World Stroke Day on Oct. 29 is a time to raise awareness about the signs, symptoms, treatments and ways to prevent stroke. Each year, an estimated 15 million people around the globe experience stroke, according to the World Health Organization, with one-third resulting in death. That's why immediate stroke treatment is crucial.

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When the symptoms of stroke present, calling 911 and seeking care immediately is the most crucial step to prevent disability or death.

“We have excellent treatments to reverse stroke symptoms, but these treatments are incredibly time-dependent,” says Dr. Stephen English, a Mayo Clinic neurologist.

For an ischemic stroke, which occurs when blood flow to the brain is blocked, there are two main treatment options to restore blood flow.

The first treatment that we can potentially offer is a medication that helps to dissolve blood clots," says Dr. English. "The second stroke treatment is a treatment where we can intervene by placing a catheter, a small tube in your blood vessels, and navigate to that clot in your brain using an X-ray. Then, we can administer a device or use suction to help remove the blood clot."

Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Surgery may be needed to repair the rupture, remove blood in the brain and prevent swelling.

"We lower blood pressure to help prevent the growth of the bleeding, then we reverse issues that can contribute to further bleeding," says Dr. English. Surgery may be needed to repair the rupture, remove blood in the brain and prevent swelling.

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Dr. Gyanendra Kumar, a Mayo Clinic neurologist not involved in the study, says it's long been known that respiratory infections increase the risk of stroke in the days following infection.

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Flu symptoms can come on suddenly, including cough, sore throat, fatigue and sometimes a fever.

"Respiratory infections, in the first three days after the onset of the infection, increase the risk of a stroke," says Dr. Kumar.

There are several theories on why getting the flu might increase the chances of stroke.

"Some of these are increased hypercoagulable state, a transient period where you have a greater predisposition to form clots," says Dr. Kumar.

When clots form, they can block blood flow to the brain.

There are two broad subtypes of strokes: the ischemic kind, which is the clotting kind of stroke, and the hemorrhagic, or the bleeding type of stroke. The vast majority of strokes, close to 90%, are ischemic strokes," he explains.

A stroke is a medical emergency. That's why reducing risks are so essential, and the flu shot may be another tool.

"This has the potential to prevent clotting disorder and manage stroke, potentially," says Dr. Kumar.

• Mayo Clinic Minute: Why pregnant women need flu shots.
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For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed.

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World Stroke Day is Oct., 29. Almost 800,000 people in the U.S. suffer from stroke annually. Stroke remains a leading cause of death worldwide and is the primary cause of disability in the U.S.

A stroke can occur when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen. Within minutes, brain cells begin to die. 

"A stroke is a medical emergency. Knowing the signs and symptoms of stroke, and seeking prompt medical attention, can make all the difference in terms of survival and recovery," says Dr. David A. Miller, director of the Comprehensive Stroke Center at Mayo Clinic in Florida.

Signs of stroke include:

• Sudden numbness or weakness in the face, arms or legs, especially on one side of the body.
• Sudden confusion, trouble speaking or difficulty understanding speech.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or lack of coordination.
• Sudden severe headache with no known cause.

Though the risk for stroke rises with age, Dr. Miller says anyone at any age can suffer a stroke.

Faye Baracats, a pharmacist with no known risk factors for stroke, was only 41 when she was diagnosed with a hemorrhagic stroke after feeling dizzy and developing a headache while at work.  "I thought I was just dehydrated," says the mom who spent three weeks in the hospital and is now a stroke advocate. Read her story.

Stroke is the leading cause of disability in the U.S., often due to the fact that people do not recognize the severity of their symptoms. "If any of these symptoms happen, no matter how old you are, don't wait; seek medical attention immediately," says Dr. Miller.

"Stroke is a medical emergency. Though you may be inclined to ignore certain symptoms, the faster we can diagnose and treat a stroke, the better the outcome," he adds.

Reduce your risk for stroke by focusing on lifestyle changes, including managing blood pressure, diabetes and cholesterol.

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• "Mayo Clinic Minute: Artificial intelligence may help some stroke patients"

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A pharmacist for a regional grocer, health and wellness was the foundation of Faye Baracats' life. She advocated daily to her patients the importance of living a healthy lifestyle, eating well, and exercising.

Faye, 42, and mom to two teenagers, also practiced what she preached. She followed a Mediterranean diet and exercised regularly.

During her lunchbreak one day in August 2020, Faye suddenly felt unwell.

"I felt a rush of blood in the right side of her head. I thought I just got up too fast," she says. "But then I began getting dizzy and a headache came on."

