Episode 80

7 Warning Signs Your Body Gives You Before a Stroke

24:43 November 10, 2026 By Dr. Ravi Kumar MD
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Show Notes

For a week before her stroke, the left side of her face kept going numb and tingly. It came on, faded away, and came back again. She thought it was a dental problem. By the time she reached the ER, most of the right half of her brain had died.

In this solo episode, Dr. Ravi Kumar, a board certified neurosurgeon, counts down the seven warning signs your body gives you before a stroke, and explains why each one gets missed. The patient in the opening is a composite, but Ravi has treated patients like her over and over throughout his surgical career.

He starts with the idea that ties all seven signs together. A stroke is a plumbing problem: an artery that feeds part of your brain either clogs or leaks, and whatever that part of the brain controls stops working. Any of these signs can be a stroke itself, but when a symptom comes and then goes away, that is the warning, and it is your chance to get ahead of the stroke. Every minute a big stroke goes untreated, the brain loses about 1.9 million nerve cells.

The countdown runs from the quiet signs to the obvious ones. Sudden numbness on one side of the body, which can be the only sign of a small lacunar stroke, and how to tell it apart from the pinched nerves Ravi sees in his spine clinic. Sudden confusion or trouble understanding speech, which the person having it often cannot recognize, so the family has to catch it. The thunderclap headache of a ruptured aneurysm, which about one in eight people were first told was something else, most often a migraine. Then the two signs missing from the FAST checklist most people learn: sudden loss of balance and sudden trouble seeing. A 2017 study in Stroke found that about one in seven stroke patients had none of the FAST signs, which is why more hospitals now teach BE FAST, with B for balance and E for eyes. Ravi also shares a simple eye check you can do while vision trouble is happening, and, with his wife as the model, shows how to check someone for a stroke with three quick tests.

Number one is the warning that comes days before. In an Oxford study of more than 2,400 people with a stroke caused by a clot, nearly one in four had a warning first, and almost half of those warnings came in the week before. That warning is a transient ischemic attack, or TIA. In the EXPRESS study, being seen in under a day and starting treatment right away cut the 90 day stroke risk from about 10% to about 2%.

Ravi then takes you behind the doors of what happens after you call 911: why the CT scan comes first, why you should never take an aspirin at home for a suspected stroke, the time windows for clot busting medication and clot retrieval, and how bleeds and aneurysms are treated. He closes with prevention: 10 changeable risk factors are linked to about 90% of strokes, high blood pressure alone to almost half, and there are three things you can check at home today.

Episode Resources

If you think you or someone near you is having a stroke right now, stop and call 911 or your local emergency number. Do not drive yourself, and do not take an aspirin at home for a suspected stroke.

In this episode, you will discover:

  • Why a symptom that comes and goes is not the all clear: When a stroke sign fades after a few minutes, that is often the warning, and your chance to get ahead of the stroke
  • How to tell stroke numbness from a pinched nerve: A pinched nerve follows a strip down the arm or leg, hurts, and changes as you move; stroke numbness hits the face, arm, or leg on one side suddenly, and moving does not change it
  • Why stroke confusion gets put to bed: With aphasia the person often has no idea anything is wrong, and unlike dementia, which creeps in over months, stroke confusion shows up in minutes
  • What a thunderclap headache and a sentinel headache are: About one in eight people with a bleed from a ruptured aneurysm were first diagnosed with something else, most often a migraine, and some get a smaller warning headache days or weeks earlier
  • Why FAST misses about one in seven strokes: Strokes in the back of the brain cause balance and vision trouble rather than a droopy face or weak arm, which is why more hospitals now teach BE FAST
  • How to tell dangerous dizziness from benign vertigo: Positional vertigo comes with head movement and settles; dizziness out of nowhere that does not settle, especially with trouble walking, double vision, or slurred speech, is a call to 911
  • A simple eye check you can do while vision trouble is happening: Cover one eye, then the other, to tell whether the problem is in the eye or in the brain
  • Why weakness on the right points to the left side of the brain: And a new 2026 hypothesis on why our brains are cross wired in the first place
  • How to check someone for a stroke in three quick tests: Smile, arms out with eyes closed, and repeat a simple sentence
  • The warning that comes days before: Nearly one in four people had a TIA before their stroke, almost half of those in the week before, and about seven in ten did not realize what had happened
  • How acting fast after a TIA changes the odds: Being seen within a day cut the 90 day stroke risk from about 10% to about 2% in the EXPRESS study
  • What happens after you call 911: Why the CT scan comes first, why you should never take an aspirin at home, and the time windows for clot busting medication and clot retrieval
  • The 10 changeable risk factors linked to about 90% of strokes: And why stroke is rising in adults aged 45 to 64
  • Three things to check at home: Your blood pressure, your pulse, and your family history of brain aneurysms

