Learn FAST + 23 Other Warning Signs of a Stroke

Nearly 800,000 people in the United States each year have a stroke, resulting in 160,000 deaths from stroke-related causes according to the National Institute of Neurological Disorders and Strokes. This makes stroke the fifth leading cause of death in the United States. In addition, strokes are the leading cause of serious long-term adult disability; over two-thirds of survivors are affected by a temporary, or permanent, disability. (1, 2)

According to the Centers for Disease Control and Prevention, every 40 seconds someone in the United States has a stroke, and every four minutes, someone dies of a stroke. Of the nearly 800,000 people that have a stroke, 610,000 experience a stroke for the first time. Approximately 90 percent of strokes are ischemic strokes. These strokes occur when the flow of blood to the brain is blocked. (3)

Recognizing the warning signs of a stroke is vital. And the faster emergency medical intervention is sought, and treatment begins, the better the possible outcome. In fact, patients who arrive at the emergency room within three hours of the first signs of stroke are often less disabled after three months than patients whose care was delayed. (4) If any you or someone you love experiences any warning signs of a stroke, don’t delay — call 911 immediately.

What Is a Stroke?

The brain must have a constant supply of oxygen and blood delivered by blood vessels; when the supply is cut off or interrupted, brain cells begin to die. This, in essence, is a stroke. Think of a stroke as a brain attack — similar in many ways to a heart attack. In both cases, blocked blood vessels often cause the injury to the organ, which results in limited or no circulation of blood.

Strokes can occur closer to the surface of the brain or can occur deep within the brain. The damage experienced varies widely from person to person. The type of stroke, where it occurs, and the severity, all play a role in the prognosis and recovery timeline.

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Strokes fall into two general categories: ischemic strokes and hemorrhagic strokes. Ischemic strokes are the result of a blockage in a blood vessel in the neck or brain, while hemorrhagic strokes are the result of bleeding into the brain. Let’s take a closer look at the most common types of strokes.

Ischemic Stroke. An ischemic stroke occurs when blood vessels in the brain or the neck are blocked. This blockage cuts off the circulation of blood and oxygen to the brain. In fact, ischemic strokes are by far the most common, with up to 90 percent of all strokes caused by a blockage. There are three leading causes of an ischemic stroke:

Thrombosis: A clot forms inside an artery in the brain or neck due to cholesterol-filled plaque that dislodges and starts to move. One-half to two-thirds of all strokes fall into this category.

Embolism: A clot that moves from another part of the body to the brain, blocking an essential artery.

Stenosis: Severe narrowing of an artery leading to the brain that cuts off the proper circulation of blood and oxygen.

Up to one-fifth of all strokes are a lacunar stroke, according to Harvard Medical School. (5) A lacunar stroke falls into the ischemic stroke category as it is a result of a blockage in a blood vessel; however, this stroke occurs in the tiny arteries deep inside the brain. The pounding pulse of high blood pressure damages these delicate arteries, often causing these strokes.

Fortunately, lacunar strokes have a far better recovery rate than other types with more than 90 percent of survivors recovering significantly within the first 90 days after the stroke.  However, it is important to note that this kind of stroke may have very minor symptoms that may be harder to recognize; as with all strokes, immediate emergency medical intervention is necessary for the best results. (6)

Transient Ischemic Attacks (TIA) are also known as a mini stroke. Here, like an ischemic stroke, blood flow is temporarily decreased. These often last for less than five minutes. These mini strokes typically don’t cause lasting symptoms because the blockage is temporary; however, it is still essential to seek emergency care immediately, even if the symptoms clear. TIAs put you at a significantly greater risk for strokes that can cause permanent damage or death. (7)

Hemorrhagic Stroke. Considerably rarer than an ischemic stroke, hemorrhagic strokes are estimated to account for only between 10 and 15 percent of cases. However, they account for between 30 and 60 percent of all stroke-related deaths. Instead of a clot causing a blockage in an artery, a blood vessel ruptures, leaking blood into the brain. The blood then builds up, compressing brain tissue, causing the damage associated with a stroke. There are two main causes of a hemorrhagic stroke: aneurysm and AVM. (8, 9)

Aneurysm. When a cerebral aneurysm bursts, or a weakened blood vessel leaks, a hemorrhagic stroke can occur. Somewhere between 1.5 and 5 percent of the general population has, or will develop, a cerebral aneurysm. However, only between 0.5 and 3 percent will suffer from a brain bleed. High blood pressure is believed to contribute and pose an increased risk. (10)

AVM. Arteriovenous Malformation, or AVM, are typically congenital (but not hereditary). They are believed to occur in less than 1 percent of the population. With AVM, arteries are abnormal, often appearing tangled, causing blood to divert from the arteries to the brain. Twenty-five percent of those with AVM will experience bleeding into the brain causing brain damage and stroke. (11)

What Are the 23 Warning Signs of a Stroke?

