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What a beautiful article.

My girlfriend had three strokes, in succession, two years ago (when she was 22). The night before these strokes occurred, she had a transient ischemic attack (TIA). She began speaking gibberish to her friends. She texted me later that night explaining what happened. Her friends had laughed about it because they thought she was just acting like a goofball. I had no idea these were signs of a TIA, but I told her that if it happened again she needed to go to the doctor immediately.

The next day, the right side of her body went numb. This time, she was around people who noticed something was wrong, and she was immediately rushed to the emergency room. By the next day, I had flown a thousand miles (from the location of my new job) to be with her. She couldn't remember many words. She couldn't read a clock. She did not know the answer to 3 + 0.

It turned out that, similar to the author of this article, clots had traveled through the hole in her heart and up to her brain. Luckily, she recovered fully and was back to her old self within about a month. She had surgery to fix the PFO a couple months later. The neurologist told her that nine times out of ten, the clot travels a different path, and the victim is left dead or braindead. I am so lucky. Writing about this has me in big tears.

I am going to stop writing and go hug her now.

I'm the writer of the story--thank you so much for reading. I'm glad to know that my experience helps people gain further understanding of strokes/brain injuries. I hope your girlfriend is in a better place, now.
Thanks for this.

Are you in the US? If so, how much did the ordeal cost?

About 15 years ago my father had a stroke at our house. I was about 12 years old and at home at the time along with my grandmother. We didn't know what was happening. At one second he was okay and in another he was on the floor. It was almost impossible to put him back at the bed even with the help of one of our tenants.

We called my mother at work and the funny thing is that before she came home to take him to the ER he was able to ask for coffee (and drink it) and also to smoke a cigarette.

Moving 15 years forward he's still with us (62 years old) with no movement at all on the left side of his body. Had a heart attack with major surgery, is on more than 15 different medications, has diabetes and a bunch of other "minor problems".

My mother gave up her life to take care of him and everyday is a struggle because of the existing problems prior to the stroke and the ones that came after he became bitter and really mean to those who love and take care of him.

I'm not sure why I wrote about this but I felt like sharing. It's not easy when people don't recover, but for some reason I believe we have to take care of them and do our part.

Thanks for sharing.
I was 32 when I had a stroke (March 4th, 2003). It was a different kind of stroke, affecting a different part of my brain, essentially related to vision. I was half blind, but I only realized something was "strange" when I saw myself in the mirror: I had only one eye. My brain knew I should have two: I was half blind.

The first diagnosis was migraine with aura (blindness in my case). But the aura should have lasted no more than an hour. Two days later, the aura (blindness) was still there (a sign of infarct but my doctor didn't know it).

I spent 2 days alone in the dark. I forgot to eat but I knew I had to call a taxi to take me to the hospital. I wasn't scared, I though it was just a migraine. It really looked and felt like my usual migraines. So my doctor had me take anti-migraine pills, which are vasoconstrictors. That might have caused the actual stroke: extreme vasoconstriction. Never take anti-migraine treatment during the aura. Never.

It took 2 days before I was diagnosed at the hospital, but they just told me "I see a shadow on the CT scan"... so I spent the next 2 days wondering what kind of shadow? stroke or cancer? And no, I didn't think about asking.

It took one week to be hospitalized for 10 days (my mother called the hospital, harassed them until she could talk to a doctor, who said it was an emergency... one week after the stroke).

It took 15 days before I woke up in the morning and thought "Wow! WOW! I'm back now!". Before that, I spent most of my time sleeping, reading half a page between two naps. I was sleeping more than I was awake.

It took 3 months before I could look at everything I wanted. Before that, looking at trees (and other complex objects) was "painful", and watching movies was too exhausting (especially action movies). During these 3 months, I recovered from blindness, but not completely. I still have a blind spot in my field of view today.

It took 6 months before my mood was really restored. Before that, I needed a daily nap, lots of soothing music, and no pressure at all.

I took aspirin daily for 3 years, after which my neurologist told me I could stop.

