When someone is experiencing stroke symptoms, it's almost an understatement to say time is of the essence.
“During a stroke, the brain loses seven million neurons a minute. When brain cells die, permanent damage can occur, so there is no time to lose in seeking medical treatment,” says stroke neurologist Panayiotis Mitsias, M.D. “At the first sign of a stroke, call 911.”
According to the American Heart Association, stroke is the fifth leading cause of death in the U.S. Each year, nearly 800,000 people experience a new or recurrent stroke. On average, someone suffers a stroke every 40 seconds and someone dies of a stroke every four minutes. Stroke is a leading cause of long-term disability in the United States.
Who’s at Risk for Stroke?
The risk of having a stroke increases with age. In fact, the risk of having a stroke more than doubles each decade after the age of 55. However, according to the Centers for Disease Control and Prevention (CDC), strokes can and do occur at ANY age. Just over 30 percent of strokes occur in people under the age of 65, according to the CDC’s latest data.
Family history and lifestyle and health factors also affect risk for stroke, including high blood pressure, high cholesterol, smoking, obesity and diabetes. A prior stroke or heart attack also puts you at a much higher risk for having a second stroke.
Signs of a StrokeWhen someone may be having a stroke, remember the symptoms and be FAST:
- Face drooping
- Arm weakness
- Speech difficulty
- Time to call 911
Why Timing Is So Critical After a Stroke
More than 85 percent of strokes are classified as ischemic, which means it's an acute (or sudden) stroke that occurs when a clot blocks a blood vessel, cutting off blood flow to a part of the brain.
"Anyone showing signs of an acute stroke needs to be evaluated very rapidly, because it is critical to determine whether or not the patient is a candidate for acute reperfusion therapies," says Dr. Mitsias. "These are our only hope currently to reverse the damage done by the stroke."
What are acute reperfusion therapies? These are the treatment options to restore blood flow to the regions of brain that are affected and to minimize tissue damage. The long-term goal is to improve outcome by reducing stroke-related disability and death. These therapies include:
- Intravenous tPA (tissue plasminogen activator): This drug targets blood clots and improves blood flow. Patients who receive tPA within four and a half hours of initial stroke symptoms are more likely to recover with little or no disability than patients who do not receive the drug. tPA cannot be used beyond that four and a half hour window from symptom onset.
- Endovascular thrombectomy (EVT): Patients with blockage of a large intracranial vessel can benefit from a procedure called endovascular thrombectomy (EVT). This is done with the use of catheter which a highly specialized doctor (a neuro-interventionalist) navigates to the location of the clot causing the blockage and removes it with the use of specific equipment. Advanced neuroimaging studies are needed to determine the location of the clot and the viability of the affected brain tissue before EVT is done. The therapeutic time window for these procedures can extend from 0-6 hours and 6-24 hours from the time the stroke symptoms start, depending on the specific circumstances. Again, all actions need to happen very fast.
With timing of treatment so critical, it is important for those who know the person having the stroke to be aware of when the first symptoms were noticed and communicate this information with the EMS personnel and the treating physicians.
At the first signs of a stroke, call 9-1-1.
Dr. Panayiotis Mitsias is a vascular neurologist, specializing in stroke care, at Henry Ford Hospital in Detroit and Henry Ford West Bloomfield Hospital.
Note: Updated and re-edited from a post originally published May 2015.