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Stroke warning signs are often ignored, even though strokes can strike anyone, anywhere, at any time.

Strokes strike anyone, anywhere, anytime.  The World Stroke Organization said a person suffers from a stroke every two seconds and one dies from it every six seconds.  It’s deadlier than Acquired Immune Deficiency Syndrome, tuberculosis and malaria combined, health officials claimed.

In the past, stroke was a disease of those in their twilight years.  But not anymore.  In fact, one in four people around the world will have a stroke at age 25 or older, according to a study published in the New England Journal of Medicine.

After heart attack, stroke is the second leading cause of death in the Philippines.  It is the number one cause of disability, points out the Stroke Society of the Philippines and the Department of Health. 

“Our mortality rate from stroke nearly doubles that of the United States and we join the ranks of our neighbors (that is, Korea, China, Indonesia and India) in having especially high deaths from it,” wrote Dr. Antonio Moya, a neurology resident at NewYork Presbyterian Weill Cornell Medical Center.

“Don’t confuse a stroke with a heart attack,” reminds Dr. Isadore Rosenfeld, bestselling author of The Best Treatment.  “A stroke is what happens when the blood supply to a portion of the brain is interrupted; a heart attack is what you suffer when the blockage is in an artery within the heart.”

There are two types of strokes: ischemic and hemorrhagic.  Ischemic stroke is the most common type, where there is a blockage in the flow of blood to the brain.  “About 80 percent of strokes are ischemic,” explains The Merck Manual of Medical Information.  “Brain cells, thus deprived of their blood supply, do not receive enough oxygen and glucose (a sugar) which are carried by blood.”

The hemorrhagic type is less common and it happens when the artery in the brain bursts causing blood to leak inside the brain.  “This type is usually precipitated by high blood pressure,” says Dr. Willie T. Ong, an active consultant in cardiology at the Manila Doctors Hospital and Makati Medical Center.  “If the bleeding does not stop, this can result in death.”

About 20% of strokes are hemorrhagic.  The Mayo Foundation for Medical Education and Research, based in Minnesota, says one cause of hemorrhagic stroke is an aneurysm, which caused the death of martial arts icon Bruce Lee, American comedian John Ritter, and Filipina actress Isabel Granada.  This “ballooning” from a weak sport in a blood vessel wall develops with advancing age.  Some aneurysms may also form as a result of a genetic predisposition.

“As aneurysm forms, the vessel wall becomes thin and stretched,” the Mayo Clinic points out.  “An aneurysm that grows to at least three-eights of an inch in diameter (about the size of the head of a thumbtack) is most likely to rupture.”

But the most common cause of hemorrhagic stroke is hypertension.  “High blood pressure, if uncontrolled, can be a deadly disease,” says Dr. Ong.  “It’s unfortunate that many people do not take the necessary steps to control it.”

Blood pressure – or BP as it is commonly known – is needed so the blood can circulate through the body, giving vital organs the much-needed oxygen and food.  Under normal conditions, your heart beats about 60 to 80 times a minute.

The blood pressure rises with each heartbeat and falls when the heart relaxes between beats.  Like the air pressure in tires, blood pressure can change from minute to minute.  The pressure in the tires depends on the temperature and whether the car is driven.  Blood pressure changes with posture, exercise, sleeping or even the level of the arm when the blood pressure is measured.

“A person is said to have high blood pressure if there is a persistently high blood pressure of blood within the arteries,” Dr. Ong explains.  “If it isn’t lowered down to normal levels, then over time, the excessive pressure can damage and stiffen the arteries.  In addition, the heart will slowly thicken, enlarge and eventually weaken.  The brain can suffer a stroke and the kidneys and eyes will also be damaged.”

According to the Merck manual, strokes usually damage only one side of the brain.  Because nerves in the brain cross over to the other side of the body, symptoms appear on the side of the body opposite the damaged side of the brain.

“Despite its grim toll, stroke ranks low in the public awareness,” Gail McBride writes for the American Health.  “Many lives might be saved if more people recognized the warning signs of stroke.”

