my friend had a stroke and i didn't call 9-1-1

when i think of a stroke, i imagine slurred speech, a droopy face and maybe the inability to move an arm or leg. in fact, i know the heart & stroke foundation’s fast rule for identifying stroke: face drooping, can you lift your arms, is your speech slurred or jumbled, and time — call 9-1-1.so when my friend called to say he was feeling a little funny, that he was having trouble focusing his eyes and that he had a headache, i didn’t think of a stroke. he had had a stressful day, after all. he was tired. he was very worried about his father, who has lung cancer. when i went to his place to see him, he spoke clearly and articulately, describing a headache on one side of his head, that his vision was a bit blurry and that he felt a little off balance, but that that was because of his eyes. i suggested a visit to the hospital. he made a joke about “stroking out,” and said that when he closed his eyes, he felt better. we talked about migraine, vertigo and stress.recognizing his symptoms was complicated by two things. first, he had just finished antibiotics for a significant eye infection, the same eye through which his vision was blurry. secondly, he had experienced something similar 10 years ago, for which tests turned up negative for stroke and the treating neurologist told him that he could expect a similar episode at some point in his life.and so he went to bed. i shudder to think of what could have happened as he slept.when he woke in the morning, his vision hadn’t gotten better and he described feeling like he was being pulled to one side when he walked, so he headed to the emergency room. hours later, to our honest surprise, he was diagnosed as having had a stroke. a little while later, he saw the ct scan of his brain that showed a small portion of his cerebellum — the part of the brain that controls motor function — was completely black. gone.while vision problems weren’t top of mind for me as being symbolic of a stroke, patrice lindsay says vision that is double and blurry is very much a sign of a stroke, but it’s not “confirming.”“headaches and vision issues could for sure mean a stroke, but they could also be caused by 10 other things,” she says. “face drooping, arm or leg weakness, mumbled speech and saying things that aren’t making sense, or the inability to understand what’s being said — these signs are more likely to be a stroke than anything else.”lindsay, a registered nurse and the director of systems change and stroke program at heart & stroke, says that less common — but still important — signs of stroke are headaches (“the worst headache of your life”), balance issues, dizziness, nausea and vomiting.

what are the types of stroke?

there are three types of stroke. an ischemic stroke results from a clot in a blood vessel that blocks blood supply to the brain, a hemorrhagic stroke results from bleeding from a ruptured blood vessel and a transient ischemic attack (tia) which is also called a mini stroke, caused by a temporary clot. stroke is the leading cause of adult disability in canada and the third leading cause of death. every year, there are more than 50,000 strokes — one stroke every 10 minutes — and nearly 14,000 die.

what are the risk factors?

“high blood pressure is the number one risk factor for stroke, even more than heart disease,” she says, explaining that high blood pressure damages the walls of the arteries making them more susceptible to the build up of pieces of fatty tissue and cholesterol. “it’s not just the pressure itself, but the damage it can do.”but not having high blood pressure doesn’t get you off the hook for stroke risk.“you can totally be ‘healthy,’ and have a stroke,” says lindsay, who had a stroke when she was 38 years old. her symptoms were paralysis on her left side and face and she was unable to speak. “sometimes we never know what caused a stroke, and we call that a cryptogenic stroke.” in her case, she had a heart condition that she was unaware of.other risk factors include high cholesterol, diabetes, heart disease (including atrial fibrillation), smoking, obesity, alcohol consumption and stress. a family history of stroke, gender — strokes are more common in men than women, though women are more likely to die — and whether or not you have already experienced a stroke also increases the likelihood that you will have a stroke. and while stroke risk increases as you age — doubling every decade after 55 — younger people can also experience stroke.

call 9-1-1

if you think you may be having a stroke, time is of the essence, says lindsay, who also leads the heart and stroke best practices guidelines for healthcare professionals on how to treat stroke in canada. “the first step is to call 9-1-1, not only because it’s critical to get care quickly, but also because not every hospital is equipped to treat an acute stroke and an ambulance gets you to the right hospital.”

