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THINK YOU ARE HAVING A STROKE? CALL 9-1-1 IMMEDIATELY!

F.A.S.T. is an easy way to remember the sudden signs of stroke. When you can spot the signs, you'll know that you need to call 9-1-1 for help right away. F.A.S.T. is:

 
F

FACE
DROOPING

Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
A

ARM
WEAKNESS

Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
S

SPEECH
DIFFICULTY

Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly?
T

TIME FOR
  9 1 1

If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you'll know when the first symptoms appeared.
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    Stroke Index            
  What is a Stroke?
  About Stroke
  What Happens During a Stroke?
  Quick Treatment Is Critical for Stroke
  Types of Stroke
 
  • Ischemic Stroke
  • Hemorrhagic Stroke
  • Transient Ischemic Attack (TIA)
 
  Symptoms
  Stroke Warning Signs Seen Hours or Days Before Attack
  Common symptoms of a TIA
  Exams and Tests
  The doctor will do a physical exam to
  Treatment
  Support Groups
  Outlook (Prognosis)
  When to Contact a Medical Professional
  Prevention
  Reference
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What is a Strokes?

A stroke occurs when the blood supply to the brain is blocked or when a blood vessel in the brain ruptures, causing brain tissue to die. A stroke often starts as a sudden feeling of numbness or weakness on half of the body.

Stroke is the fourth leading cause of death in the United States and is a major cause of adult disability.1,2 About 800,000 people in the United States have a stroke each year.2 One American dies from a stroke every 4 minutes, on average.2 Get more quick facts about stroke.

Stroke is a medical emergency. Know the signs and symptoms of stroke, and call 9-1-1 right away if you think someone might be having a stroke. Getting fast treatment is important to preventing death and disability from stroke.

You may be able to prevent stroke or reduce your risk through healthy lifestyle changes. In addition, medication can reduce stroke risk for some people.

What are the signs of a stroke?
Signs of a stroke in ASL
 
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About Stroke
  To understand stroke, it helps to understand something about the brain. The brain controls our movements; stores our memories; and is the source of our thoughts, emotions, and language. The brain also controls many functions of the body, like breathing and digestion. To work properly, your brain needs oxygen. Although your brain makes up only 2% of your body weight, it uses 20% of the oxygen you breathe.1 Your arteries deliver oxygen-rich blood to all parts of your brain. Illustration of tissue death in the frontal cut-section of the brain, as well as a blood clot that caused the damage.
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What Happens During a Stroke
 

If something happens to interrupt the flow of blood, brain cells start to die within minutes because they can’t get oxygen. This is called a stroke. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. A stroke can cause lasting brain damage, long-term disability, or even death.

If brain cells die or are damaged because of a stroke, symptoms of that damage start to show in the parts of the body controlled by those brain cells.
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Quick Treatment Is Critical for Stroke
  A stroke is a serious medical condition that requires emergency care. Call 9-1-1 immediately if you or someone you are with shows any signs of a stroke.

Learn more about the types of stroke, the signs and symptoms of a stroke, what treatments are available for stroke, and what happens after a stroke.

The following are downloadable fact sheets about stroke and related conditions:

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Types of Stroke
 

The main types of stroke are

  • Ischemic stroke.
  • Hemorrhagic stroke.
  • Transient ischemic attack (a warning or “mini-stroke”).

Ischemic Stroke
 

Most strokes (85%) are ischemic strokes.1 If you have an ischemic stroke, the artery that supplies oxygen-rich blood to the brain becomes blocked.

Blood clots often cause the blockages that lead to ischemic strokes. Read more about factors that increase risk for ischemic stroke.
   
hemorrhagic Stroke
  A hemorrhagic stroke occurs when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them.

High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke.

There are two types of hemorrhagic strokes:

  • Intracerebral hemorrhage is the most common type of hemorrhagic stroke. It occurs when an artery in the brain bursts, flooding the surrounding tissue with blood.
  • Subarachnoid hemorrhage is a less common type of hemorrhagic stroke. It refers to bleeding in the area between the brain and the thin tissues that cover it.
Transient Ischemic Attack (TIA)
  A transient ischemic attack (TIA) is sometimes called a "mini-stroke." It is different from the major types of stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.2

It is important to know that

  • A TIA is a warning sign of a future stroke.
  • A TIA is a medical emergency, just like a major stroke.
  • Strokes and TIAs require emergency care. Call 9-1-1 right away if you feel signs of a stroke or see symptoms in someone around you.
  • There is no way to know in the beginning whether symptoms are from a TIA or from a major type of stroke.
  • Like ischemic strokes, blood clots often cause TIAs.
  • More than a third of people who have a TIA end up having a major stroke within 1 year if they don’t receive treatment, and 10%-15% will have a major stroke within 3 months of a TIA.3

Recognizing and treating TIAs can reduce the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke.

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Symptoms
  The symptoms of stroke depend on which part of the brain is damaged. In some cases, a person may not know that a stroke has occurred.

