Neurology and Neurosurgery

Stroke 101 and why it’s critical to call 911 for symptoms

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Are there different types of strokes? Can you have a stroke and not know it? When should you call 911 for symptoms? And what exactly is stroke first aid? Find out and save a life!


By Joshua Marcus, MD, Neurosurgery, Nuvance Health


What would you do if one side of your body unexpectedly went numb? How about seeing one side of your partner’s face droop or hearing a friend suddenly have difficulty talking? 


You may recognize these classic signs of a stroke, which is a life-threatening emergency. Other stroke symptoms might not be as well known. We also need more awareness about how critical it is to call 911 for a possible stroke.


Common reasons for not calling 911 are understandable, like being unsure about your symptoms and not wanting to be a burden. As a neurosurgeon who specializes in cerebrovascular diseases, including stroke, I know seconds count when it comes to preventing long-term disability and death.


Here’s what you need to know about the types of strokes, including silent ones, calling 911 and stroke first aid.



What causes a stroke?


Every time your heart beats, about 15% to 20% of your blood supply goes to the brain. Your brain is only about 2% of your body weight. However, your body prioritizes sending blood to the brain because it’s a powerhouse that needs ample oxygen and nutrients to function.


When the blood supply is interrupted, your brain cells can quickly die from a lack of oxygen and nutrients. An interruption can happen from a blockage in a blood vessel or a burst blood vessel. In fact, coronary artery disease as a result of plaque buildup is a major risk factor for stroke.


What are the three types of strokes?


There are three main types of strokes:


Ischemic stroke: An ischemic stroke is also called a “brain attack.” Like a heart attack, blood supply is blocked from the brain, cutting off its oxygen supply. An ischemic stroke is the most common type, accounting for about 87% of all strokes.


Diabetes is a risk factor for an ischemic stroke because it can damage blood vessels and put a kink in the supply chain of blood to the brain. Heart disease, high blood pressure and high cholesterol are risk factors, too, because these conditions narrow the arteries.


Hemorrhagic stroke: A hemorrhagic stroke occurs from bleeding in or around the brain. Blood vessel abnormalities, such as aneurysms and arteriovenous malformations (AVM), can rupture and cause a hemorrhagic stroke.



Transient ischemic attack: A transient ischemic attack (TIA) causes a temporary blockage of blood supply to the brain. Called a mini stroke, the blockage resolves itself. Symptoms may last for minutes to hours and usually resolve within 24 hours.


A TIA is a warning sign you could experience an ischemic stroke. Seek emergency care, even if your symptoms resolve. Although you may not need immediate treatment after a TIA, your doctors can examine you and order tests to find the underlying cause. If you can treat the cause, such as high blood pressure or arrhythmia (irregular heartbeat), you can lower your risk of experiencing a full-blown stroke.



Can you have a stroke and not know it?


You can have a stroke and not know it. Called a silent stroke, blood flow is blocked to an area of the brain, but it doesn’t cause symptoms. This happens when the affected area of the brain doesn’t control obvious functions like talking and walking.


At the time of the attack, a silent stroke can subtly affect movement and mental processing, such as thinking skills. Most people won’t know they had a silent stroke unless they have imaging of the brain for something else. A silent stroke can increase dementia risk because it damages a part of the brain. About 25% of people over age 80 have at least one such area of tissue death, called a “silent infarct,” in the brain, according to the American Stroke Association.



What are stroke symptoms?


Speaking of our brains, acronyms help us remember information by simplifying it for easier recall. Remember B.E.F.A.S.T. to recognize signs of stroke and call 911:


  • B — Balance: Loss of balance or coordination, dizziness

  • E — Eyes: Trouble seeing out of one or both eyes

  • F — Face: Facial weakness, uneven smile

  • A — Arm: Unable to lift both arms evenly, numbness, weakness

  • S — Speech: Difficulty speaking, slurred speech

  • T — Time: Call 911



Should you call 911 for stroke symptoms?


If you or someone else suddenly experience any stroke symptoms, call 911 right away!


Time is brain when it comes to stroke. The faster you are evaluated and treated for stroke, the greater your chance of making a full recovery. 


Stroke is a leading cause of disability and death, but it doesn’t have to be. By calling 911, emergency medical services (EMS) will start the rapid stroke response by:


  • Supporting your airway, breathing and circulation and giving you oxygen, if needed.

  • Evaluating you for stroke symptoms.

  • Interviewing anyone with you to determine when symptoms started, which affects treatment decisions.

  • Alerting the emergency department (ED) they will arrive with a possible stroke patient. The ED will initiate a stroke alert and be ready for you.

  • Quickly bringing you to the appropriate hospital capable of caring for stroke patients.


