahead of the acronym: B and E. These stand for “balance” and “eyes,” since a loss of balance and a sudden change in vision can also signal a stroke. Severe headache is another warning that shouldn't be overlooked, he says.
COVID-19 and Strokes
As the sum of coronavirus cases continues to climb, experts are learning more about the virus and the illness it causes, called COVID-19. And an increasing number of reports from hospitals around the world show that in some patients, the disease can lead to stroke. One of the reasons, experts predict, has to do with COVID-19’s impact on blood clotting. Critical illness and severe infections also predispose patients to stroke.
However, not everyone who has a stroke experiences the hallmark symptoms or is clued into them right away. Headache and dizziness, for example, are easy to attribute to everyday triggers such as allergies and stress. Arm weakness? Perhaps it was tweaked at the gym.
"The brain is tricky; neurology is tricky. So these things can sometimes be written off or ignored,” Elkind says. “And that's why it's so important to educate people about these things, so that [people] don't do that.”
Here's what four stroke survivors experienced during the days and minutes leading up to their strokes.
'Oh crap, I'm having a stroke'
Doug Tapking, 77, Draper, Utah
Ten years ago, Doug Tapking and his wife, Karen, were waiting for a table at a steak house in Thousand Oaks, California, when Tapkin got a muscle cramp in his left arm. It wasn't his first one that day either. Earlier in the afternoon, the then-66-year-old had a charley horse in his left leg and left arm while packing for an upcoming vacation. He'd also been having severe headaches for days — sinus pressure, he thought.
By the time the couple and their friends were seated for dinner, the cramping in Tapking's arm had subsided and conversation turned toward the Tapkings’ upcoming cruise trip. That's when his friend, John, started to notice something was off.
"He looks at me at some point and says, ‘What's wrong? Stop mumbling; you're mumbling,’ " Tapking recalls. “And I don't remember mumbling. Frankly, I thought we were just having a conversation like we're doing right now. So he would ask a question and I would respond. At least I thought I was responding. … And all of a sudden he blurts out, ‘Are you having a stroke?’ “
Know the Warning Signs of a Stroke
Acting fast can reduce the risk of damage or death from stoke. Here are the common warning signs to keep in mind.
B: Balance or coordination may be off.
E: Eyes. Sudden blurred or double vision
F: Face drooping
A: Arm weakness
S: Speech difficulty
T: Time to call 911
If you experience any of these symptoms, it's best to call 911, says Mitchell Elkind, M.D., professor of neurology and epidemiology at Columbia University and president-elect of the American Heart Association. Arriving to the hospital in an ambulance means you will be seen right away and your stroke treatment will be faster.
John proceeded to ask Tapking a series of questions: whether he could smile, for instance, or raise his arms. Tapking, somewhat oblivious to what was happening, played along.
"My right arm came up without any trouble, but my left arm was limp at my side. So I reached out and I grabbed my left arm at my wrist, you know, I kind of pulled it up to my chest level. And I let go of it, and it just fell immediately into my lap,” he says. “And at that point, I vividly remember saying to myself, Oh crap, I'm having a stroke."
Tapking remembers someone calling 911, but the rest is pretty much a blur. He later learned that the left side of his face was drooping, or as wife Karen puts it, looked “totally melted.” The paramedics rushed Tapking to the closest hospital, where doctors right away diagnosed an ischemic stroke, which results from an obstruction and is the most common type of stroke. It turns out a “severe dissection” in an artery in his brain was blocking his blood flow.
"Think of a garden hose with multiple layers — a high-pressure hose — and a dissection is the internal portion of that hose separating and coming down into the middle of it,” thus causing a buildup of blood, Tapking explains.
Doctors broke up the clot that had formed near the dissection and inserted a stent to repair the damaged blood vessel. They also gave him a clot-busting drug.
Unlike many stroke survivors, Tapking made a full recovery, with no lasting physical or mental damage. He credits his friend's quick recognition of the stroke and the fast care he received at the hospital for his fortunate outcome. Now an advocate for stroke education and treatment, Tapking urges everyone to know where their closest stroke center is. He also says if you notice something out of the ordinary — be it a pattern of headaches or a series of cramps — “pay attention to it.” Your body could be trying to warn you that something is wrong.
'An explosion in my brain'
Maury Mendenhall, 45, Washington, D.C.
"It was like an explosion in my brain,” Maury Mendenhall says about the intense pain she experienced back in May of 2018. The mother of two had just returned home from a work trip to Zimbabwe and Nigeria and was lying in bed, hoping to overcome jet lag and shake a headache that had been building up for weeks.
Feeling ill was unusual for Mendenhall, who works on HIV/AIDS projects at the United States Agency for International Development (USAID). “I am not the type of person who has headaches often,” she says. “But each day, my headaches got a little bit worse, and I remember going to work [earlier in the week] and trying to talk to people and not being able to clearly say the things I wanted to say. And there wasn't anything I could do to make [the headaches] better.”
The pain got so intense that morning after her trip that Mendenhall burst into tears. Her mother, who was in town to watch the kids while she was traveling, came upstairs to check on her. “I could barely talk to her at that point. But when I saw my mom, I said, ‘Help. Big help.’ “
They drove to MedStar Washington Hospital Center, which was five minutes from her house, and by the time they arrived, Mendenhall couldn't get out of the car “and nothing that I said made any sense,” she recalls.