I had a few migraines after that, and even ended under oxygen at the hospital once, but I always recovered within 15 days.

It was 10 years ago, and it changed my life. I quit my job as a developer, spent 2 years wondering what to do next, then became a wedding photographer. In february this year, almost 10 years after, I got a new job as a developer.

I'm back on rails (node.js to be precise :-)

> It was a different kind of stroke, affecting a different part of my brain, essentially related to vision. I was half blind, but I only realized something was "strange" when I saw myself in the mirror: I had only one eye. My brain knew I should have two: I was half blind.

There's something going on here beyond just loss of raw visual input. If you lose an eyeball, or hold your eye closed, and look in the mirror, your one good eye will still show you that you have two eyes (or, as the case may be, sockets / sets of eyelids). Perceiving yourself as having one has to involve a loss of brain function, not just a loss of eye function.

> Before that, looking at trees (and other complex objects) was "painful"

You are the only other person I have ever heard describe looking at complex objects as sometimes painful. This happens to me sometimes, mostly with very complex and disfigured cartoon faces. Very strange. I have never had someone understand what I'm talking about when I try and describe it. Do you have any idea what causes this effect?

Wow, your doctors suck.
Thanks for sharing, awesome write-up (your doctor sucks).
wow. you usually hear how the usa is a litigious place and that make doctors scared of new treatments and what not... but that's just negligence. anyway you look at it. probably from several professionals you talked to during those first days.
>I wandered outside the boundaries of telemetry. They lost my heartbeat. When I returned, they scolded me.

The audacity of health care industry workers (those who should know what a certain disease entails) who place blame on their patients for acting normally is infuriating.

I had kidney stones once at a young age. I remember barely walking into the emergency room one night after they became too painful.

As soon as I arrived, white as a sheet of paper, they asked me a few questions... doped me up on morphine... and managed to "lose" me on a gurney in a hallway somewhere for a few hours until my girlfriend at the time came and found me.

They took xrays I believe and I was free to go with some more painkillers in hand.

Apparently the hospital told me that I was supposed to call them by X date if I wanted any more painkillers.

I called them back about a week after that date had passed, asked for a refill, and was scolded like I was some drug addict just looking for a fix. I think they even hung up on me. How could I be so stupid as to have forgotten a date they told me when I was high as a kite by their own doing? Right.

I ended up passing them without any painkillers which as many of you have probably heard is unbelievably painful.

I understand that it can get monotonous working in a hospital, but with the amount of money they're paid to work there you would hope that they would be required to operate with a little compassion. Considering the fact that many people in a hospital are leaving this world.

What if the author's last memory was that of a person she didn't know berating her for something she wasn't sure she even did?

> ...was scolded like I was some drug addict just looking for a fix...

It's tough dealing with drugs and potential abuse. You know if you're really in need or not, but they deal with people wanting them for any reason just because, and so the skepticism starts to show. There's the default assumption at hospitals/pharmacies of just locking everything down so the healthcare providers themselves can't abuse them too.

My father was in the ER the other month for severe abdominal pain. He got morphine _after_ it was discovered that his blood pressure was through the roof and he wouldn't tolerate even a light touch in the area. Then multiple people were required for disposal and documentation of whatever was left over - after someone had to go get it from an automated dispensing cabinet and _then_ scan both the drugs and his bracelet QR code to verify the order (+allergies+other things). It was impressively thorough.

In comparison, my neurologist and doctor are really freehanded with nerve pain meds for my legs. Can't really recreationally abuse anticonvulsants or antidepressants or lidocaine patches, I guess. Also on the pain front, having something that can be directly tested goes a far way for the disbelief/skepticism that might otherwise be a problem. :(

Remember this -

  You have FOUR HOURS to get a person with a stroke to the emergency.
If you do, their chances of survival are dramatically higher.
I think many people that haven't personally faced what a stroke is in one way or another don't realize how dangerous and life changing the disease is. Also, they don't understand how to detect it.

