If you or a loved one have high blood pressure or diabetes, it is very important to be aware of the warning signs and symptoms that can appear before and during a stroke.¹ A stroke is a medical emergency, and quick medical attention is crucial to prevent severe and long-lasting complications. 

A stroke (or cerebral vascular accident) occurs when blood flow to a part of the brain is cut off, causing cell death.  As such, a stroke can be life-threatening or life-changing. Indeed, it is the second leading cause of death and the third leading cause of disability worldwide.² Read on to learn how to recognise a stroke quickly.

What is a stroke?

Depending on what is causing the lack of blood flow to the cells of the brain, strokes can be classified into different types:

Ischaemic stroke

The term ‘ischaemic’ refers to when the body’s cells do not receive enough blood and, by extension, oxygen. Consequently, they cannot function properly. Ischaemic strokes usually occur when a blood vessel supplying blood to the brain is partially or totally obstructed by a blood clot. This type of stroke is the most common, with approximately 85% of strokes being ischaemic.³

Haemorrhagic stroke

Haemorrhagic strokes occur when a blood vessel ruptures and  rupture bleeds inside and/or around the brain. This exerts pressure on nearby structures, causing cells to die. Haemorrhagic strokes are also known as intracranial or cerebral haemorrhages, and represent approximately between 12 to 15% of stroke cases.³

Transient ischaemic attack (TIA)

A transient ischaemic attack (TIA) occurs when blood vessels supplying blood to the brain are partially blocked for a short period of time. Whilst a TIA can cause similar symptoms to an ischaemic stroke, they usually disappear in less than 24 hours. However, it is still important to seek medical attention as TIAs are a risk factor for an upcoming ischaemic stroke.⁴

Common warning signs

There are many signs that can be associated with a stroke. The most common signs, that can be presented, before or during the stroke, are explained below:⁵

• Confusion: having difficulty thinking clearly, or feeling tired without a specific or associated reason. 
• Headache: a sudden severe headache, alongside nausea or sudden sensitivity to light, can be a sign of impending stroke. 
• Vision problems: such as double vision, or diminished, blacked out, or loss of sight in one or both eyes.
• Speaking problems: having difficulty speaking, finding words, or understanding what others are saying.
• Weakness: losing strength or experiencing numbness and/or tingling on one side of the body.
• Trouble walking: experiencing a lack of coordination, dizziness, or loss of balance whilst trying to walk.
• Loss of consciousness: this can be brief, like fainting, or more persistent.
• Seizures: whilst seizures are rare, they may coincide with headache or loss of consciousness..

FAST and BE-FAST acronyms

An accurate diagnosis of stroke requires several tests. However, the acronyms FAST and BE-FAST are helpful for an early diagnosis outside of a medical environment.⁶ Each acronym refers to tell-tale symptoms of strokes to look out for:

The FAST acronym

• F (Face): one side of the face is drooping.
• A (Arm): difficulty to lift one arm.
• S (Speech): slurred or absent speech.
• T (Time): time to call 999/112.

BE-FAST acronym

The BE-FAST acronym is largely identical to the FAST acronym, with the addition of the “BE”: 

• B (Balance): loss of balance.
• E (Eyes): loss of sight in one or both eyes, or double vision. 
• F (Face): one side of the face is drooping.
• A (Arm): difficulty lifting one arm.
• S (Speak): slurred or absent speech.
• T (Time): time is precious, so go and get help as soon as possible. 

Risk factors

There are many factors that can influence an individual’s risk of having a stroke. These can be divided into non-modifiable factors (that cannot be changed) and modifiable factors (that can be changed).⁷

Non-modifiable factors

• Hereditary/genetic factors, such as history of stroke in siblings, parents or grandparents.
• History of stroke or TIA.
• Sex - individuals assigned female at birth are in more danger of having a stroke than those assigned male at birth.⁸
• Age - each year of age increases the risk of  stroke, regardless of gender.⁸ 
• People of African descent and people of Hispanic/ Latin American descent are at an increased risk of stroke than other ethnicities.⁷ 

Modifiable factors

• High blood pressure (or hypertension) has been mentioned as the biggest risk factor associated with death by stroke.⁹ Indeed, any increase in blood pressure increases the risk of having a stroke.⁷ 
• In diabetes, high levels of glucose in the blood can damage blood vessels, making them more rigid and more likely to be obstructed by a blood clot.¹
• Being overweight or obese contributes to inflammation inside the body and increases your risk of high blood pressure, diabetes, high cholesterol, heart disease, and stroke.¹⁰ 
• Similarly, a poor diet is a risk factor for high blood pressure, diabetes, and obesity, among others. 
• Having a sedentary lifestyle and not exercising regularly are thought to make the blood vessel walls less elastic (flexible).¹¹ As such, an inactive person can have rigid blood vessels that are more prone to blockage without having any other condition associated.
• Smoking exposes the blood vessels to several harmful substances, which cause them to become rigid. This has been linked to increased stroke risk in European populations.⁸
• Excessive alcohol consumption is associated with heart disease and stroke because it makes blood vessels more rigid.⁵
• Hyperlipidemia (excessive levels of fats in the blood) causes plaque to accumulate within blood vessels, which is known as atherosclerosis.⁷ 
• Atrial fibrillation occurs when the beat of the heart does not follow a normal rhythm, and it can cause the detachment of a piece of plaque (such as those seen in atherosclerosis) from the wall of blood vessels.⁷ These plaque fragments can go on to cause blockages.

There are more modifiable risk factors for stroke, but these are some of the most commonly associated with it. Conditions such as diabetes, or high blood pressure, can be controlled with adequate medical treatment that includes improving the quality of the regular diet, and doing more physical activity. Stopping smoking and drinking alcohol have both short- and long-term benefits, so it is important to seek medical help to quit if needed.

What to do if you suspect someone is having a stroke?

• The first and most important thing to do is to contact emergency services, in the UK, the numbers to contact are 999 or 112. 
• If possible, try to register when the signs of stroke appear.
• After calling for help, stay with the person having the stroke and try to keep them calm.
• If you are having a stroke, avoid driving to the hospital. Ask for help and try to be calm.

As the last part of FAST and BE-FAST acronyms say, time is very important in order to avoid fatal complications in stroke. Therefore, it is essential to ask for help contacting emergency services, even if symptoms are only present for a short time.

Summary

To be aware of the warning signs of stroke is crucial because you can recognise them and act fast. Remember that quick diagnosis and treatment can make all the difference when it comes to avoiding long-term complications - and they can even be the difference between life or death. Hence, learning acronyms such as FAST or BE-FAST is helpful for doing an early diagnosis outside of the hospital.