Key Takeaways

A symptom that goes away is still a reason to call. A TIA is often the only warning you get before a major stroke, and many people wait until Monday. Monday can be too late.

Learn BE FAST, not just FAST. Balance, Eyes, Face, Arms, Speech, Time. The B and the E catch strokes in the back of the brain that the classic checklist misses.

Note the time, call 911, and do not drive yourself. Paramedics start care on the way and take you to a hospital that can treat a stroke. The time symptoms started, or when the person was last normal, decides which treatments are still possible.

Never take an aspirin at home for a suspected stroke. Only a CT scan can tell whether it is a clogged artery or a bleed, and if it is a bleed, a blood thinner is the last thing you want.

Check your blood pressure at home. Sit quietly for five minutes, then take two readings a minute apart at the same time each day. The goal for most adults is below 130/80, and every 10 points lower on the top number came with roughly a quarter lower stroke risk.

Check your pulse and ask your family one question. An irregular rhythm from atrial fibrillation makes a stroke nearly 5 times more likely and can be silent. If two or more close family members have had a brain aneurysm, guidelines say you should be offered a scan of the arteries in your brain.

Your Checklist for the First 10 Minutes

  1. Look at the clock and write down the time.
  2. Call 911 or your local emergency number.
  3. Do not drive yourself.
  4. Do not take an aspirin.
  5. Tell the dispatcher when it started, which side was affected, and whether it has happened before.

Transcript

[00:00 –> 00:14] Dr. Ravi Kumar: I had a patient, a middle aged woman, whose stroke was so big that I had to remove the whole right side of her skull to save her life. For a week before that, her body had been warning her, and she had no idea.

[00:14 –> 00:31] Dr. Ravi Kumar: This patient is actually hypothetical, but I’ve treated patients like this over and over throughout my surgical career. Most people think a stroke comes out of nowhere, but often, your body warns you first, and most people have no idea what that warning means. Welcome to The Dr Kumar Discovery.

[00:31 –> 00:50] Dr. Ravi Kumar: My name is Dr. Ravi Kumar. I’m a board certified neurosurgeon, and in this episode, I’m going to count down the seven warning signs your body gives you before a stroke and why each one gets missed. Stay for number one because it can show up days before the stroke, and most people don’t even recognize it.

[00:50 –> 01:05] Dr. Ravi Kumar: Before we get into it, I just want to let you know that this episode is for informational purposes only. So work with your own doctor, and if any of this is happening to you or someone near you right now, you need to hit pause and call 911.

[01:05 –> 01:25] Dr. Ravi Kumar: Also, this show is separate from my role as assistant professor at UNC. Okay. So first, let’s discuss the concept that ties all seven early signs of stroke together. A stroke is essentially a plumbing problem, an artery that feeds part of your brain either clogs or leaks, and whatever that part of the brain controls stops working properly.