I have seen it several times. The first time it happened to my grandfather, nobody in the family realised what's wrong only that he seemingly was losing memory and repeating things he just said. Several hours passed until we thought we should perhaps call the medics - stroke was immediatelly recognized by the doctor and the emergency saved my grandfather only with very mild consequences afterwards. The second time my grandfather got a stroke, he started stuttering and had difficulty speaking. Again, we did not believe it could be stroke, because, you know, he might just be feeling bad. And again, the emergency saved him within a few hours. During the third and final stroke that we know of family was already aware and he was taken to the hospital early but he was released just a couple hours later with instructions to stay in bed and rest. Overall, about 6 to 8 hours passed until he got the required medical care. After that stroke he spent almost five years doing nothing, just existing - with almost completely blank mind. If only the doctors were professionals and we, the family, would have paid better attention, he would have been saved.

TL;DR: pay attention to the people you know. If something is slightly off and the person himself does not seem aware of it, this is definitely a strong signal that it might be a stroke.

My understanding is that early presentation to hospital with ischaemic stroke does not improve survival [1]. The reason for early presentation is that if thrombolysis with clot busting drugs is administered early then long term neurological outcome is better. Survival alone is not improved however.

As discussed in another comment, the earlier the better. The idea is for as little time as possible to have elapsed between blocking off the blood supply and opening it up again. The reason for this is that when part of the brain becomes ischaemic, a central core dies instantly but around this there is a halo or penumbra that is not dead but at risk. This penumbra of tissue dies off over time, and can be saved if the blood supply is reconstituted. The penumbra can be visualised using quite clever MRI [2]. Having said that, trials that have tried implementing this kind of imaging to guide thrombolysis have not been positive, as compared to just thrombolysing everyone.

[1] http://www.ncbi.nlm.nih.gov/pubmed/23791822 [2] http://en.wikipedia.org/wiki/Perfusion_scanning#MR_Perfusion

My dad had a cerebral stroke a few years ago. As everyone else was trying to arrange an emergency ambulance, his doctor was on the phone with him asking him to stay awake. Apparently, he said "if you fall asleep, you'll die." Fighting to stay awake for those few hours was one of the hardest things he's ever had to do.
The only equation that matters is

Time = Brain

every second a stupendously large number of neurons die. at 4 hours the damage is complete, there will be total wipe-out of the infarcted area. you really want to get to emergency within half an hour.

Note, this is for an ischaemic stroke. If you have a haemorragic stroke (usually in the elderly and in those with ruptured aneurysms) there will be little that is possible except supportive care

As someone who had two grandparents have strokes absolutely this, prompt medical attention significantly reduced both the damage and the recovery/rehabilitation time.

If you think even remotely it's a stroke then straight to the hospital you go.

https://www.youtube.com/watch?v=yXONEHmupy0 (UK National Health Service Advert about strokes)

Gatsky addresses this in more technical terms [1], but this is more an issue of long term outcomes if they survive than of survival. Not that this is less important (some people would say it is more important!) -- just different.

[1] https://news.ycombinator.com/item?id=8348741

Thrombolysis works only for ischemic strokes. The much worse hemorrhagic stroke doesn't even have that window. Fortunately, it is somehow rarer.
So, time for a quick Throne of Thunder raid, then.
Strokes can present in truly any number of ways. The Cincinnati Stroke Scale, often seen in public health campaigns as "FAST", provides three simple, quick assessments that can reliably delineate a majority of strokes. It is the standard for basic EMTs as well. More advanced providers should perform a more comprehensive exam, testing all the cranial nerves (actually usually just II through XII). A more formalized, advanced stroke scale is the NIH stroke scale: http://stroke.nih.gov/documents/NIH_Stroke_Scale.pdf

While there are often some kind of neurologic deficit associated with a stroke, the goal standard is, of course, a CT or CTA that should be administered immediately upon arrival in the ED of a suspected stroke (depending on the presentation of symptoms an exam by a neurologist may occur first).

The symptoms described in this story would absolutely make me think this person was having a stroke if she had verbalized them to someone with my training.

It's also worthwhile to point out that the person having a stroke may not realize they are having a stroke. People may have the obvious symptoms - slurred speech and hemiparesis - and refuse to acknowledge that these problems exist, because, in their mind, they don't.

