Decoding Strokes

May is stroke awareness month — a time to highlight strokes, their causes, and their impact. Strokes rank among the leading causes of death and disability in Oklahoma and across the United States, affecting approximately 800,000 people each year.

In Oklahoma, adults aged 55 and older, particularly those in Black, Native American, and Hispanic communities, face a greater risk of stroke and associated complications. Conditions such as hypertension, diabetes mellitus, atrial fibrillation, hyperlipidemia, smoking, and hormone therapy can elevate this risk.

But did you know that many strokes can be prevented through healthy lifestyle choices and effective management of medical conditions?

“Stroke is often preventable,” said neurologist, Dr. Jorge Ortiz-Garcia, M.D., assistant professor in the Department of Neurology, and Chief of the Section of Critical Care Neurology at the University of Oklahoma College of Medicine. “At OU Health, we believe prevention is our most powerful tool. By focusing on healthy habits such as managing blood pressure, staying active, eating well, and avoiding tobacco, we can reduce the risk of stroke and protect the brain before damage occurs.”

Not all strokes are the same. Understanding the different types of strokes, how to prevent them, and how to recognize when you or someone you love is having one will help you to live a longer and healthier life.

Understanding Strokes

A stroke is a “brain attack”. It happens when blood can’t get to the brain or a blood vessel bursts, which causes brain cells to die. There are two different ways this can happen, leading to the two main causes of strokes. Ischemic strokes happen when a blood vessel in the brain gets blocked (cerebral infarction) or there a mini-blockage that doesn’t last long (transient ischemic attacks, or TIA). Hemorrhagic strokes happen when there is bleeding inside the brain (intracerebral hemorrhage) or bleeding around the brain (subarachnoid hemorrhage). Each kind of stroke has different signs, how it affects someone, and how doctors treat it.

Every minute counts during a stroke because the brain loses millions of cells rapidly, making immediate treatment essential to reduce damage and improve recovery.

Types of Ischemic Stroke

Ischemics and transient ischemic attack (TIA) are both types of ischemic strokes.

Ischemics

An ischemic stroke occurs when a blood clot blocks a blood vessel in the brain, cutting off the supply of oxygen and nutrients. This type of stroke can cause significant brain damage and is considered a medical emergency. Approximately 85% of all strokes are ischemic, making it the most common type of stroke.

• Ischemics Stroke Symptoms: Sudden weakness or numbness, difficulty speaking, vision issues, dizziness, severe headache, and confusion.
• Typical Treatment: Clot-busting drugs (alteplase or tenecteplase) should be administered within the first 4.5 hours of stroke onset. In selected cases, surgical procedures, such as mechanical thrombectomy, may be performed within 24 hours of stroke onset to remove the clot, and blood thinners are used for long-term prevention.
• Recovery: Physical, occupational, and speech therapy; lifestyle modifications; regular follow-ups.

Transient Ischemic Attack (TIA)

A Transient Ischemic Attack (TIA), often called a "mini-stroke," is a special type of ischemic stroke that occurs when blood flow to the brain is temporarily blocked. This leads to stroke-like symptoms that typically last only a few minutes and do not cause permanent damage. TIAs are relatively common, with about 240,000 people in the United States experiencing one each year.

• TIA Stroke Symptoms: Transient, or temporary weakness or numbness, difficulty speaking, vision issues, dizziness, severe headache, and confusion.
• Typical Treatment: antiplatelet therapy, blood thinners, and statins.
• Recovery: Lifestyle changes and regular check-ups are required.

Types of Hemorrhagic Stroke

Hemorrhagic stroke includes both intracerebral hemorrhage and subarachnoid hemorrhage.

Intracerebral Hemorrhage

Intracerebral hemorrhage is a type of stroke that happens when a blood vessel in the brain suddenly bursts and bleeds into the brain. It is typically caused by high blood pressure or weakened blood vessels.

Intracerebral hemorrhages account for 10% of all strokes. While less common than ischemic strokes, they are linked to higher mortality and disability rates.

• Hemorrhagic Stroke Symptoms: Severe headache, nausea, vomiting, loss of consciousness, numbness or weakness, confusion, and vision problems.
• Typical Treatment: Medications to control blood pressure, surgery to remove the blood and lower the pressure in the brain, and supportive care.
• Recovery: Physical, occupational, and speech therapy; regular check-ups; and lifestyle changes.

Subarachnoid Hemorrhage

A subarachnoid hemorrhage is a type of stroke caused by bleeding in the space between the brain and the tissues that cover it. It Is often caused by a ruptured abnormal blood vessel with an aneurysm. It accounts for about 5% of all strokes.

• Subarachnoid Hemorrhage Stroke Symptoms: Severe headache, nausea, vomiting, loss of consciousness, numbness or weakness, confusion, and vision problems.
• Typical Treatment: Medications for blood pressure management and surgical options for repairing ruptured blood vessels — either through aneurysmal clipping via open surgery or coil embolization via endovascular intervention (cerebral angiogram); manage vasospasm, intracranial pressure, and provide support care.
• Recovery: Physical, occupational, and speech therapy; regular check-ups; lifestyle changes.

Stroke Prevention

Many strokes can be prevented by making healthy lifestyle choices and managing medical conditions. The American Heart Association’s Life’s Essential 8 outlines key strategies to reduce your risk:

• Eat Better: Focus on a balanced, nutritious diet rich in fruits, vegetables, whole grains, and lean proteins.
• Be More Active: Aim for at least 150 minutes of moderate physical activity each week.
• Quit Tobacco: Avoid smoking and exposure to secondhand smoke.
• Get Healthy Sleep: Aim for 7–9 hours of quality sleep per night.
• Manage Weight: Maintain a healthy body weight to reduce damage to your heart and brain.
• Control Cholesterol: Maintain your cholesterol levels within a healthy range through diet, activity, or medication.
• Manage Blood Sugar: Prevent or control diabetes to protect your blood vessels.
• Manage Blood Pressure: High blood pressure is the leading cause of stroke; know your numbers and take action.

Importance of Regular Health Check-Ups and Monitoring

Getting regular checkups is essential for lowering your risk of stroke. This includes keeping an eye on blood pressure and blood sugar and managing conditions like diabetes and high cholesterol. New technologies, like remote patient monitoring (RPM), lets people track their blood pressure and blood sugar from home. Healthcare providers see these results in real-time and can step in quickly if needed.

BE FAST
The BE-FAST acronym will help you identify the main stroke symptoms:

• B: Balance - Sudden loss of Balance
• E: Eyes - Sudden loss or changes Eye vision
• F: Facial drooping – One side of the face may droop or feel numb
• A: Arm or leg weakness – Difficulty raising one arm or leg that drifts downward
• S: Speech difficulties – Slurred speech or trouble speaking
• T: Time to get help immediately – call 911 and note the time when the person last seemed normal

If you or a loved one experience these signs, act quickly in seeking medical treatment by calling 911. Every second counts. Acting quickly can save lives.

“At OU Health, we are proud to be a Comprehensive Stroke Center, offering the highest level of stroke care available,” said Dr. Ortiz-Garcia. “From rapid diagnosis with advanced imaging technology to cutting-edge treatments like mechanical thrombectomy and specialized neurocritical care, our expert team is equipped to respond quickly and effectively, giving patients the best possible chance at recovery.”

Learn more about OU Health’s comprehensive stroke program and team of experts.