[01:25 –> 01:42] Dr. Ravi Kumar: So every sign in this video is telling your brain which part of your brain is actually in trouble. Any of these signs can be a stroke itself, but when a sign or symptom comes and then goes away, that is the warning. And it’s your chance to get ahead of the stroke.

[01:42 –> 01:53] Dr. Ravi Kumar: So I’ll tell you what each of these warnings actually looks like, and then you can recognize it early. Because every minute a big stroke goes untreated, the brain actually loses 1.9 million nerve cells.

[01:53 –> 02:12] Dr. Ravi Kumar: Okay. With that, let’s get started with the countdown. Number seven is a sudden numbness on one side of your body. Half your face maybe feels thick or full of sand, like after the dentist, or one arm, or the arm and the leg on the same side of your body go tingly or numb.

[02:12 –> 02:32] Dr. Ravi Kumar: And if it fades after a few minutes, that’s not the all clear. That’s the warning. Sometimes numbness is the only sign. This is often a brain artery that gets blocked, then spontaneously clears. And sometimes it’s a small stroke deep in the brain, and the brain then learns to work around this little tiny stroke fairly quickly.

[02:33 –> 02:50] Dr. Ravi Kumar: We call this small stroke a lacunar stroke, and it can make the face, arm, and leg all numb on one side with no weakness at all. In fact, in a Dutch study published in 2024, more than a third of mini strokes didn’t show any weakness, and numbness was one of the things those people experienced instead.

[02:50 –> 03:05] Dr. Ravi Kumar: I see a lot of numbness in my spine clinic, and most of it’s a pinched nerve in the neck or the back. A pinched nerve follows a strip down the arm or the leg, and it usually is very painful. And it changes when you move.

[03:05 –> 03:28] Dr. Ravi Kumar: It gets worse or it gets better in different postural positions. A stroke tends to hit the face, the arm, or the leg on the same side, and it comes on suddenly, and moving around doesn’t change it. What I tell patients is that sudden numbness on one whole side of your body, especially the face and arm together, is a stroke sign until a doctor proves otherwise.

[03:28 –> 03:43] Dr. Ravi Kumar: You should note the time the symptoms started and call emergency services. So numbness is something you feel. The next sign is one the person having the stroke often can’t recognize at all, which is why it’s usually the family that has to catch it.

[03:43 –> 03:58] Dr. Ravi Kumar: Number six is sudden confusion or suddenly not understanding what people are saying. You ask your spouse a simple question, and they answer with words that sound normal, but just don’t fit together. Or your mother looks at you as if your words make no sense.

[03:58 –> 04:13] Dr. Ravi Kumar: We call that aphasia, which is a problem with language, and stroke is its most common cause. One kind is especially easy to miss. The person speaks easily, sometimes a lot, but the sentences just don’t make sense, and they have real trouble understanding you.

[04:13 –> 04:22] Dr. Ravi Kumar: And here’s what makes it so dangerous. The person it’s happening to often has no idea anything is wrong, and oftentimes, the family doesn’t recognize it either.

[04:22 –> 04:37] Dr. Ravi Kumar: So the family thinks they’re tired or having a senior moment, and they put them to bed with an untreated stroke. So the way you tell aphasia apart from memory problems that come with age is how fast they come on. Dementia creeps in over months and years.

[04:37 –> 04:53] Dr. Ravi Kumar: The confusion of a stroke shows up in minutes in someone who was fine the last time you saw them. If someone you know well suddenly can’t follow a conversation or talks in a way that just doesn’t make sense, don’t argue with them, and don’t wait for them to agree.

[04:53 –> 05:10] Dr. Ravi Kumar: Make the call. Okay. So the first two warning signs can be very quiet, but the next one is anything but quiet. And it’s the kind of stroke that brings neurosurgeons like me into the hospital in the middle of the night. Number five is a headache that hits like a thunderclap.