In the midst of the COVID-19 pandemic, the store was short-staffed, and Faye says she never thought her symptoms were something serious.

"It never crossed my mind. I don't have high blood pressure, or high cholesterol and I'm not a diabetic. I thought I'm stressed, exhausted and maybe I'm dehydrated."

She asked her coworker to call her daughter, hoping to go home and sleep it off.

When her daughter arrived, though, Faye's symptoms has worsened. She was incoherent, her words were not making sense and she had trouble standing.

Her daughter drove her to Mayo Clinic, which has a Comprehensive Stroke Center, where doctors diagnosed Faye as having a hemorrhagic stroke. A blood vessel had burst in her brain.

It wasn't until Faye woke up in the ICU that she became aware of how life threatening her situation had been. "I was in and out of consciousness, but I know I'm lucky to be alive," says Faye, who spent 21 days in the hospital before being released.

Today, she's back at work and though trying to be more mindful and slow down her pace, she's more passionate than ever about health and wellness. But now, advocating for stroke awareness. "We need more education in the workplace about stroke symptoms and awareness," Faye says.

"The shock of not knowing what was happening makes me realize how many lives can be saved by recognizing the symptoms of stroke because it never occurred to me it could be a stroke. I want others to find hope in my story and, learn how to identify a stroke."

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The blood biomarker is a protein known as neurofilament light (NFL). The protein is abundant in neurons found in the brain. When neurons are injured following a stroke or from other neurological diseases, NFL is released into cerebrospinal fluid that bathes the brain and then into the blood. The amount of NFL released is indicative of neuron injury in the brain, according to the research team. Stroke is a leading cause of death, but symptoms vary widely from temporary and nondisabling, to severe, long-term impairment.

"Estimating the severity of a stroke and how well a person is expected to recover is important to patients and their loved ones," says Tania Gendron, Ph.D., first author of the paper.

"Reliably predicting a patient’s prognosis is also important to their care, as it informs treatment and rehabilitation decisions. We sought to determine whether the amount of NFL in patients’ blood could be used to predict their prognosis after a stroke — be it an ischemic stroke, which occurs when blood flow to the brain is blocked by a clot, or a hemorrhagic stroke, which occurs when a weak blood vessel bursts and bleeds into the brain."

The retrospective study involved participants who enrolled in, and donated blood for, the Mayo Clinic in Florida Familial Cerebrovascular Diseases Registry directed by James Meschia, M.D., a neurologist and chair of the Department of Neurology at Mayo Clinic in Florida. Researchers used an investigative blood test to measure NFL concentrations in blood collected from 314 patients following a stroke and in blood from 79 healthy individuals. This allowed them to determine whether NFL is elevated after a stroke. They also examined whether NFL levels are indicative of stroke severity and eventual recovery. To do so, the researchers examined correlations between NFL levels and the degree of brain injury, in addition to neurological, functional or cognitive status of patients at the time their blood was collected. The study also examined whether NFL levels could anticipate future recovery by reliably predicting post-stroke outcomes and survival. To verify their findings, the researchers used a similar approach to evaluate NFL as a prognostic biomarker in two additional groups of stroke patients.  

The blood samples and clinical information were provided by clinical research authors on the paper from Mayo Clinic, University of Pennsylvania, Yale University, Massachusetts General Hospital and Washington University. 

"We discovered that blood levels of NFL do predict stroke severity," says Leonard Petrucelli, Ph.D., one of the senior authors on the paper. "We found that higher NFL levels forecast worse functional outcomes and shorter survival time after a stroke. We found this to be the case for ischemic stroke and hemorrhagic strokes. Our study establishes NFL as a promising prognostic biomarker for stroke." Dr. Petrucelli is the Ralph B. and Ruth K. Abrams Professor of Neuroscience.

Currently, brain imaging is used to determine damage from a stroke. While a blood test for NFL is not yet available in the clinical setting, researchers hope that in the future, physicians may be able to decrease use of imaging — using instead an NFL blood test to better determine the best course of treatment — as well as boost clinical trials with better matched groups of patients based on degree of brain injury and severity of symptoms.

"We are hopeful that our findings will ultimately change how patients are treated by using NFL biomarkers in clinical trials to allow for more rapid and reliable detection of therapeutic effects," says Dr. Meschia. "Our findings may also help us better plan rehabilitation needs for patients who need it most and for longer term."

This research was funded by the National Institutes of Health, Mayo Clinic, and the Donald G. and Jodi P. Heeringa family. See the published paper for a full list of authors, funding sources and competing interests.

