Seven surprising facts about stroke

Time is brain. During a stroke, 32,000 brain cells per second (1.9 million per minute) die. But if a patient receives timely treatment, the damage can be minimized. So it's critically important to know the warning signs and symptoms of a stroke. However . . .

One in three Americans can't name even a single stroke warning sign. These warning signs include sudden: numbness or weakness of the leg, arm or face; confusion or trouble understanding; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; or severe headache with no known cause. An easy way to remember signs and symptoms is FAST. F: Face drooping. A: Arm weakness. S: Speech difficulty. T: Time to call 9-1-1 if any of these symptoms are present.

Strokes are surprisingly common in young people. And more young people are showing risk factors for such strokes. Between 532,000 and 852,000 people ages 18 to 44 in the United States have had a stroke. And between 1995-96 and 2007-08, U.S. hospital discharges for stroke among patients ages 15 to 44 increased by amounts ranging from 23 percent to 53 percent, depending on age and gender, according to a report, co-authored by Biller, in the journal Neurology.

Strokes are also common in presidents. Ten U.S. presidents likely suffered strokes, according to a study Biller and colleagues published in the Journal of Stroke and Cerebrovascular Diseases. Woodrow Wilson, Franklin Roosevelt and Dwight Eisenhower suffered strokes while in office, and Roosevelt's stroke was fatal. Seven other presidents suffered apparent strokes after leaving office: John Tyler, Millard Fillmore, John Quincy Adams, Andrew Johnson, Chester Arthur, Richard Nixon and Gerald Ford.

How sex triggered a stroke. In the Journal of Stroke and Cerebrovascular Diseases, Biller and colleagues described an unusual case of a woman who suffered a stroke during sexual intercourse. Doctors believe a small clot formed in one of the veins in her thigh, broke loose and traveled to the right atrium (upper right pumping chamber). Pressure changes in the heart, triggered by sexual intercourse, enabled the clot to travel, through a hole in her heart, from the right atrium to the left atrium. From there, the clot traveled up to the brain and triggered a stroke.

The worst possible stroke. Among the most feared and devastating strokes are ones caused by blockages in the brain's critical basilar artery system. When not fatal, basilar artery strokes can cause devastating deficits, including head-to-toe paralysis called "locked-in syndrome," according to a review article in MedLink Neurology by Biller and colleagues.

A character in "The Count of Monte Cristo," described as a "corpse with living eyes," had what appears to be locked-in syndrome. More recently, the book and movie "The Diving Bell and the Butterfly" describe a journalist with locked-in syndrome. He was mentally intact, but able to move only his left eyelid. He composed a moving memoir by picking out one letter at a time as the alphabet was slowly recited.

Neck manipulation may be associated with stroke. Treatments that involve neck manipulation may be associated with strokes, according to an American Heart Association Scientific Statement written by Biller and other leading stroke experts. A small tear in a neck artery, called a cervical dissection, is among the most common causes of strokes in young and middle-aged adults. A dissection can lead to a blood clot that travels to the brain and triggers a stroke. Sudden movements that hyperextend or rotate the neck can cause a cervical dissection. Some maneuvers used by health practitioners also extend and rotate the neck.

"Although a cause-and-effect relationship between these therapies and cervical dissection has not been established and the risk is probably low, a dissection can result in serious neurological injury," Dr. Biller said. "Patients should be informed of this association before undergoing neck manipulation."

Women have a higher stroke mortality rate than men. Six in ten stroke deaths occur in women, largely due to strokes occurring later in life in women, when strokes are more dangerous.