[05:10 –> 05:26] Dr. Ravi Kumar: It goes from nothing to worse pain of your life in under a minute, which is very different from a headache that builds slowly over an afternoon. The one I worry about most is a ruptured aneurysm, and it’s one of the ones I get called in for all the time.

[05:26 –> 05:41] Dr. Ravi Kumar: We call it a subarachnoid hemorrhage, and most of the time, it’s from a ruptured aneurysm. Think of an old garden hose with a weak spot that slowly bulges out. An aneurysm is that bulge in an artery at the base of the brain, and one day, it just bursts.

[05:41 –> 05:56] Dr. Ravi Kumar: Blood spills into the space around the brain and irritates the lining there, which is why pain is so sudden and so severe, and why it often comes with a stiff neck or vomiting. The reason it gets missed is that it looks like a bad migraine.

[05:56 –> 06:11] Dr. Ravi Kumar: Sometimes even a doctor thinks it’s a migraine. In a study published in JAMA in 2004, about one in eight people with this kind of bleed were first diagnosed with something else, most often a migraine, actually. And many of them got worse before the bleed was found.

[06:11 –> 06:24] Dr. Ravi Kumar: So here’s the warning sign for this type of stroke. Some people get a smaller sudden headache days or weeks before the big bleed, possibly from a tiny leak from the aneurysm. We call this a sentinel headache.

[06:24 –> 06:45] Dr. Ravi Kumar: So if you’ve had one sudden severe headache unlike any other that you’ve ever had before, even if it went away, that’s worth getting checked out. What I tell patients is simple. If you’ve ever had a thunderclap headache that reached full strength in seconds, That’s a reason to call 911 or emergency services rather than waiting and seeing.

[06:45 –> 07:09] Dr. Ravi Kumar: So that headache makes people pay attention, but the next two warning signs are actually missing from the stroke checklist that most people learn, which is a big reason they get missed. Number four is a sudden loss of balance. The room tips, or you can’t walk in a straight line, or you need to reach for the wall to stay upright, or one leg won’t do what you tell it to do.

[07:09 –> 07:25] Dr. Ravi Kumar: Most people learn one checklist for stroke. It’s called FAST, which stands for face, arm, speech, time. So face is a weak face. Arm, a weak arm. Speech is garbled or difficult to understand speech. And time means it’s time to call 911 or emergency services.

[07:25 –> 07:42] Dr. Ravi Kumar: A study published in the journal Stroke in 2017 went back through 736 stroke patients, and about one in seven had none of the FAST signs. What those patients had most often was trouble with balance or trouble with their eyes.

[07:42 –> 08:01] Dr. Ravi Kumar: So the researchers added two letters to the front of that mnemonic, B for balance and E for eyes. So it’s now BE FAST, and more and more hospitals now teach it. And here’s why. The back of your brain gets its blood from a different pair of arteries than the front of your brain.

[08:01 –> 08:11] Dr. Ravi Kumar: They climb up through the little tunnels in the bones of your neck and enter through the base of your skull. The part of the brain they feed coordinates your movements and keeps you upright.

[08:11 –> 08:19] Dr. Ravi Kumar: So when one of them clogs, you don’t necessarily get a droopy face or a weak arm. You get a world that spins and throws off your balance.

[08:19 –> 08:36] Dr. Ravi Kumar: So the FAST checklist was built around the front of the brain, and it misses strokes that affect the back of your brain. The inner ear can also cause this kind of spinning and balance issues. The most common cause of this is tiny loose crystals in the semicircular canals.

[08:36 –> 08:51] Dr. Ravi Kumar: It’s called benign positional vertigo, and it’s not a dangerous condition. This will typically be brought on by moving your head, like rolling over in bed or looking up, and it usually lasts a few minutes and then it goes away. Sometimes it can persist longer.

[08:52 –> 09:06] Dr. Ravi Kumar: What worries me is dizziness that comes out of nowhere and doesn’t settle down, especially with trouble walking, double vision, or slurred speech. And if that kind of symptom comes on and then clears, that’s the warning of a potential impending stroke.