Most of the time, symptoms develop suddenly and without warning. However, symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur if the stroke is caused by bleeding in the brain. The headache:

  • Starts suddenly and may be severe
  • Occurs when you are lying flat
  • Wakes you up from sleep
  • Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include:

  • Change in alertness (including sleepiness, unconsciousness, and coma)
  • Changes in hearing
  • Changes in taste
  • Changes that affect touch and the ability to feel pain, pressure, or different temperatures
  • Clumsiness
  • Confusion or loss of memory
  • Difficulty swallowing
  • Difficulty writing or reading
  • Dizziness or abnormal feeling of movement (vertigo)
  • Lack of control over the bladder or bowels
  • Loss of balance
  • Loss of coordination
  • Muscle weakness in the face, arm, or leg (usually just on one side)
  • Numbness or tingling on one side of the body
  • Personality, mood, or emotional changes
  • Problems with eyesight, including decreased vision, double vision, or total loss of vision
  • Trouble speaking or understanding others who are speaking
  • Trouble walking
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Stroke Warning Signs Seen Hours or Days Before Attack
  Warning signs of a stroke may appear as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.

Eighty percent of strokes are "ischemic," caused by the narrowing of the large or small arteries of the brain, or by clots that block blood flow to the brain. They are often preceded by a transient ischemic attack (TIA), a “warning stroke” or “mini-stroke” that shows symptoms similar to a stroke, typically lasts less than five minutes, and does not injure the brain.

 

The study examined 2,416 people who had experienced an ischemic stroke. In 549 patients, TIAs were experienced prior to the ischemic stroke and in most cases occurred within the preceding seven days: 17 percent occurring on the day of the stroke, 9 percent on the previous day, and 43 percent at some point during the seven days prior to the stroke.

“We have known for some time that TIAs are often a precursor to a major stroke,” said study author Peter M. Rothwell, MD, PhD, FRCP, of the Department of Clinical Neurology at Radcliffe Infirmary in Oxford, England. “What we haven’t been able to determine is how urgently patients must be assessed following a TIA in order to receive the most effective preventive treatment. This study indicates that the timing of a TIA is critical, and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack.”

  The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, autism and multiple sclerosis.
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Common symptoms of a TIA which are similar to those of a stroke yet temporary, include:
 
  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion or problems understanding
  • Sudden difficulty speaking
  • Sudden vision difficulty in one or both eyes
  • Sudden dizziness, loss of balance or coordination, or difficulty walking
  • Sudden, severe headache with no apparent cause
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Exams and Tests
  The doctor will do a physical exam to:
  • Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
  • Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.
  • Check for high blood pressure

You may have the following tests to help find the type, location, and cause of the stroke and rule out other disorders:

  • Angiogram of the head to look for a blood vessel that is blocked or bleeding
  • Carotid duplex (ultrasound) to see if the carotid arteries in your neck have narrowed
  • Echocardiogram to see if the stroke could have been caused by a blood clot from the heart
  • Magnetic resonance angiography (MRA) or CT angiography to check for abnormal blood vessels in the brain

Other tests include:

  • Blood tests
  • Electrocardiogram (ECG) and heart rhythm monitoring
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The doctor will do a physical exam to:
  Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.Check for high blood pressure
  Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.Check for high blood pressure
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Treatment
  A stroke is a medical emergency. Quick treatment is needed. Call 911 or your local emergency number or seek urgent medical care at the first signs of a stroke.

People who are having stroke symptoms need to get to a hospital as quickly as possible.

  • If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.
  • To be effective, this treatment must be started within 3 to 4 1/2 hours of when the symptoms first started.

Other treatments given in the hospital will depend on the cause of the stroke. These may include:

  • Blood thinners such as heparin, warfarin (Coumadin), aspirin, or clopidogrel (Plavix)
  • Medicine to control symptoms such as high blood pressure
  • Special procedures or surgery to relieve symptoms or prevent more strokes
  • Nutrients and fluids
  • Feeding tube in the stomach (gastrostomy tube)

Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital.

The goal of treatment after a stroke is to help you recover as much function as possible and prevent future strokes.

Recovery from your stroke will begin while you are still in the hospital or at a rehabilitation center. It will continue when you go home from the hospital or center.

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Support Groups
  Support and resources are available from the American Stroke Association | www.strokeassociation.org.
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Outlook (Prognosis)
  The outlook depends on:
  • The type of stroke
  • How much brain tissue is damaged
  • What body functions have been affected
  • How quickly you get treated

Problems moving, thinking, and talking often improve in the weeks to months after a stroke.

Many people who have had a stroke will keep improving in the months or years after their stroke.

Over half of people who have a stroke are able to function and live at home. Other people are not able to care for themselves.

If treatment with clot-busting drugs is successful, the symptoms of a stroke may go away. However, patients often do not get to the hospital soon enough to receive these drugs, or they cannot take these drugs because of a health condition.

People who have a stroke due to a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke due to bleeding in the brain (hemorrhagic stroke).

The risk for a second stroke is highest during the weeks or months after the first stroke. The risk begins to decrease after this period.

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When to Contact a Medical Professional
  Stroke is a medical emergency that needs to be treated right away. Call your local emergency number (such as 911) if someone has symptoms of a stroke.
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Prevention
  Reducing your stroke risk factors lessen your chances of a having stroke.
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Reference
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