what is the treatment for stroke?

the most important thing for health professionals is to determine for certain whether or not the person is having a stroke, and then if it is caused by a bleed or a clot — the latter accounts for about 85 per cent of all strokes.“a ct scan will tell doctors if you are having a stroke and what type of stroke it is,” she says. “if it’s a clot, clot busting drugs can be given up to four and a half hours after onset of symptoms, which is the last time someone saw you well.” past that point, lindsay says some severe strokes can be treated with an endovascular thrombectomy (evt), where doctors insert a thin tube through an artery in the groin, guiding it to the brain and using a retrievable stent to pull the clots out in order to restore blood flow. evt is recommended within the first six hours of the start of a stroke, and can be done up to 24 hours in some people.“this is a hugely effective procedure,” she says. “there’s a number we use in medicine that symbolizes how many people we need to treat for a good outcome. in cancer, it’s in the hundreds. with evt, it’s one in four.”since evt is highly specialized, only 23 hospitals in canada can do it. but as part of the best practices guidelines every hospital has a plan to get patients to one of these hospitals.“i’ll never forget what one of my patients said to me after an evt,” says lindsay. “she looked at me and said, ‘my husband went from planning my funeral to planning my welcome home party’. [evt] works.”if the stroke is caused by a bleed, sometimes surgery is necessary to stop the bleeding.“these patients tend to be much sicker than those with a clot,” she says.

once you have a stroke, are you at risk for a second one?

yes — there’s a 20 per cent risk of having another stroke, says lindsay.“we call these ‘front-end loaded,’ meaning that out of that 20 per cent, the majority of strokes will happen in the first two to four weeks,” she says. “that’s why we promote aggressive secondary prevention, like finding out the reason for the stroke, if there is one, testing the heart, checking blood pressure and cholesterol.”she also says that depending on the reason behind the stroke, patients may be given aspirin, or anticoagulants like coumadin or warfarin.

what are the long term risks of stroke?

“dementia is a risk, but vascular cognitive impairment is our bigger concern,” says lindsay, adding that the guidelines recommend that stroke patients be tested for cognitive impairment, as well as depression. “mental health issues are big among people who have had a stroke.”in fact, lindsay pegs the risk of depression among people who have had a stroke at 30 to 40 per cent.“there are two reasons for this,” she says. “first, there’s the trauma of having a stroke. but also, you have had a brain injury, so depending on where the stroke hit, it could affect your emotional centre.”lindsay says because of the stigma around cognitive and mental health issues after stroke, people are afraid to admit that they may be having troubles. “but it’s important to acknowledge that these experiences are normal and that there is help.”

how can you prevent a stroke?

quit smoking, consume alcohol in moderation, exercise, maintain a healthy weight and control stress.“basically, maintain a healthy lifestyle,” says lindsay. “and watch for the signs.”my friend did everything right. at 57, he’s a non-smoker, he exercises and is fit, watches his alcohol consumption and has no other health issues, yet all of that did not preclude him from having a stroke. thankfully, despite the delay in getting to the hospital, and a five hour wait to get a ct scan, he is now at home, working on resolving some very slight difficulties with balance and occasional blurred vision. i missed the signs the first time, but that won’t happen again.we don’t need a reminder of how lucky he is. the after-effects of a stroke can include having trouble eating and swallowing, loss of vision, difficulty walking, inability to speak or recognize familiar faces, incontinence and paralysis. according to the ontario stroke network, of every 100 people who have a stroke, 15 die, 40 are left with a moderate to severe impairment, 25 recover with a minor impairment or disability, 10 are so severely disabled they require long-term care and 10 recover completely.“this is why time is so important if you think you are having a stroke,” says lindsay. “getting care as soon as possible can make all the difference to what happens next.”lisa machado is the executive producer of healthing.ca. lisa.machado@postmedia.com | @iamlisamachadodon’t miss the latest on covid-19, reopening and life. subscribe to healthing’s daily newsletter coming out of covid.