[09:06 –> 09:17] Dr. Ravi Kumar: So when you suddenly lose your balance and it doesn’t make sense to you, you need to make the call to emergency services instead of lying down and waiting it out.

[09:17 –> 09:35] Dr. Ravi Kumar: Okay. So we’ve discussed four warning signs. Numbness on one side of the body, sudden confusion, the thunderclap headache, and a sudden loss of balance. Balance is the B in BE FAST. The E is for eyes, and this is the sign people are most likely to blame on something else.

[09:35 –> 09:50] Dr. Ravi Kumar: Okay. So number three is sudden trouble seeing. Sometimes it’s double vision. Sometimes the whole left or right half of what you see is suddenly missing. And when that comes from the back of the brain, people often don’t notice it themselves. They just know something is off.

[09:50 –> 10:08] Dr. Ravi Kumar: There’s a version of this that hits just one eye. It feels like a shade being pulled down over the eye, and a few minutes later, it lifts and everything looks normal again. We call that amaurosis fugax, which means fleeting blindness, and it’s one of the classic warning signs of stroke.

[10:08 –> 10:25] Dr. Ravi Kumar: I take it very seriously because the retina at the back of your eye is actually brain tissue, and it’s fed by a branch of the same big artery that feeds the whole side of your brain. This type of stroke warning, amaurosis fugax, can sometimes be confused with a migraine aura.

[10:25 –> 10:39] Dr. Ravi Kumar: An aura usually adds something like flashing lights or zigzag lines, and it builds and spreads over several minutes. A stroke usually takes something away, like a part of your vision just goes dark and it’s there all at once.

[10:39 –> 10:58] Dr. Ravi Kumar: So here’s a simple check that you can do while it’s happening. Cover one eye and then cover the other. If there’s a missing piece of your vision in only one eye, the problem is with that eye or the artery feeding it. If the mirror version of the visual field is missing, whichever eye you cover, the problem is in the brain.

[10:59 –> 11:16] Dr. Ravi Kumar: Either way, and even if it clears, the answer is the same. Call 911 or emergency services. Okay. So the next sign is the one most people know. What they don’t know is that the problem isn’t where they feel it, and I want to show you how to check for it on someone you love.

[11:16 –> 11:32] Dr. Ravi Kumar: Okay. So number two is when one side of your body stops working. One side of the face droops or the arm gets weak or your leg doesn’t work properly or the words just come out slurred because the face is not working or the brain is not controlling the speech properly.

[11:32 –> 11:47] Dr. Ravi Kumar: Here’s the part people miss. If your right hand suddenly goes weak, the problem isn’t in your hand most likely. It’s in the left side of your brain Because a stroke on one side of the brain shows up on the opposite side of the body.

[11:47 –> 12:02] Dr. Ravi Kumar: And for most people, the left side of the brain is also where language lives, which is why weakness on the right so often comes with trouble speaking. Hippocrates wrote about this cross connection between the brain and the body more than 2,000 years ago.

[12:02 –> 12:19] Dr. Ravi Kumar: And to this day, nobody knows for sure why we’re wired this way. In October 2026, two neuroscientists at the University of Minnesota proposed that it goes back about 500 million years to the way the first animals with a backbone mapped what they saw onto the opposite side of their brains.

[12:20 –> 12:34] Dr. Ravi Kumar: It’s a hypothesis, not proof, but it’s a good reminder of how much we still don’t understand about the brain. Okay. So let me show you how to check for this on someone who you think may be having a stroke. My lovely wife has agreed to be our model.

[12:34 –> 12:58] Dr. Ravi Kumar: So if you’re watching this episode, you’ll be able to see what I’m talking about. First, ask them to smile, and look at the corners of the mouth to see whether one side is lower or not moving. Second, ask them to close their eyes and hold both arms straight out in front of them, palms up for about 10 seconds, and watch whether one arm drifts down or turns in.

