How to identify and respond to a stroke

Imagine you’re at a dinner party and the person sitting across the table from you suddenly stops making sense, and not because of the glass of wine in their hand. Then maybe one side of their face starts to droop. The person you’re looking at with growing concern might be feeling dizzy or may have trouble using their fork. They might suddenly be unable to move or feel half their body or see anything to their left.

They might be having a stroke. The American Stroke Association suggests remembering the acronym FAST, which stands for face drooping, arm weakness, speech difficulty, and time to get help quickly.

The aforementioned symptoms may not all happen at once and they may be more subtle. Other signs include slurring one’s words, losing the ability to speak altogether, or not recognizing parts of their body. These symptoms might not even mean someone is having a stroke at all, as they can be caused by seizures, injuries, psychological disorders, or low blood pressure. Whether or not you or the person experiencing symptoms thinks it’s a stroke, it is important to rule it out as strokes can leave someone permanently disabled.

The best thing someone can do in a situation like this, whether at a dinner party or alone at home, is immediately call 911.

“If there are stroke-like symptoms, I recommend calling 911,” says Sasha Yakhkind, a clinical assistant professor in the Department of Neurology and Neurosurgery at Tufts University School of Medicine and a physician who works in the Neurocritical Care Unit at Tufts Medical Center. “I know it can make things scary, but that’s the best way to get to a hospital that can address stroke symptoms as quickly as possible.”

A robust system of pre-hospital stroke care exists to address the time-sensitive nature of these sudden health crises. Calling 911 for Emergency Medical Services (EMS) sets the patient up for the quickest and most appropriate care and takes the burden of figuring out what to do and where to go out of the hands of the patient or their loved ones.

EMS professionals are trained to recognize signs of stroke. If a stroke is suspected, the patient will be routed directly to the nearest hospital certified as a stroke center. On their way to the stroke center, the EMS team will call the hospital to let the medical team know they are about to receive a potential stroke patient. The emergency medicine, neurology, neurosurgery, pharmacy, radiology, and neurocritical care teams are mobilized so the patient can be treated as quickly as possible.

“Time is brain. Every second, neurons are dying, so we need to get blood back to the brain as quickly as possible,” Yakhkind says.

Returning blood to the brain is necessary when a patient has an ischemic stroke, characterized by a clot in the blood vessels. Hemorrhagic stroke is the second most common type of stroke and occurs when blood vessels in the brain burst and bleed. What happens next depends on the type of stroke.

Upon arrival at the hospital, vital signs and blood sugar levels are checked and a doctor evaluates the patient on the way to the CT scan. High or low blood sugar can mimic stroke-like symptoms, which can be resolved after the imbalance is corrected. The patient’s blood pressure will be adjusted depending on what is seen on the CT scan. If there is bleeding in the brain, blood pressure is strictly controlled to prevent the bleeding from getting worse. If there is not, a blood clot can potentially be dissolved with medication if the patient meets certain criteria. In certain cases, the clot can be surgically removed.

Most likely, the patient will then be admitted to the neuro ICU. There, the medical team works to stabilize the patient and begins to determine what caused the stroke. Sometimes, strokes are so severe that patients are unable to breathe without a ventilator or suffer damage to other organs. The neuro ICU team is equipped to take care of the entire patient, not just their brain injury.

“I interact with patients’ loved ones a lot because it’s a very scary thing to have a family member in the ICU. Our goal is to try to minimize the secondary trauma that can happen from that experience. The questions from families vary a lot, but the biggest commonality is fear,” Yakhkind says.

There is a wide spectrum of outcomes for patients depending on the severity of the stroke, the location of the stroke in the brain, the health of the patient, and how quickly the patient was treated. Some patients’ symptoms completely or almost completely resolve after surgery or medication. These patients can sometimes go home one or two days after they arrived and should follow up with a neurologist to work on preventing future strokes.

At the other end of the spectrum are patients who experience severe brain damage that compromises their ability to move and communicate. While some symptoms of strokes can improve within three to six months as the brain rewires and reorganizes itself, some patients are left with severe disability.

“No matter how uncomfortable it may feel, talking to family members about what they would want if something like this were to happen ahead of time allows families to have more closure if the unthinkable comes to pass,” Yakhkind says. “The goal is to be prepared and to avoid the worst-case scenario.”

Yakhkind emphasizes that there is a very good system and tools in place to turn some devastating strokes into miraculous recoveries.

“The first step is recognition, and that starts with you,” she says.