If you or someone you love is experiencing any of the following warning signs of a stroke, please seek emergency medical attention immediately — even if the symptoms fluctuate or disappear. The sooner treatment can begin, the better the prognosis for recovery.

FAST Test

Use the “FAST” test to determine if you, or some you love is having a stroke:

Face: Smile into the mirror, does one side of the face droop?

Arms: Raise both arms above the head, does one drift or fall, or is one arm unable to raise?

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Speech: Repeat a simple phrase, is speech slurred or strange?

Time: If you observe any of these signs, dial 911 or get emergency help immediately.

In addition to the FAST test, remember that depending on the type of stroke, where the stroke is occurring, and the severity of the stroke, the signs and symptoms can vary greatly. Here are the most common warning signs of a stroke: (12, 13, 14)

1. Headache that is unusual, and severe
2. Unusual or slurred speech
3. Inability to speak
4. Sudden weakness on one side of the body
5. Paralysis in the face, arm, or leg
6. Sudden numbness or tingling in any part of the body, including the face
7. Stiff neck
8. Severe muscle stiffness that comes on rapidly
9. Compromised coordination of the arms, hands and legs
10. Unsteady walk or poor balance resulting in staggering, weaving or veering
11. Vision loss, blurred vision, double vision, or trouble focusing
12. Inability to look at a bright light or sunshine
13. Unusual rapid eye movements or involuntary eye movements
14. Seizure
15. Vomiting and nausea
16. Dizziness
17. Difficulty swallowing
18. Irregular breathing
19. Stupor
20. Confusion
21. Memory loss
22. Unusual behaviors
23. Loss of consciousness or coma

Warning Signs of Cerebral Aneurysm (Subarachnoid Hemorrhage)

When a cerebral aneurysm ruptures, the first symptom is an incredibly severe headache, that comes on suddenly. Some patients have reported that it felt like a gunshot wound, or being struck by lightening. In addition, the headache is often followed by nausea, vomiting, stiff neck, dizziness, confusion, seizure and a loss of consciousness. Time is of the essence.

A Special Note about Warning Signs of Strokes in Children

The greatest risk of stroke in children is during the first year of life, specifically in the first 60 days. According to E. Steve Roach, M.D., professor of pediatric neurology at Ohio State University College of Medicine, the first symptom of a stroke in children is often seizures that involve only one arm or leg. (15) Additionally, in children, 45 percent of strokes are hemorrhagic, with only 55 percent being ischemic. Learn to recognize the warning signs of a stroke in infants and children. And, while it is still considered rare, in the event of an emergency, mention it to emergency responders and physicians.

Stroke Causes and Risk Factors

Eighty percent of all strokes are preventable, according to the American Stroke Association. (16) Minimize your risk of stroke by recognizing opportunities for improving your general overall health:

• High Blood Pressure: According to Dr. Natalie Rost, associate professor of neurology at Harvard Medical School, and associate director of Acute Stroke Service at Massachusetts General Hospital, “High blood pressure is the biggest contributor to the risk of stroke in both men and women.” (17)
• Being Overweight: Losing just 5 to 10 percent of your body weight lowers your risk for high blood pressure and other known stroke risk factors. (18)
• Atrial Fibrillation: Irregular heartbeats can cause clots to form in the heart that then break away and travel to the brain. Those with atrial fibrillation are at a five-fold risk of stroke.
• Diabetes: Both Type 1 and Type 2 diabetes damage blood vessels over time, making blood clots more likely.
• Smoking: Smoking thickens blood, increases plaque buildup, and accelerates clot formation.
• Family History: There is a genetic tendency in strokes; a predisposition to heart disease, high blood pressure, and diabetes, as well as lifestyle, are believed to be risk factors for stroke.
• High Cholesterol: Excessive LDL can cause plaque buildup in the blood vessels leading to atherosclerosis, a common stroke cause.
• Gender: Men have a higher risk for stroke: however, more women die from stroke.
• Race: African Americans and those with sickle cell disease have a heightened risk for stroke.
• TIA: If you’ve had previous strokes or TIAs, you are at a greater risk.
• AVM: The vein abnormalities associated with AVM put you at an increased risk for hemorrhagic stroke.
• Alcohol Abuse: Men who consume two or more drinks a day and women who consume one or more drinks per day are at an increased risk. Cirrhosis is associated with an increased risk of stroke, particularly hemorrhagic stroke. (19)
• Drug Use: The use of cocaine, heroin, and amphetamines increases the risk for stroke.
• Poor Sleep: Sleep disorders are linked to heart health; insomnia and sleep apnea influence diabetes, obesity and blood pressure. The brain needs periods of regeneration to stay healthy. (20)
• Vitamin D Deficiency: Recent studies indicate that low vitamin D levels are associated with higher risk for stroke, and worse outcomes in patients suffering from ischemic strokes. (21)
• Using Artificial Sweeteners: A recent study examined the soda drinking behaviors of close to 3,000 adults and found that drinking diet soft drinks nearly triples the risk of stroke and dementia. (22)

Conventional Treatment

Act fast – the sooner treatment begins, the better. When the brain’s blood and oxygen supply is restored quickly and completely, a full recovery is possible. The greater the delay, the more severe and long-lasting the damage can be.

