How to respond to the signs of a stroke

Stroke is the fifth leading cause of death and a major cause of disability in adults in the United States. Stroke takes the lives of more than 165,000 Americans each year, according to the Centers for Disease Control and Prevention. On average, one American dies from stroke every 3.5 minutes.

These are startling statistics. But if you remember to act fast at the first signs of a stroke, you can increase the chances of survival for you or a loved one. Here’s what to do if you think someone is having a stroke. (Spoiler alert: Call 911.)

The basics of stroke

Stroke is caused when a part of the brain is deprived of blood flow and therefore doesn’t get enough oxygen. The result is that part of the brain either stops working properly or dies.

Stroke can happen in two ways:

• A blood clot in the brain causes what’s called an ischemic stroke. These account for 87 percent of all strokes.
• Bleeding in the brain causes a hemorrhagic stroke. This happens in about 13 percent of all strokes.

Understand B.E. F.A.S.T. to spot the signs of a stroke

Every minute counts when it comes to stroke. The sooner treatment starts, the better the chances of survival and recovery.

“We, as physicians, like to give [clot-busting] medication within four hours of stroke onset, because we know it works better and the outcomes are better,” says Peter Paganussi, MD, an emergency medicine doctor based in Virginia. “We really try to give it in under two hours, if we can.”

How can you tell if someone is showing signs of a stroke? Know the acronym B.E. F.A.S.T.:

• Balance: Is the person suddenly uncoordinated or having trouble with balance?
• Eyes: Is the person having suddenly blurred or double vision, or sudden, painless vision loss in either or both eyes?
• Face: Drooping or numbness on one side of the face is a common stroke sign. Ask the person to smile and see if the smile is uneven.
• Arms: Is there arm weakness? Ask them to raise both arms. Does one arm drift down?
• Speech: Slurred speech is also a stroke sign. Ask them to repeat a simple phrase, such as “The sky is blue.” Can they do it?
• Time: If any of these signs is present, call 911 immediately. Call even if the symptoms go away. There may have been a mini-stroke, which can warn of a bigger stroke to come.

Sometimes, a severe headache or vertigo (the feeling that the world is spinning around) can signal a stroke, too.

What to do—and what not to do

It bears repeating: Call 911. The sooner you alert healthcare professionals, the better.

“The biggest piece of advice I can give is to call 911 immediately and let the operator know it’s possibly a stroke,” says Jeff Wagner, MD, a neurologist with HealthONE Neurology Specialists in Englewood, Colorado. As soon as the symptoms start, check the time, so you’re able to tell the medical team, he adds.

You might think it’s faster to get in the car and head to the hospital on your own, but that certainly isn’t safe if you’re the one having symptoms. And if it’s another person you’re calling about, it’s better to wait for a medical crew. They will know which nearby hospital is best equipped to handle stroke. They can also call ahead to the emergency room so that providers there are ready and waiting.

What’s more, “paramedics can start doing treatments that can make a difference on the way to the hospital,” Dr. Wagner says.

Treatment should happen quickly

Some strokes are treated with a minimally invasive procedure to extract the clot. For most strokes, the most effective treatment is a blood thinner and clot-busting drug called recombinant tissue plasminogen activator (TPA). There are two types of TPA: alteplase and tenecteplase.

TPA is injected into a vein in the arm (also called an intravenous or IV injection). It’s more effective if given within a few hours after symptoms first start, and testing has to be done first to ensure that the benefits will outweigh the risks in a given patient. That’s why it is critical that stroke victims get to the hospital fast.