Prisma Health On Call: Answers to your stroke questions

This month, we’re connecting readers to the stroke specialists at Prisma Health. | Photo provided by Prisma Health

Welcome back to Prisma Health On Call, our Q+A series that connects you, our readers, to the healthcare professionals at Prisma Health.

This month, Prisma Health’s stroke specialists are here to answer your questions related to stroke — including those about hereditary risk, tips for preventing stroke, and the most important things to know.

See the full Q+A below. (Big thanks to Forrest J. Lowe, MD, Neel N. Shah, MD, and Joseph P. Hanna, MD, for their knowledge + expertise.)

Q: I recently heard about a stroke patient getting to the hospital fast enough to have their “stroke reversed.” What does that mean and how is it possible to reverse a stroke?

A: If you get to the hospital within 4.5 hours of stroke symptom onset, a medication that dissolves the clots that cause strokes can potentially be given to reverse stroke symptoms. The blood-clot-busting medication is time sensitive, which is why you must get to the nearest hospital immediately after symptom onset. 

Q: If my doctor says I am in generally good health, what should I be doing to prevent a stroke? Are there early warning signs to be aware of?

A: Avoiding smoking, controlling high blood pressure, eating a healthy diet (avoiding fast food) that is balanced and low in salt, and getting daily aerobic exercise are all ways to decrease your risk of stroke. 

Early signs of stroke are referenced by the BE FAST acronym:

BBalance (loss of coordination)
EEyes (vision change that is sudden in onset)
FFace (facial droop)
AArms (limb weakness of arm or leg)
SSpeech (slurred speech or inability to speak or understand)
TTime (immediately call 911 and get the hospital)

Q: What’s the difference between a mini stroke and a stroke?

A: A “mini stroke” is the common term for a TIA (Transient Ischemic Attack). TIAs occur in the same way as a stroke, which is due to blockages to blood vessels in the brain resulting in symptoms similar to a stroke. The difference between a TIA and a stroke is that during a TIA blood flow returns to the part of the brain deprived of oxygen and does not result in permanent damage. During a stroke the symptoms do not resolve and permanent damage is done due to lack of oxygen to brain tissue. 

Q: How do you know if you have had a mini stroke?

A: A “mini stroke” (or TIA) is difficult to diagnose without a proper evaluation by a Neurologist. The best course of action is to call 911 when symptoms start and be seen at your nearest hospital to ensure you are quickly evaluated to prevent worsening of your symptoms. 

Q: My father had a hemorrhagic cerebral stroke. I’m 31. Is this type of stroke hereditary? What can I do to minimize my risk?

A: ​​There are many types of hemorrhagic stroke, but genetic/hereditary causes tend not to be very common. The most significant risk factors for hemorrhagic stroke are high blood pressure and smoking. Addressing these two risk factors would be the best way to reduce your risk.

Q: Are most strokes deadly? What’s the most important thing to do if you think someone is having a stroke?

A: Not all strokes are deadly, but the most important thing to do for someone you think may be having a stroke is to call 911 so the patient can be immediately seen by a Neurologist. 

Q: What should my physician(s) be monitoring to assess my stroke risk?

A: Blood pressure is the most important treatable risk for stroke and should be assessed frequently until it is within the range that your physician believes is best to mitigate stroke risk. Serum bad cholesterol (or LDL) should also be assessed + reduced either with diet or medications until below a desired level. Finally, diabetes mellitus control lessens stroke risk when well-controlled. Your physician should also inquire whether you are exercising, eating well, and sleeping adequately. If you are overweight, a structured diet with a goal of weight reduction should be offered.

Q: How can you tell if someone with dementia is having a stroke? My mom had a stroke but had none of the physical signs — she only had a decrease in her mental capacity, which just seemed like a step down in her dementia.

A: ​​Patients with dementia may not be able to communicate like you or I that there is something wrong. Even though dementia is a slowly progressive condition, a sudden decline in cognition is reason for alarm; therefore, seeking medical attention is necessary.

Q: I have had two “mild” strokes preceded by migraines. Yesterday I had several dizzy spells which I thought were vertigo. Can dizziness be a sign of stroke?

A: Yes, dizziness in several forms can be a sign of a stroke. Stroke experts suggest seeking care for unexplained dizziness.

Q: How can you tell the difference between Bell’s palsy and a stroke?

A: Bell’s palsy is a non-traumatic injury to the facial nerve that affects the facial muscular strength above + below the eye. A stroke usually only affects facial strength below the eye resulting in milder facial weakness. Taste and hearing may also be impacted by Bell’s palsy, but is spared with stroke.*