Treatment depends on the type of the stroke, the location, and your general overall health. For an ischemic stroke, drugs that break up blood clots are given via an IV. The most common drug given is Alteplase IV r-tPA. It dissolves the clots and improves blood flow; it must be administered within three hours. This means it’s imperative that you recognize stroke warning signs as quickly as possible. (23)

In some cases, the blood clot may have to be removed physically after the clot-dissolving drugs have been given. This procedure needs to be done within six hours. Typically, the surgeon threads a catheter through an artery in the groin, up to the blocked artery. The clot is then grabbed and removed.

For a hemorrhagic stroke, often the first step is the administering of drugs to prevent clots from developing. Once the bleeding ceases, surgery may be required. Coils, removal of AVM, intracranial bypass, surgical clipping, and radiosurgery are just some of the options the medical team has at their disposal. (24)

Long-term treatment for stroke survivors may include various prescription drug therapies including Heparin, Plavix, Coumadin or daily aspirin. These treatments may help keep existing clots from getting bigger, and may prevent new clots from forming. (25)

14 Natural Ways to Recover from a Stroke

1. Rehabilitation. Physical therapists, occupational therapists, rehabilitation nurses, speech therapists, recreational therapists, psychiatrists or psychologists, and vocational therapists, should all be a part of the team. Reversing some of the effects of stroke is possible, and with a multi-disciplinary approach, stroke survivors can improve physical function, gain independence, improve cognitive functioning and communication, while enhancing coping skills and preventing depression. (26)

2. Exercise. After a stroke, being physically active builds strength and endurance, while improving balance and coordination. Research shows that regular exercise can reduce your risk for another stroke. Begin slowly; even sitting and standing intermittently can help you improve. Follow the directions and plans given to you by your physical therapist, building up your confidence and fitness levels. (27)

3. Eye Exercises. Nearly 25 percent of all stroke survivors experience vision loss. However, you may be able to improve vision through eye exercises. Computer games designed for vision, as well as standard letter search or word search puzzles, are great to incorporate into your daily life. (28)

4. Drink Black or Green Tea. Research has found that drinking a minimum of three cups of black or green tea each day may reduce your risk for stroke. If you’ve had a stroke, you have an increased risk for additional strokes, and drinking tea may reduce the incidence of recurrent ischemic strokes. In addition, improved blood sugar, weight loss and lower LDL levels are positive side effects from tea consumption. (29)

Black tea is known to boost heart health and lower stress hormones, making it ideal when recovering from a stroke. There is also research that indicates that black tea may help to prevent arteriosclerosis, a common cause of stroke.  Green tea has the highest levels of antioxidants and is a great drink to enjoy that may reduce your risk of Alzheimer’s, protect against certain eye diseases, and support bone health. (30)

5. Pomegranate. High LDL levels may increase your risk for stroke; if you have already had a stroke, lowering LDL is a must. According to researchers from the Israel Institute of Technology, pomegranate concentrate, when used with a low-dose statin drug (a common conventional treatment after a stroke), may significantly reduce cholesterol levels while hindering the oxidation of cholesterol in both cells and blood. (31) 

Research shows that pomegranate juice fights cancer, protects against cartilage inflammation and osteoarthritis, improves memory, lowers high blood pressure, and boosts heart health. Select only 100 percent pure pomegranate juice that doesn’t contain any added sugar. After a stroke, drink up to eight ounces each day to reap the benefits. (32, 33)

6. Pilates. According to a study published in the Journal of Bodywork and Movement Therapies, doing Pilates twice a week for nine months improves extremity strength, balance, posture and overall quality of life. (34) Another study has shown that for those with chronic stroke conditions, Pilates enhances both static and dynamic balance. (35) Find a certified Pilates instructor in your area who will work with you one-on-one to develop a program to increase your strength and balance after a stroke.

7. Support Network. The physical and emotional tolls of a stroke are dramatic. Research shows higher levels of support are associated with faster, and more extensive, recovery. In fact, the larger the network, the better, as a small network is associated with an increased risk for additional strokes. (36)

Local support groups through the American Heart Association may be a good place to start, as well as finding support within your church. Remember, the caregivers of stroke survivors also need support and should strive to find a support system separate and away from the stroke survivor.

