Dr. Lauren Peruski is wearing a white lab coat and is smiling into the camera.
Dr. Lauren Peruski

More than 160,000 Americans die every year of a stroke, and many more than that face a lifetime of disability as a result of a stroke. It’s a grim statistic, especially given that 80% of strokes can be prevented. We talked with neurologist Dr. Lauren Peruski with the Novant Health Neurosciences Institute about how to prevent stroke and what signs may indicate that someone is having a stroke.

First, what is a stroke?

A stroke can happen in two ways. An ischemic stroke is when the blood supply to the brain is blocked. A hemorrhagic stroke is when a blood vessel in the brain bursts. Loss of blood supply causes brain tissue to die, and that can lead to brain damage, disability and death.

What are some of the risk factors, and what can people do to reduce those?

There are some risk factors – like age and family history – we can’t control. But there are a lot of risk factors we can control.

The big one tends to be high blood pressure or hypertension. That’s the most common risk factor. If you're diagnosed with high blood pressure, make sure you're checking your blood pressure regularly and taking your blood pressure medication. If you have high blood pressure, it puts you at increased risk of stroke, heart attack and many other things.

The next big one is smoking. Unfortunately, a lot of people in this region still smoke tobacco regularly. That's a big stroke risk factor.

The next important one would be high cholesterol. It’s important to try to maintain a low-cholesterol diet. The one doctors typically recommend is the Mediterranean diet with a lot of healthy oils, fish, nuts, fresh vegetables. Try to stay away from greasy foods, fried foods, carbohydrates.

Another risk factor is diabetes of either kind. Still another is atrial fibrillation, or irregular heartbeat. That can cause clots to develop in the heart, and then those clots can be released out into the bloodstream and can actually go to the brain and cause a stroke. A-fib is usually treated by blood thinners, but not every patient is a good candidate for those. If you are prescribed blood thinners, make sure you're taking those on a regular basis.

All these risk factors cause a lot of wear and tear on your blood vessels over time. Having high blood pressure, high cholesterol and diabetes causes wear and tear and buildup of plaque in the blood vessels. And that's what leads to an increased risk of stroke.

Another risk factor that’s less commonly known is obesity – combated by diet and regular exercise. About 30 minutes of aerobic exercise five times a week is recommended to reduce risk of stroke. Another risk factor is sleep apnea. If you’re diagnosed with sleep apnea, the best thing you can do is use your CPAP machine.

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We’ve heard this before, but please remind us of the symptoms of stroke.

Right. We use the “BE FAST” acronym.

  • B—Balance: Is the person suddenly unsteady?
  • E—Eyes: Is someone suddenly having blurred vision, double vision or complete loss of sight in one or both eyes?

  • F—Face: Ask the person to smile. Does one side of the face droop?
  • A—Arms: Ask the person to raise both arms. Does one arm drift downward?
  • S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
  • T—Time: If you see any of these signs, call 911 right away.

So, we know to call 911 if we see someone exhibiting any of these. But what if you’re by yourself? Are there any indications that people get that they may having a stroke?

It's very hard to identify yourself if you're having a stroke; that can be very challenging. But if you notice you have double vision or loss of vision in one eye, that can be a sign of stroke and something you should call 911 for right away. If you suddenly feel weak or numb on one side of your body, or you have some facial drooping, if you're trying to smile and you notice one side of your face looks asymmetric from the other, those are definitely signs you should call 911.

And another symptom that's a little bit less commonly picked up is dizziness. If you have a sudden spinning sensation or dizziness, that should be checked into, as well.

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While you wait for the ambulance, what should you do? Is water for the patient a good idea?

I would recommend not drinking water or attempting to take pills because there could be underlying swallowing impairment, and the patient could choke. So just waiting in a chair or lying down, if needed, is the best option.

Why is it so important to try to prevent stroke?

Stroke can cause life-altering and lifelong complications. People who suffer from stroke may live with lifelong disabilities that really change the way you live or your ability to be independent. Having trouble with language, speaking and understanding – those can definitely make it be hard to return to your old life. Working, going to the store, doing your finances – those kinds of things can all be impacted. If your vision is impacted, it may be hard, or impossible, to drive.

If you're weak on one side of your body, it may impact your ability to walk or to have the same level of physical activity you were able to before. You may have trouble swallowing. So, sometimes folks with stroke need to have a feeding tube in place.

These are scary things to think about, and they can’t necessarily be reversed. That’s why we put so much emphasis on stroke prevention.


What if someone shows those symptoms temporarily, but they get better?

Even if the symptoms are improving, still call 911 immediately, because they can worsen again. It’s very important to get to the hospital right away.

At what age do people start to be more susceptible to stroke?

It’s more prevalent in patients 60 and up. Older people tend to have more incidents of high blood pressure, high cholesterol. They've been living with diabetes for longer. Strokes can certainly happen in the young, though it's rare – but certainly if you see someone who’s a teenager or in their 20s or 30s having stroke symptoms, it definitely could still be a stroke. I recommend everyone react the same and call 911.

Anything else people ought to know?

If you suspect stroke and are headed to the hospital, take a list of your medications and dosing information. Providers will want to know that.

I want to remind people to eat a good Mediterranean diet, get regular exercise and keep up with your primary care doctor appointments, so that they can be watching all these risk factors. A lot of folks that come in with stroke haven't been to a doctor in a long time, and it's something that could have potentially been prevented.