[12:58 –> 13:13] Dr. Ravi Kumar: And third, ask them to repeat a simple sentence. Something like, “The sky is blue today.” “The sky is blue today.” And listen for slurred words or wrong words. If one of those is off and it came on suddenly, you don’t need all three.

[13:13 –> 13:34] Dr. Ravi Kumar: Just note down the time and call 911. And if the droop or the weak arm goes back to normal after a few minutes, that’s the warning version, and it’s every bit as much of a reason to call. Remember the B and the E as well because sudden trouble with balance or vision counts too, and a normal check doesn’t rule out stroke.

[13:34 –> 13:57] Dr. Ravi Kumar: So if something still feels wrong, err on the side of calling emergency services. Okay. So those are the six signs that you’ll notice while a stroke is happening. Number one on our countdown list is the warning that comes days before. A study from Oxford published in Neurology in 2005 looked at more than 2,400 people who had had a stroke caused by a clot in an artery which blocks the artery.

[13:57 –> 14:14] Dr. Ravi Kumar: Nearly one in four had a warning first, and in almost half of those, that warning came in the week before the stroke. Let me say that again. For a lot of these people, there was a warning, and there was time to potentially prevent the stroke.

[14:14 –> 14:37] Dr. Ravi Kumar: We call that warning a transient ischemic attack or a TIA. Most people call it a mini stroke, but it can be almost any of the signs that we just went through, whether that’s numbness, confusion, a droop, garbled words, lost vision, or balance, except that it actually goes away usually within minutes because the artery clogs for a few minutes and then it opens back up.

[14:37 –> 14:54] Dr. Ravi Kumar: And that’s exactly why it gets missed. In another Oxford study published in Stroke in 2010, about seven in ten people didn’t realize what had happened to them. And the ones who had waited the longest before seeking attention had their warning signs on Friday, a weekend, or a holiday.

[14:54 –> 15:10] Dr. Ravi Kumar: People wait for Monday with this type of problem, and Monday can be too late. So I want to come back to that patient that I mentioned at the beginning of the episode. For about a week before her stroke, the left side of her face kept going numb and tingly.

[15:10 –> 15:28] Dr. Ravi Kumar: It would come on, fade away, and then come back again. She thought it might be a dental problem, so she decided to ignore it. Then one morning, her son found her in bed unable to move the left side of her body. By the time she got to the ER, it was too late for any clot busting medications.

[15:28 –> 15:44] Dr. Ravi Kumar: She had a complete right MCA stroke, which means most of the right half of her brain had died. I had to take her to the operating room and remove the whole right side of her skull so her brain could swell outward instead of inward, crushing the rest of her brain.

[15:44 –> 15:59] Dr. Ravi Kumar: That surgery saved her life, but it didn’t revive the lost brain tissue. So there is good news here. Acting fast after a TIA really changes the odds. The trial that showed this was called EXPRESS, and it was published in The Lancet in 2007.

[15:59 –> 16:12] Dr. Ravi Kumar: When people with a warning like this were seen in under a day instead of about three and started treatment right away instead of weeks later, their risk of stroke over the next three months fell from about 10% to about 2%.

[16:12 –> 16:29] Dr. Ravi Kumar: So think about my patient again. Those episodes of numbness on the left side of her face were likely TIAs. If she had come in on the first day, we would have had a real chance to find the cause and treat it, and she might never have needed me in the operating room.

[16:29 –> 16:44] Dr. Ravi Kumar: Okay. So you’ve seen a warning sign, and you’ve made the call. Now I want to take you behind the doors because what happens in the next hours is where all of this pays off. And at the very end, I’ll give you a simple checklist for the first ten minutes after you see this warning sign.

