Strokes: Sudden, Serious and Sometimes Sneaky

I’m a procrastinator some days. I take that back — most days. One Thursday evening in 2018 was no different. My husband had gone out to run some errands and, at 36 weeks pregnant, I finally decided to write thank you notes for my baby shower two weeks prior.

I wasn’t feeling great but kept telling myself it was just pregnancy related, and to finish up so I could go to bed. Suddenly, I noticed that a little spot on the card I was writing seemed to disappear. I had worked a full day on my feet running between busy neuroscience units, so I assumed it was just exhaustion.

Then, the spot grew longer in an oblong fashion. Strange. As the seconds went by, my vision continued to deteriorate to the point that I couldn’t see the card anymore. I quickly narrowed my differential diagnosis: I was either experiencing hypoglycemia or preeclampsia. I had beaten it into my head that these were the two biggest problems that could arise as I got closer to delivery — logical, as I had chronic hypertension prior to pregnancy and was losing my lifelong battle with weight management.

I decided to check my blood pressure. It was slightly elevated, in the 140s, and I was also relatively tachycardic (in the 150s). I attributed these signs to nerves (not surprising because I couldn’t see) and decided to have a snack with juice. I waited … with no improvement.

At this point I realized I needed help and picked up the phone. Luckily, my favorite stroke nurse practitioner, Ashley Chalifoux, was only a quick call away.

Hindsight Is 20/20

Throughout the next 45 minutes of visual field loss, I never once believed I was having a stroke. Retrospectively, it’s so clear. The risk factors were present. There were red flags left and right, including my sudden loss of vision.

Stroke Symptoms

During a stroke, there is a sudden neurologic deficit caused by either an occlusion or a hemorrhage in a vessel feeding the brain. Depending on where this vessel is supplying oxygen — to the front part of the brain versus the back, the right or the left, a large arterial hemorrhage versus a slow small venous bleed — signs and symptoms can vary. You may experience sudden weakness, visual changes, balance issues, facial droop, garbled speech, wrong words or confusion. Each stroke may look different, but they tend to have one thing in common: suddenness.

When symptoms start, so does the clock for available treatments. And as we know well, time is brain. The brain doesn’t carry the same oxygen stores as the rest of the body, which is why a deficit appears so quickly. Tissue is already dying.

Knowing all of this, I still chose to think that what was happening to me was anything but a stroke, because ‘a stroke could never happen to me.’ Now I know that strokes can occur at any time, to anyone, anywhere. I was fortunate to have a transient ischemic attack (TIA), which is often the precursor to a stroke and, without the proper attention, can be an overlooked warning sign.

Risk Factors and Prevention

One stroke occurs in the U.S. every 40 seconds. While mortality rates are improving, we still aren’t making headway on stroke occurrence. Ultimately, this leads to a significant number of people with lifelong disabilities — which could be prevented by focusing on risk factors.

Modifiable Stroke Risk Factors

• High blood pressure
• Tobacco use
• Diabetes mellitus
• Atrial fibrillation
• Alcohol use
• Drug use
• Obesity
• Physical inactivity
• Poor diet
• High blood cholesterol

A large part of stroke prevention is recognizing your modifiable risk factors and acting upon them. While many of the modifiable risk factors require lifestyle changes, some can be controlled by medication adherence and collaboration with your primary care physician.

Often, we may not want to take medications because of the way they make us feel. But it is 2021; there are options and ways to minimize those pesky unwanted adverse effects. Work with your healthcare provider to decide which medications may be the right choices for you and your lifestyle.

In addition to modifiable risk factors, it’s important to know your non-modifiable risk factors. Age, race and gender will change your risk of stroke. Your risk increases as you get older, beginning at age 55. If you have optimized your modifiable risk factors, you still need to keep in mind that non-modifiable factors can put you at risk.

Learn more about stroke risk factors from the American Stroke Association, and find more information on stroke education in the AACN CSI Academy project ”Patient Stroke Education: Get the FAST Facts.”

For My Family

After my TIA, I wanted to be healthy for my son. Ashley Chalifoux and her world-class stroke team helped me identify my modifiable risk factors and learn stroke prevention measures. I worked on weight loss, found a love for running and fine-tuned my diet.

Today, when I run and push my stroller with my now 3-year-old son and new baby daughter, I think about how I’m doing it for them and for my healthy future. I have the knowledge to help prevent a stroke, spot one when it happens and get treatment quickly — the keys to saving a healthy brain.

Do you and your patients know how to spot a stroke?

AACN and Courtney would like to thank Ashley Chalifoux for her expert guidance, input and knowledge in developing this blog.