May is National Stroke Awareness Month. Here’s what you need to know.

This story first appeared in Healthy You - April 2025, The Gazette’s quarterly health publication.

It’s the leading cause of serious long-term disability and among the top five causes of death in the United States: more than 795,000 people in the U.S. experience a stroke, approximately 610,000 of which are first-time strokes.

Each May, the U.S. promotes National Stroke Awareness Month. The American Heart Association and the American Stroke Association provide educational materials, events and resources to help people understand stroke and take steps to protect their brain health. The goal is to empower Americans to recognize the signs of stroke early and seek prompt medical attention, which can significantly improve outcomes. But what is a stroke, exactly?

“There are two common types of stroke,” said Dr. Hannah Roeder, clinical assistant professor of neurology at the University of Iowa Medical Center at the University Campus. “The most common is ischemic, where a blood clot blocks an artery in the brain, cutting off blood flow to the affected area.” This deprives the brain tissue of oxygen and nutrients, leading to cell damage and potentially permanent disability.

“The second type of stroke is a hemorrhagic — or bleeding — stroke. A blood vessel in the brain ruptures and bleeds into the surrounding brain tissue.” This causes pressure on the brain and damage to brain cells.“Whether ischemic or hemorrhagic, some people recover to baseline — their initial standard level of health. For others, a stroke can be catastrophic, or it can be in between with some degree of disability. Which symptoms occur depends on which part of the brain is affected.”

There are several symptoms of a stroke. “A common way to remember stroke symptoms,” says Dr. Roeder,” is the BE-FAST acronym.”

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BE-FAST helps recognize strokes even earlier than the well-known FAST, especially those affecting the back of the brain, which may not always present with facial drooping or arm weakness.

Dr. Mark Milton, a clinical cardiac electrophysiologist at the Mercy Cardiology Clinic in Cedar Rapids, warns of several risk factors for stroke, including cardiovascular disease and a therosclerotic disease, where plaque builds up in the arteries, blocking blood flow to the brain.

He adds that hypertension is also a culprit as it can cause a therosclerotic disease or Lacuna Infarcts — a s mall, deep brain stroke that occurs when a capillary ruptures in critical areas of the brain. Other risk factors include atrial fibrillation and deep vein thrombosis, a blood clot that forms in a deep vein, typically in the legs. If the clot becomes dislodged and travels to the brain, it can lead to a stroke.

There are also several factors that can also predispose you to stroke, including hypertension, high blood pressure, diabetes and lipid abnormality ( high levels of cholesterol and triglycerides, or low levels of HDL cholesterol).“W hile old age predisposes you,” Roeder said, “stroke still occurs in young people even without traditional risk factors.”

If you have a stroke or suspect you’re having one, it’s critical to act fast and call 911. The sooner medical attention is received, the less brain damage occurs, and the better the chance of recovery. For every minute that passes while having a stroke, 1.9 million brain cells are lost. Each hour in which treatment fails to occur, the brain loses as many neuron as it does in almost 3.6 years of normal aging.

Once at the hospital, you’ll be quickly assessed to determine the severity of your condition. A thorough neurological examination is performed to assess your level of consciousness, reflexes, muscle strength, coordination and sensory function.

“The next step is a brain MRI to outline the damage to the brain. A CT angiogram will look at the carotid and brain arteries to see if there’s any vascular abnormality in the carotid or brain to explain the stroke,” Milton said.

If there’s no bleeding or vascular abnormality in the blood vessels, arteries or veins, you’re considered to have had a cryptogenic stroke, a type of stroke where the underlying cause can’t be determined. In some cases, the cause is atrial fibrillation— a quivering of the heart, which causes low velocity of blood flow, and in turn, blood clots.

“Often, atrial fibrillation isn’t detected during initial evaluations,” Milton said, “and that leads to a classification of the stroke as cryptogenic.”

If atrial fibrillation is potentially the cause, the patient will wear a heart monitor for 30 days. If atrial fibrillation is in fact detected during that time, the next step would be a loop recorder to be implanted under the skin on the chest to continually monitor the heart.

“The doctor then knows that the patient needs to be on blood thinner or anticoagulation medication,” Milton said.

Today, treatments for stroke offer great promise. “Clot busting medication is used for an ischemic stroke,” Roeder said. “The common window for treatment is up to 4.5 hours after the onset of the stroke symptoms. However, today, a new window for treatment goes further out.”

Recent research suggests newer medications may extend this window up to 24 hours depending on the patient and imaging results, allowing for clot busting even beyond the traditional timeframe. Another treatment is a t hrombectomy, which removes or retrieves the blood clots to prevent further damage. Today, more patients are eligible for this treatment as well.

Just as treating strokes is vital, so is stroke prevention. “ Patients believed to have atherosclerotic disease may be prescribed either antiplatelet medications or anticoagulants, depending on their specific condition and risk factors. And with patients with atrial fibrillation — many of whom don’t even know they have atrial fibrillation — we put them on anticoagulants to help prevent a future stroke,” Milton said.

A final word of advice from Dr Milton:

“Follow up with your primary care doctor, and get screened for high blood pressure and any cardiovascular disease. Avoid tobacco use as smoking triggers atherosclerotic disease, and manage your sugar since diabetes is also a serious exacerbator of atherosclerotic disease.”

Roeder couldn’t agree more. She also refers to Life’s Essential 8 from the American Heart Association and American Stroke Association.

“Reduce your risk of heart disease with healthy eating, exercise, don’t use tobacco or drugs, maintain good blood pressure and cholesterol, reduce sugar, maintain a healthy weight and get plenty of sleep,” she said.

According to physicians, an ounce of prevention goes a long way in heart and brain health.