[16:44 –> 16:58] Dr. Ravi Kumar: So what happens after you call 911? When the paramedics reach you, they check you for the same signs that I’ve just taught you about. They start care on the way to the hospital, and they take you to a hospital that can treat a stroke.

[16:58 –> 17:12] Dr. Ravi Kumar: Often, they call ahead so the team is ready when you come through the door. That’s the reason you call 911 or emergency services instead of driving to the hospital. The first thing we do is a CT scan of the head, and the main question it answers is simple.

[17:12 –> 17:34] Dr. Ravi Kumar: Is this a clogged artery, or is it a bleed? That’s why you never take an aspirin at home for a suspected stroke. Because if it’s a bleed, a blood thinner is the last thing you want. This is also where your clock matters. We have specific windows of time that we can give clot busting medications, or use interventions that open up the arteries.

[17:34 –> 17:48] Dr. Ravi Kumar: If someone wakes up with symptoms, the clock starts when they were last normal, which might be when they went to bed. That’s what happened to my patient. Her clock had been running all night, which made it too late to get clot busting medications.

[17:48 –> 18:01] Dr. Ravi Kumar: And today, there are scans that can still tell us whether treatment will help even if we’re unsure of when their stroke symptoms first started. If the stroke is caused by a blocked brain artery, we have two big tools. The first is a clot busting medication.

[18:02 –> 18:17] Dr. Ravi Kumar: These medications are given within about 4.5 hours of when the stroke first started. And the goal at any hospital is to be given within an hour of you coming through the door. The second tool is for a big blocked artery.

[18:17 –> 18:35] Dr. Ravi Kumar: A thin tube is actually threaded through the artery up into the brain, and then the clot is actually pulled out. For some people, that can still be done up to 24 hours after the stroke started. If it’s a bleed, the plan is different, and this is where my specialty comes in.

[18:35 –> 18:50] Dr. Ravi Kumar: We bring the blood pressure down. We reverse any blood thinners right away. And if it’s an aneurysm, we secure it, ideally within the first 24 hours, either by clipping it with surgery or by filling it from the inside with tiny coils through a catheter.

[18:50 –> 19:04] Dr. Ravi Kumar: And if it’s a TIA, meaning stroke symptoms that went away, you’ll still get the full workup, ideally within 24 hours, and that includes an MRI of the brain, pictures of the arteries in the head and neck, and a check of your heart rhythm.

[19:04 –> 19:12] Dr. Ravi Kumar: When people come to the ER with symptoms that have already gone away, an MRI finds an actual stroke in about 40% of them.

[19:12 –> 19:26] Dr. Ravi Kumar: So that warning often isn’t only a warning. You’ve actually had a small stroke, but you’re preventing a larger one. And if it turns out not to be a stroke at all, that’s good news, and checking is exactly what the stroke team is there for.

[19:26 –> 19:42] Dr. Ravi Kumar: So that’s what happens when you have a TIA or a stroke. If that happens, don’t despair. Treat it early and start with preventative measures to make sure it doesn’t happen again. But what about preventing a stroke in the first place? Because ideally, that’s where we all start.

[19:42 –> 20:11] Dr. Ravi Kumar: Well, we have some pretty good data on the risk factors and what you can do to lower your risk. First, let’s talk about who’s at risk. Your risk goes up with age, but don’t assume that this is only an old person’s problem. A CDC report published in 2024 found that the share of adults aged 45 to 64 who had had a stroke went up by 15% over the last decade, while it stayed flat in people 65 and older.

[20:11 –> 20:28] Dr. Ravi Kumar: And here’s the most important number in this section. In a study of stroke across 32 countries, 10 things we can change were linked to about 90% of strokes, and high blood pressure alone was linked to almost half of all strokes that occurred.

[20:28 –> 20:44] Dr. Ravi Kumar: So the first thing to check is your blood pressure at home. Sit quietly for five minutes first with your back supported, feet flat on the ground, and your arm resting at the level of your heart. And then take two readings a minute apart at the same time each day.

