DEAR MAYO CLINIC: Many in my social circle are now at the age when we're more likely to have a stroke. What symptoms should we watch for? And what happens if someone has a stroke?

ANSWER: If you're 55 or older, you're at greater risk of stroke. A stroke is a medical emergency. It happens when either the blood supply to the brain is blocked or a blood vessel in the brain leaks or bursts. In both cases, brain cells begin to die in minutes, so it can be life-changing to recognize the symptoms in your friends and family.

Stroke risks

In addition to age, lifestyle factors ranging from being overweight, physical inactivity, heavy drinking, smoking or being exposed to secondhand smoke and using illegal drugs such as cocaine and methamphetamine can contribute to your stroke risk.

There also are medical conditions that increase your stroke risk, including:

High blood pressure.

High cholesterol.

Diabetes.

Obstructive sleep apnea.

Cardiovascular disease.

Personal or family history of stroke or heart attack.

COVID-19 infection.

Taking birth control pills or hormone therapy.

Men are at higher risk, as are African American and Hispanic people. Women are more likely to die of a stroke than men.

Time is critical

The American Stroke and Heart Association has created an easy way to remember stroke symptoms: BE FAST.

Here's what each letter stands for:

B: Balance or coordination. Sudden onset of walking like you're intoxicated, and not being able to grasp or turn a doorknob with one of your hands, are just two examples.

E: Eye. Sudden onset of double vision, loss of vision in one or both eyes, or not being able to see the full visual field can indicate a stroke.

F: Face. Sudden onset of one side of your face drooping. A limb on that same side also may become weak.

A: Arm. Sudden onset of weakness or complete paralysis in one arm or leg. One way to test for arm weakness is to have the person hold both arms straight out in front of them. Be concerned if one arm begins to drift downward on its own.

S: Speech. Sudden onset of slurred speech, or trouble finding words or speaking gibberish.

T: Time: It's estimated that a person loses 1.6 to 2 million brain cells every minute when blood supply to the brain is affected, so time is brain.

Because time is critical when a person has a stroke, call 911 for immediate care and transportation to an emergency department. However, if you're living in a rural area, too much time may elapse before help arrives. Give the person one tablet of aspirin, preferably a low-dose aspirin (about 81 mg), then safely drive them to the closest emergency department. Tell staff that you suspect a stroke.

If your medical facility doesn't have a comprehensive or primary stroke center, the healthcare team may connect via audio-video technology ( telestroke ) with a stroke neurologist who can examine the patient and recommend treatment options.

Treatment

Treatments have advanced significantly in the past 30 years. The first breakthrough was the development of clot-busting medications that can dissolve the clot that's blocking blood flow in the blood vessel. For the best outcomes, patients are carefully selected for this treatment.

For some patients, endovascular intervention is a newer and additional treatment option. It's typically performed within 24 hours of the onset of symptoms. A CT or MRI scan of the blood vessel can pinpoint the blood clot. Using guided imagery, a neurointerventionist threads a thin wire up through an artery in the groin to the brain, grasps the clot, removes it and opens the affected blood vessel.

In addition to treatments, other factors contribute to better recovery from stroke while patients are in the hospital. These include controlling their blood pressure, ensuring their blood sugar is neither too high nor too low, and maintaining a comfortable body temperature — not too hot or too cold. Their care team will develop a recovery plan for them once they return home.

Significant strides also have been made to ensure patients don't have another stroke. These include controlling blood pressure and diabetes and treating obstructive sleep apnea. Patients also typically are prescribed a blood thinner to reduce the chance of clots forming. New developments in these medications, such as apixaban, make them simpler to take without regular blood tests.

On the horizon is the formulation of medications called neuroprotective agents that reduce the catastrophic effects on the brain caused by inflammation when a stroke occurs. But the research and studies in this area continue.

The best stroke care is still avoiding a stroke by reducing your risks. But if a stroke happens, remember: BE FAST.

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Felix Chukwudelunzu, M.D., Vascular Neurologist, Mayo Clinic Health System in Eau Claire and Menomonie, Wisconsin

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