Imagine you’re at a dinner party and the person sitting across the table from you suddenly stops making sense, and not because of the glass of wine in their hand. Then maybe one side of their face starts to droop. The person you’re looking at with growing concern might be feeling dizzy or may have trouble using their fork. They might suddenly be unable to move or feel half their body or see anything to their left.

They might be having a stroke. The American Stroke Association suggests remembering the acronym FAST, which stands for face drooping, arm weakness, speech difficulty, and time to get help quickly.

The aforementioned symptoms may not all happen at once and they may be more subtle. Other signs include slurring one’s words, losing the ability to speak altogether, or not recognizing parts of their body. These symptoms might not even mean someone is having a stroke at all, as they can be caused by seizures, injuries, psychological disorders, or low blood pressure. Whether or not you or the person experiencing symptoms thinks it’s a stroke, it is important to rule it out as strokes can leave someone permanently disabled.

The best thing someone can do in a situation like this, whether at a dinner party or alone at home, is immediately call 911.

“If there are stroke-like symptoms, I recommend calling 911,” says Sasha Yakhkind, a clinical assistant professor in the Department of Neurology and Neurosurgery at Tufts University School of Medicine and a physician who works in the Neurocritical Care Unit at Tufts Medical Center. “I know it can make things scary, but that’s the best way to get to a hospital that can address stroke symptoms as quickly as possible.”

A robust system of pre-hospital stroke care exists to address the time-sensitive nature of these sudden health crises. Calling 911 for Emergency Medical Services (EMS) sets the patient up for the quickest and most appropriate care and takes the burden of figuring out what to do and where to go out of the hands of the patient or their loved ones.

EMS professionals are trained to recognize signs of stroke. If a stroke is suspected, the patient will be routed directly to the nearest hospital certified as a stroke center. On their way to the stroke center, the EMS team will call the hospital to let the medical team know they are about to receive a potential stroke patient. The emergency medicine, neurology, neurosurgery, pharmacy, radiology, and neurocritical care teams are mobilized so the patient can be treated as quickly as possible.

“Time is brain. Every second, neurons are dying, so we need to get blood back to the brain as quickly as possible,” Yakhkind says.

Returning blood to the brain is necessary when a patient has an ischemic stroke, characterized by a clot in the blood vessels. Hemorrhagic stroke is the second most common type of stroke and occurs when blood vessels in the brain burst and bleed. What happens next depends on the type of stroke.

Upon arrival at the hospital, vital signs and blood sugar levels are checked and a doctor evaluates the patient on the way to the CT scan. High or low blood sugar can mimic stroke-like symptoms, which can be resolved after the imbalance is corrected. The patient’s blood pressure will be adjusted depending on what is seen on the CT scan. If there is bleeding in the brain, blood pressure is strictly controlled to prevent the bleeding from getting worse. If there is not, a blood clot can potentially be dissolved with medication if the patient meets certain criteria. In certain cases, the clot can be surgically removed.

Most likely, the patient will then be admitted to the neuro ICU. There, the medical team works to stabilize the patient and begins to determine what caused the stroke. Sometimes, strokes are so severe that patients are unable to breathe without a ventilator or suffer damage to other organs. The neuro ICU team is equipped to take care of the entire patient, not just their brain injury.

“I interact with patients’ loved ones a lot because it’s a very scary thing to have a family member in the ICU. Our goal is to try to minimize the secondary trauma that can happen from that experience. The questions from families vary a lot, but the biggest commonality is fear,” Yakhkind says.

There is a wide spectrum of outcomes for patients depending on the severity of the stroke, the location of the stroke in the brain, the health of the patient, and how quickly the patient was treated. Some patients’ symptoms completely or almost completely resolve after surgery or medication. These patients can sometimes go home one or two days after they arrived and should follow up with a neurologist to work on preventing future strokes.

At the other end of the spectrum are patients who experience severe brain damage that compromises their ability to move and communicate. While some symptoms of strokes can improve within three to six months as the brain rewires and reorganizes itself, some patients are left with severe disability.

“No matter how uncomfortable it may feel, talking to family members about what they would want if something like this were to happen ahead of time allows families to have more closure if the unthinkable comes to pass,” Yakhkind says. “The goal is to be prepared and to avoid the worst-case scenario.”

Yakhkind emphasizes that there is a very good system and tools in place to turn some devastating strokes into miraculous recoveries.

“The first step is recognition, and that starts with you,” she says.