According to Dr. Ong, you can tell a person having a stroke by following a short code.  He calls it STRAW and it stands for:

Smile: Ask the person to smile.  “If one side of the face lags behind or looks crooked, then that is a telltale sign of a stroke,” Dr. Ong says.  “This is because a stroke can affect the nerves controlling the muscles of the face.”

Talk a few words: Let the patient speak and then ask him to stick out his tongue.  “In a stroke, the person cannot speak coherently and may slur his words,” he says.  “And when he puts out the tongue, the tongue may point slightly to one side of the face.  However, in mild cases of stroke, there could only be a difficulty in pronouncing the words.”

Raise arms and legs:  According to Dr. Ong, the patient may lose the strength of one side of his arms or legs during a stroke.  “There could also be numbness of the limbs,” he says.  “And when you ask the person to raise both hands, one arm could be lagging behind.  Another technique is to ask the person to trip your hand tightly.  If one hand is weaker, then this is another sign of a stroke.”

Ask questions:  Among those be asked pertains to headache, eye problems or numbness of the hands or legs.  Dr. Ong explains: “In the ischemic type, the patient may not complain of a headache.  Eye problems, such as blurring of vision and trouble seeing peripheral objects, may also be a sign of a stroke.  A commonly missed finding is numbness of the arms or legs.  Touch the person’s arms and legs lightly.  Then ask the person if he has the same feeling for both sides of the arms or legs.  If there is some loss of sensation on one side, then it could be a stroke.”

Walk: Let the patient walk in a straight line. “Because a stroke can affect the strength and balance of one’s legs, the patient can have difficulty walking,” he says.  “Can he stand straight or does he fall on one side?  Is there something wrong with his stride?”

Stroke afflicts people at the prime of their age and the peak of their career.  Aside from hypertension, other risk factors include family history of stroke, diabetes, obesity, heart disease, atrial fibrillation, high blood cholesterol level, smoking and those who previously had suffered from transient ischemic attack (TIA) or “mini-stroke.” People eating diet rich in saturated fats, living sedentary life, and heavy liquor drinkers are also at risk for stroke.

“If you have palpitations, or if you feel your heartbeat skips once in a while, it is best to see your physician to rule out atrial fibrillation, which is an abnormal heart rhythm that increases your risk of stroke,” says Dr. John Jerusalem A. Tiongson, a neurologist from The Medical City.  “Patients who have previous heart attacks must be assessed for stroke risk as well.”

There are no known first aid treatments with this kind of illness which many patients think are sufficient to reverse the stroke process.  So, if you observe those warning signals, seek medical advice right away.  As the Mayo Clinic points out: “Seeking immediate emergency care is critical – newer drugs to dissolve clots in the brain may greatly decrease complications, but for maximum benefit they must be taken within three hours of stroke onset.”

Meanwhile, a study conducted by the National Stroke Association in the United States has shown that 80% of stroke is preventable. 

“Prevention of stroke is even more important than acute treatment since prevention arguably saves more Filipino lives than acute stroke units,” wrote Dr.  Moya.  “The battle cry of public health is prevention, prevention, prevention!”

In an article he wrote for Rappler, Dr. Moya offered eight “essential survival tips to prevent brain attack”:

1. If you’re a smoker, stop smoking.  Smoking doubles your lifetime risk of a stroke.

2. Know your blood pressure and aim for a blood pressure of less than 120/80.

3. Avoid soft drinks and reserve them for special occasions only.  Same goes for sugary cookies and “energy drinks” or vitamin waters that oftentimes are loaded with more sugar than conventional soft drinks.

4. Learn to read nutritional labels, paying close attention to grams of sugar, fat and calories.

5. Easy eating guide: About half of your plate should have vegetables and legumes.  Avoid red meat and pork, try to get protein from plant sources.

6. Know the main risk factors for a stroke: high blood pressure, smoking, high cholesterol levels, and diabetes.

7. Time is brain!  Go to the hospital immediately upon suspecting a stroke, preferably with an acute stroke unit, immediately if you have a stroke.

8. Exercise daily and be SMART about your goals in exercising: specific, measurable, attainable, realistic and time-bound.