8. Sleep. Sleep disorders are associated with a greater risk for strokes. So, after a stroke, it is imperative that you get the sleep your body and brain needs for recovery. After a stroke, both your body and your mind suffer effects and falling asleep may be difficult. Natural sleep remedies can help you get the sleep you need. Here are some strategies to start now:

• Cool room
• Turn off technology at least 30 minutes prior to going to bed
• Practice visualization or meditation to unwind your mind
• Use essential oils in a diffuser or sprinkle some calming lavender oil on your pillow and sheets to alleviate insomnia.

9. Control Blood Sugar Levels. Diabetes is a risk factor for stroke; treating your diabetes naturally after a stroke is incredibly important. Even if you’ve not been diagnosed with diabetes, it’s wise to stop eating foods that cause blood sugar spikes. Start by eliminating refined sugars, grains and alcohol. Then, incorporate more high fiber foods that help keep blood sugar levels within the normal range.

10. Yoga. Like Pilates, there is research that shows that yoga improves physical, mental, and emotional function after a stroke. A recent study published in Complementary Therapies in Medicine journal found that practicing yoga twice a week for eight weeks, pain, strength, and walk scores all significantly improved for the stroke survivors in the study. (37) GABA is released in the brain during yoga, helping to reduce anxiety, many stroke survivors experience. In addition, yoga improves muscle control, vision, speech, decision-making, memory, and emotional balance making it an ideal practice after a stroke.

11. Meditation. Mental fatigue, anxiety and depression are common after a stroke. (38) Research conducted by the Institute of Neuroscience and Physiology at the University of Gothenburg, Sweden, found that mindfulness-based stress reduction is a promising treatment for mental fatigue after a brain injury or stroke.

Scientific research recognizes that meditation can reduce pain and headaches, improves sleep quality, lowers the risk for obesity, lowers inflammation, boosts productivity, memory, focus and mental performance, and increases happiness, peace and compassion. (39)

12. Acupuncture. In a randomized, controlled study, post stroke, acupuncture has positive and long-term effects. At six weeks, and again at 12 months, participants in the acupuncture group improved significantly more than the other control groups. These participants showed marked improvement in the Motor Assessment Scale, the Sunnaas Index of Daily Living, and the Nottingham Health Profile. All three of these are commonly used to determine the various aspects of recovery after a stroke. (40)

13. Mediterranean Diet. According to a study published in the journal Atherosclerosis, patients who didn’t adhere to a Mediterranean Diet are more likely to suffer a stroke and have a worse clinical presentation at admission to emergency care. (41) This diet is rich with fresh fruits and vegetables, legumes and beans, whole grains, wild-caught salmon and other fish, olive oil, and nuts and seeds.

14. Vitamin D. As mentioned above, a vitamin D deficiency is a risk factor for stroke. In addition, after a stroke, supplementing with a high-quality vitamin D and getting plenty of sunshine can help prevent subsequent strokes, improve neurologic and cognitive functioning, reduce falls and fractures, and more. (42)

Incorporate vitamin D rich foods, many of which are found in a Mediterranean Diet. Sardines, salmon, mackerel, tuna and even caviar have high levels of vitamin D. In addition, enjoy mushrooms, raw milk and free-range eggs. And, when possible, get a minimum of 20 minutes each day of sun — without sunscreen — for best absorption.

15. Horseback Riding. A recent study in Sweden has found that horse-riding therapy after a stroke results in meaningful improvement on a stroke recovery scale. Study participants participated in therapy twice a week, for 12 weeks. In fact, in this landmark study, 56 percent of participants enjoyed improvement on the scale, as well as improvement in grip, strength, cognition, gait and balance. (43)

16. Music Therapy. In the same study mentioned above with horseback riding, those who participated in music and rhythm therapy experienced a 38 percent improvement on the stroke recovery scale and added improvement in grip, strength, cognition, gait and balance. Researchers concluded that the results support using multimodal rehab programs after stroke.

Precautions

Once you’ve had a stroke, learning how to prevent another stroke is vital. Learn to manage your risk factors, quit smoking and get diabetes, high blood pressure and your weight under control, if necessary.

Final Thoughts

• Stroke is the fifth leading cause of death in the United States
• Stroke is the first leading cause of long-term disability in adults
• After a stroke, getting medical attention as quickly as possible is imperative; treatment needs to start within three hours for best results
• High blood pressure is a leading risk factor for stroke
• Vitamin D deficiency is linked to stroke. Supplementation after stroke may help in recovery and prevent additional strokes
• A support network for the survivor, and the caregiver, is essential
• The first sign of stroke in an infant or child is often a seizure-like movement in one arm or leg.
• Recognizing the warning signs of a stroke early is essential to survival.

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