A stroke alert triggers doctors and nurses from emergency medicine, radiology, neurology, neurosurgery, pharmacy and more experts, who will evaluate you and initiate appropriate treatments as quickly as possible.


For these reasons, it is imperative to call 911 and not drive yourself or someone else experiencing stroke symptoms to the ED. 



Overcome hesitancy to call 911 for stroke symptoms


Do this if you are worried about calling 911 for stroke symptoms:


Say this to the 911 operator:


  • The address of your location.

  • You suspect you or someone is having a stroke and describe the symptoms, as simply and quickly as possible.

  • The time symptoms started.

  • Age, if known.

  • To speak with someone in your preferred language, say “Stroke, <your language> interpreter” and the operator will connect you with someone who can help. For example, “Stroke, Spanish interpreter.”

  • For privacy concerns, you can stay anonymous if you are calling about a bystander.


Know this if you are worried about the cost of an ambulance:


Your life matters and calling 911 is worth it. There are systems in place to help cover the cost of emergency care. The Emergency Medical Treatment and Labor Act is a federal law that requires anyone treated for an emergent condition in a hospital emergency department to be stabilized and treated, regardless of health insurance status or their ability to pay.


Most health plans should cover a portion of emergency services. Check with your health insurance provider about what coverage you have.


Lastly, Charity Care helps individuals and families with bills for medically necessary services.


Trust this if you are worried about bothering healthcare workers:


Listen, a stroke is no joke. Always call 911 if you or someone else shows signs of a stroke. Healthcare workers are here for you, whether it’s giving you peace of mind by ruling out anything serious, to treating you for a life-threatening condition.


Understand this if you are unsure about stroke symptoms:


While we recommend calling 911 for any stroke symptoms, it is important to understand what other conditions can mimic a stroke, including:


  • Low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia)

  • Migraine

  • Brain tumors

  • Multiple sclerosis

  • Seizures


If you have any of these conditions in your medical history, speak with your doctor for management strategies and to understand your unique stroke risk.



What is the first aid treatment for stroke?


You might wonder what to do after calling 911 if you are with someone showing signs of a stroke. Here is first aid for stroke:


  1. Call 911.
  2. Get them to a safe location and position, such as lying on a bed, couch or floor.
  3. Do not give them anything to eat or drink to avoid choking.
  4. Note the time symptoms started and monitor for changes.
  5. Check their airway, breathing and circulation if they lose consciousness.
  6. Gather their belongings, if they are easily accessible, such as their mobile phone and license. 
  7. Comfort them.

What happens if you have a stroke and are alone?


It’s good practice to prepare for emergencies before they happen. Turn on emergency alerts on your mobile devices, like your smartphone or smartwatch. In the event of an emergency, you can quickly contact EMS with the push of a button or voice command. 


Also, set up an emergency alert system with your family, friends or neighbors. For example, if they get a phone call or text from you with a unique code word, it means you’re having a medical emergency and need help.


If you experience stroke symptoms and are alone:


  • Call 911 right away.

  • Activate your personal emergency alert system. 

  • If you are inside a building, home or vehicle, unlock your door so EMS can reach you swiftly. 

  • Get to a safe location and position. 


Who is most at risk for stroke?


While stroke occurs more frequently in people aged 65 and older, it can happen to anyone at any age. And stroke is increasing in people under age 50. While we need more research to know why, it might be related to lifestyle. 


Speaking of lifestyle, being inactive or sedentary, eating an unhealthy diet, drinking excessive alcohol and smoking increase stroke risk.


Individuals with the following health conditions may also have an increased risk for stroke:


  • Arrhythmia, or an irregular heartbeat, such as atrial fibrillation (AFib) 

  • Coronary artery disease

  • High blood pressure

  • High cholesterol

  • Diabetes

  • Obesity


Other conditions may not be as well known, such as chronic inflammation in the body and chronic stress can increase stroke risk.



Women should speak with their doctor to determine their stroke risk before taking birth control pills or becoming pregnant. 



Everyone should speak with their doctor about their family history of stroke and other cerebrovascular disease, including aneurysms.


The good news? Many stroke risk factors are modifiable, meaning, you can lower your risk by living a healthy life through diet and exercise and managing chronic medical conditions.


The bottom line: If you take one thing away from this article, it’s to please call 911 if you or someone you’re with shows signs of stroke. Stroke is a leading cause of disability and death, but we can change that by recognizing symptoms, calling 911, executing stroke first aid and understanding stroke risk. Seconds count when it comes to stroke outcomes and being able to continue experiencing every moment that matters to you.


Dr. Joshua Marcus is the chief of neurointerventional surgery at Danbury Hospital, part of Nuvance Health.