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Stroke is the fifth-leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. It's also a leading cause of disability. But, when treated soon after symptoms start, the effects of stroke often can be lessened or reversed.

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. Prompt treatment is crucial because early action can minimize brain damage and potential complications.

Symptoms

Watch for these signs and symptoms if you think you or someone else may be having a stroke. Pay attention to when the signs and symptoms begin. The length of time they have been present can affect your treatment options:

• Trouble with speaking and understanding.
  You may experience confusion. You may slur your words or have difficulty understanding speech.
• Paralysis or numbness of the face, arm or leg.
  You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often happens just on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.
• Trouble with seeing in one or both eyes.
  You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
• Headache.
  A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke.
• Trouble with walking.
  You may stumble or experience sudden dizziness, loss of balance or loss of coordination.

Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think "FAST" and do the following:

• Face. Ask the person to smile. Does one side of the face droop?
• Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up?
• Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
• Time. If you observe any of these signs, call 911 immediately.

Call 911 or your local emergency number right away. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.

Learn more about strokes and find more health and medical information on mayoclinic.org. This article is written by Mayo Clinic staff.

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Within a few months, Dr. Freeman, along with neurologist Dr. James Meschia, and stem cell biologist Dr. Abba Zubair, will begin a unique, U.S. Food and Drug Administration-approved study to see if stem cells can help hemorrhagic stroke patients heal. "We used to think nerve cells cannot regrow, but we believe differently now," says Dr. Zubair. "I think we are in an era of excitement, where stem cells can be used almost like a drug."

The Mayo Clinic team has already had success repairing injured brain tissue with stem cells in rodents, which helped pave the way for this next phase of testing in people. Here’s Dennis Douda for the Mayo Clinic News Network.

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Hemorrhagic Stroke

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DEAR MAYO CLINIC: Is it always possible to figure out what causes a stroke? My husband had a stroke two months ago at the age of 38. He has mostly recovered now, but his doctors never pinpointed a cause. I want him to see a specialist to make sure that nothing else is wrong. Is that a good idea?

ANSWER: Doctors often can identify the cause of a stroke, but not always. Before deciding that the cause of a stroke can’t be found, however, people who have had a stroke should receive a detailed and comprehensive evaluation to investigate all potential causes. That’s particularly important in younger people, such as your husband. Your suggestion that he see a stroke specialist is a good one.

A stroke happens when the blood supply to part of the brain is interrupted or significantly reduced, depriving brain tissue of oxygen and nutrients and causing brain cells to die. There are two basic types of strokes. By far, the most common strokes are those caused as a result of blood clots in blood vessels of the brain. These are called ischemic strokes. The clots may form in other parts of the body and travel to the brain, or they can be due to narrowing of arteries in the brain that suddenly clot off and stop blood flow. A much less common, but no less severe, type of stroke is a result of bleeding into or around the brain. This is a hemorrhagic stroke.

When investigating the underlying cause of a stroke, doctors take a number of issues into consideration. Factors that can raise the risk for a stroke include aspects of a person’s lifestyle, such as being physically inactive, being overweight or obese, drinking heavily or smoking. Medical conditions can play a role in raising stroke risk, too. High blood pressure, high cholesterol, diabetes, a sleep disorder called chronic sleep apnea, and cardiovascular diseases (such as heart failure and abnormal heart rhythm) can all be contributing factors in the development of a stroke.

An evaluation after a stroke should include tests that can help identify the medical conditions that are common causes of stroke. The tests may include a brain CT or MRI scan, imaging tests of the heart and a variety of blood tests.

For someone like your husband who is younger than age 50, there are several additional conditions that may lead to a stroke that are uncommon in older adults, including certain autoimmune disorders, hypercoagulable states and metabolic disorders. An evaluation following a stroke in younger people needs to include a thorough assessment for these conditions, as well.

Because your husband’s exams so far have not uncovered the cause of his stroke, making an appointment to see a stroke specialist is a wise next step. If he seeks additional evaluation with a specialist and the specialist still cannot identify the source of the stroke, then it is reasonable to assume that the cause won’t be found. In that case, the stroke is labeled “cryptogenic,” and no further evaluation is pursued. About 30 percent of strokes fall into that category.

Even if no specific cause is identified, your husband can take steps to lower his risk of another stroke. They include exercising regularly; staying at a healthy weight; not smoking; drinking only moderate amounts of alcohol; keeping chronic medical conditions, such as diabetes, under control; and maintaining his blood pressure and cholesterol at healthy levels. — Dr. Maria Aguilar, Neurology, Mayo Clinic, Scottsdale, Ariz.

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Hemorrhagic Stroke

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