Lower Your Stroke Risks
According to the Centers for Disease Control and Prevention, up to 80 percent of strokes in the U.S. are preventable through lifestyle changes. Mitchell Elkind, of Columbia University, lays out a few steps you can take to reduce your risk of stroke:
1. Get plenty of physical activity — at least 30 minutes a day, five days a week.
2. Eat a healthy diet and limit salt intake, which can cause a spike in blood pressure.
3. Maintain a healthy weight.
4. If you smoke, quit.
5. Know your cholesterol, blood pressure and blood sugar levels. If they are too high, work with your doctor to bring them under control.
A magnetic resonance imaging (MRI) scan revealed that a tangle of abnormal blood vessels on her brain, called an arteriovenous malformation (AVM), had ruptured, causing a pool of blood on the left side of the brain and a lot of swelling. The doctors had to temporarily remove part of her skull to relieve the pressure.
Recovery was a long and difficult road for Mendenhall, who woke up from the trauma unable to string together a sentence in a way that made sense. She'd also lost the ability to quickly process what others were saying to her. And learning to read and write again was one of the most frustrating and “embarrassing” parts of the process for the former college literature major.
Several months after her stoke — and with a lot of therapy and encouragement from her family and other brain injury survivors she met along the way — Mendenhall returned to work, albeit with a few accommodations. She now has a computer that reads to her, for example. She also records meetings so that she can go back and listen to everything that was said as many times as she needs to.
"It's hard not being able to do the things I used to do” with ease, Mendenhall says. “But I was incredibly lucky.”
'Follow your gut'
Joyce Sampson, 64, Silver Spring, Maryland
One morning about 10 years ago, Maryland resident Joyce Sampson was looking for her keys when something strange happened. She opened her mouth to ask her son to help her, only she couldn't come up with the word key.
"I kept saying, ‘Hand me the lamp’ or ‘hand me the rug’ — something like that,” Sampson recalls. “I felt like it was unnatural.” Sampson eventually found her keys, despite losing the words, and proceeded to drive herself to the hospital — “which was a mistake,” she now admits. Imaging tests revealed she had suffered a stroke in her frontal lobe. It turned out to be her first of many.
Over the next several weeks, Sampson, a former journalist, experienced a range of strange symptoms that landed her in and out of the hospital. For example, she recalls hearing a “whoosh” sound, followed by a feeling that the walls were shaking. Her limbs would often go weak, or she would randomly lose her ability to read or write.
She remembers calling her sister and trying to carry on a normal conversation. But from her sister's reaction, the words coming out of Sampson's mouth didn't make any sense. With each concerning symptom, Sampson went to the hospital. And nearly every time, doctors diagnosed a stroke. Eventually, her health care team kept her at the hospital for several days to monitor her status. When she stopped having strokes, Sampson was released to rehabilitation, followed by years of therapy to help her recover from the repeated injuries to her brain.
Sampson's advice to others? “Follow your gut,” she says. The early warning signs of stroke may not always be textbook or seem obvious. And in today's fast-paced world, it's easy to write off confusion and disorientation as stress or exhaustion, when really, it could be something much more serious.
'Rebuilding a life'
Debra Meyerson, 62, Menlo Park, California
It started with a funny feeling in her right leg — almost like she was losing a bit of muscle control. But Stanford University professor Debra Meyerson figured it was just a cramp “or a nerve thing or something.”
Later that day while on a hike with her family near Lake Tahoe, the feeling in Meyerson's leg grew worse — so bad, in fact, that they cut the walk short. Then, came the headache. Meyerson took some aspirin before bed and hoped everything would feel better in the morning. But when she woke up, her head was still throbbing.
Meyerson's husband, Steve Zuckerman, handed her some more medicine. He remembers his wife “trying to pick it up with her right hand,” he says, but that “she was having to concentrate unbelievably hard and was barely moving her hand.” That's when he put two and two together — the trouble with her right hand and right leg. Zuckerman suspected a stroke.
The couple went to the nearest hospital, where tests showed damage to Meyerson's brain. It wasn't clear, however, what was causing the harm, so Meyerson was transferred to a larger hospital about 30 minutes away. There, doctors discovered that a dissection (or tear) in her left carotid artery was blocking the blood flow to her brain, and they suspected it had been there for several months. (This explains some intermittent headaches and disorientation Meyerson experienced weeks before her stroke — one incident even landed her in the emergency room, but doctors couldn't find anything wrong. The tear likely moved during those times, slowing blood flow to the brain.)
It took until the next morning for the severity of Meyerson's symptoms to fully set in: The right side of her body was paralyzed and she'd lost all speech. Life as she knew it was forever changed.
Determined to “get back to kind of where she was,” Meyerson pushed through three tough years of rehabilitation before realizing something: She “reluctantly acknowledged that maybe this was a life change and that she was going to have to deal with rebuilding a life with disabilities” instead of just working to limit them, Zuckerman says.
Meyerson, who has aphasia — a side effect of a stroke that can affect the ability to speak or comprehend language — had to give up her position as a tenured professor, but she still works at Stanford as an adjunct professor, conducting research on the experience of stroke survivors in the rehabilitation process. With her son, Meyerson cowrote a book called Identity Theft: Rediscovering Ourselves After Stroke. She also founded a nonprofit with Zuckerman called Stroke Forward, to help survivors and their families rebuild their lives after a stroke.
"Recovery isn't just about regaining capabilities — that is critically important, and you should do as much as you can — but a significant percentage of the 800,000 stroke survivors every year just simply won't,” Zuckerman says. The goal of Stroke Forward, he explains, “is to try to reach as many people in this unfortunate situation as possible realize that they shouldn't only talk about recovering capabilities.” Because the emotional part of the recovery is just as important.