Could It Be a Stroke?
There are many signs of stroke beyond facial drooping and speech difficulty
About a year and a half ago, my wife, Jules, called me at work to say she needed me to take her to an urgent care clinic. She was recovering from a cold and some minor sinus congestion and was feeling off-balance when she walked. We wondered if that could be due to a sinus or ear infection. She also had numbness in a part of her left leg.
I left work early and drove her to the urgent care clinic, where after an examination, the physician concluded the balance issue probably was due to an ear or sinus infection. She didn’t say much about the leg numbness and sent us home with antibiotics.
Three days later, Jules — who was not working at the time and about to start training for a new job — texted me to come home right away. She was on the floor in our apartment and could barely move. I called 911, and she was taken by ambulance to a hospital emergency room, where the physicians determined she had a stroke in the cerebellum part of her brain.
We Never Considered Stroke
Jules was 54. She had high blood pressure but was on medication. Other than that, she was in good health; pretty active, not overweight and ate a healthy diet.
What's more, like many people, we knew very little about stroke and its signs and symptoms. We never considered that someone her age could have a stroke. In fact, even the physician who examined Jules at the urgent care clinic missed the stroke, perhaps because of Jules’ age.
“If a person is in their 70s or 80s and experiences sudden balance issues or numbness in a part of their body, the red flags go off,” says Dr. Robert Brown Jr., a neurologist at the Mayo Clinic in Rochester. “But the younger the person is, the less inclined we are to think it’s a stroke.”
Yet, a stroke can happen at any age, and “it’s very important that we make people aware of this because we have early acute treatments for stroke that can work very well,” Brown says.
There are two types of stroke, ischemic and hemorrhagic. Ischemic strokes are much more common, accounting for about 87 percent of all cases. In an ischemic stroke, a fatty deposit, or clot, obstructs a blood vessel supplying blood to the brain. The clot can develop at the location where it eventually blocks the blood vessel, or it can form in another location — usually the heart or large arteries in the upper chest and neck. In the latter case, the clot can break loose and travel to the brain, where it can block a smaller blood vessel.
In a hemorrhagic stroke, a weakened blood vessel in the brain ruptures and bleeds into the surrounding tissue. The American Stroke Association (ASA) and National Stroke Association (NSA) websites offer detailed information, including diagrams and animations, about strokes and how they affect people.
There Are More Signs Than 'FAST'
In their efforts to raise awareness about stroke, both the ASA and NSA promote the acronym FAST. It stands for Facial drooping, Arm weakness, Speech difficulty and Time to call 911. It’s a great tool, but there are many more signs and symptoms of stroke. In fact, Jules had none of the FAST signs.
“FAST is a great way for people to remember the most common signs of stroke, but it by no means covers all the signs and symptoms,” Brown says. “People should know that if they, or someone they’re with, experiences a sudden onset of having trouble doing something they normally would be able to do, it’s possible that it could be a stroke. Things like sudden confusion; sudden weakness or numbness in the face, arm or leg; trouble with their vision; sudden difficulty walking or speaking or a sudden severe headache.”
Time is Brain
If a stroke is recognized early, there are acute treatments that can be very effective, depending on the type of stroke. As health care professionals say, “time is brain,” meaning the longer a person goes without treatment, the more damage a stroke can cause to the brain. Early recognition and treatment is crucial. Acute treatments include “clot-busting” drugs, and thrombectomy, in which a catheter is threaded from the groin up to the brain to remove a clot in an artery.
“The key is to treat as early as possible,” Dr. Brown says.