[20:44 –> 21:01] Dr. Ravi Kumar: The goal for most adults is below 130/80. And if you ever see a reading above 180/120 together with chest pain, shortness of breath, or any of the signs that we talked about on this video, that’s a 911 call or an emergency services call.

[21:02 –> 21:19] Dr. Ravi Kumar: So if your blood pressure runs high, bringing it down works for reducing your stroke risk. In a review of 123 trials published in The Lancet in 2016, every 10 points lower on the top number, that’s your systolic blood pressure, came with roughly a quarter lower risk of stroke.

[21:19 –> 21:38] Dr. Ravi Kumar: The second thing to check is your pulse. An irregular heartbeat called atrial fibrillation makes a stroke nearly 5 times more likely, and you can have it without feeling a thing. Just put two fingers on the inside of your wrist, just below the base of your thumb, and count for a full minute.

[21:38 –> 21:55] Dr. Ravi Kumar: What you’re really feeling for is the rhythm, whether it’s steady or if it’s jumping around. If it feels irregular, tell your doctor. And if your watch checks your heart rhythm and ever alerts you, take that to your doctor too. And the last thing you want to do is ask your family a question.

[21:55 –> 22:15] Dr. Ravi Kumar: You want to know if anyone in your family history has had a brain aneurysm or a bleed in the brain. About three in a hundred adults have a brain aneurysm. And if two or more of your close family members have had a brain aneurysm, the guidelines say that you should be offered a scan of the arteries of your brain.

[22:15 –> 22:36] Dr. Ravi Kumar: And if you smoke or your blood pressure is high, that’s one more reason to fix both of those things. Okay. So those were the seven signs of a stroke. Numbness on one side of the body, sudden confusion, a thunderclap headache, sudden loss of balance, sudden trouble seeing, one side that stops working, and a neurological deficit that goes away.

[22:36 –> 22:58] Dr. Ravi Kumar: That’s how your body warns you before a stroke. If you remember one thing, make it BE FAST, B E F A S T, which stands for balance, eyes, face, arms, speech, time. And if any of this unfortunately happens to you or someone you love, here’s your checklist for the first ten minutes.

[22:58 –> 23:19] Dr. Ravi Kumar: First, look at the clock and write down the time. Second, call 911. Third, don’t drive yourself. Fourth, don’t take an aspirin. And fifth, when you talk to the 911 dispatcher, the emergency services dispatcher, tell them when it started, which side was affected, and whether it’s happened before.

[23:19 –> 23:38] Dr. Ravi Kumar: In situations like these, knowledge is power, and this is the kind of knowledge that can save someone you love. So please send this video to one person over 55 in your life. And if they ever get a warning that goes away, I want them to know what it means and what to do about it.

[23:38 –> 23:55] Dr. Ravi Kumar: Also, if you want to exercise your brain like I do every day, there’s a fun app that I created called Brain Gamer. You can find it at braingamer.app. I designed this app to exercise the different domains of your thinking and your brain, kind of like going to the gym where you might work out your biceps or your triceps.

[23:55 –> 24:06] Dr. Ravi Kumar: This is an app that works the different circuits of your brain in a very intentional way. It doesn’t feel like work, and it’s something I play every morning. You can check it out at braingamer.app.

[24:06 –> 24:20] Dr. Ravi Kumar: Okay. So to wrap all this up, every symptom that I talked about in this episode gives you something that you can notice and act on. But there’s another kind of thing that can happen to your brain that you might not notice at all.

[24:20 –> 24:34] Dr. Ravi Kumar: They’re called tiny silent strokes or lacunar strokes. And about one in five older adults already have at least one of them. I did a whole episode on what they do to your brain and the four things I see in brains that stay young.

[24:34 –> 24:41] Dr. Ravi Kumar: You should definitely check it out. Until next time, stay curious, stay skeptical, and stay healthy. Cheers.

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