If you think someone is having a stroke, record the time you first noticed symptoms and call 911 immediately.

My mother had a stroke. The fallout is very, very hard for the patient and their family.

Diet and exercise are, apparently, the easiest levers you have to control for stroke risk. Trust me: this is the best of all possible reasons to care about those. You do not want to go through it and you do not want your family to go through it. Specifics elided for privacy but suffice it to say that it combined elements of a heart attack, advanced Alzheimer's, and a profound war injury in a compact package that arrived on a normal sunny Tuesday.

Diet and exercise should really be taken care of by everybody. Lowers the risk of strokes and heart attacks considerably. In most of these young patients the reasons are due to other (most often undetected) issues like PFO though. That's also why i really have issues with health care in the US, as many people avoid checks to save costs. In germany, whenever you feel something is really wrong, you can just walk into ER and costs will be covered, no matter what.
Great article.

I had a stroke one night in my 20's. When I woke up, my right side was numb (I thought I just slept on my arm), I spoke gibberish and was unable to write but I felt fine and I thought I spoke perfectly fine. I finally figured out that something was not right when I tried to write a message to my mom on the back of an envelope to tell her that I was fine and I just drew a straight line instead of letters. That's when she called an ambulance.

Luckily I was back to normal within a month, but I struggled for some time to to find the right words when talking.

I had a TIA when I was 28 (over 10 years ago) and under heavy stress (high blood pressure; they did not find any other causes; I was healthy as I could be, just extreme stress from my own business at that time); I swore after that to never be stressed again (and took measures to make sure that is possible, like living in southern Spain for large parts of the year) and haven't been since. I even forgot how it felt. My life is so much better that I now thank this TIA. Stress is pure hell and whatever business people think they get out of it; it's bullshit IMHO; I have had way more business success than ever without stress than I had with.
Four weeks ago my girlfriend, 32 yo, had a brain stroke because a deep venous thrombosis at her left side of the head. It was intense to see how much she deteriorated in the course of just a few hours, starting with a seizure and some very acute headaches she had together with vomiting the previous days. We were in intensive care around 10 days, and then 3 days more in hospitalization. The investigation of her tendency to hypercoagulate yielded as main culprit sedentarism and the previous uninterrupted usage of oral contraceptives (mercilon) for almost ten years. We were fortunate in some sense as the cause was easy to point out and also as we discarded autoinmuse diaseases (my biggest concern) and now she is under low molecular weight heparin, hoping that the clot is reabsorbed in two or three months.

As part of the recovery, I'm reading to her My Stroke of Hindsight, of Jill Bolte Taylor, and her symptoms and the description of the episode of the acute phase match largely: speech loss, paralysys of her right part of the body and rational disconnect with external stimuli.

This article highlights also how sensible we are to the changes of what we are at the end: physicochemical interactions. I was worried my girlfriend would lose her essence, but thanks to God her recovery has been amazing so far.

I am not sure if you are the OP or know her, but this story touched my heart. It is beautiful. I am only imagine how strong she has to be, and the people around her must be to get through this. My sister and her husband are going through the very same thing -- He was progressing very well in his career and they just had their first child when he suffered his from the same reason - a hole in the heart. All the best. You and all the stroke victims have my prayers tonight.
All the stories I know and heard of stroke victims in their 30's or 40's make me think and ask: is there really a way to prevent or predict a stroke?

Would the "controversial routine full body scan" help? Specially to people who have a parent being an early stroke victim?

These things are scary as hell...

Remember FAST: http://en.wikipedia.org/wiki/FAST_(stroke)

First 3 minutes of the house episode Fetal Position (S3 E17) demonstrate it.

Two years ago this October I was homeless. I would wander around all night for fear of attacks[1] and try to sleep during the day at the university while sitting on a bench or chair. In October the winter shelters had not yet opened here, and it was so cold I feared I would freeze to death. I wandered into ER on a pretext: there was a swelling in my leg, spider bite maybe?

I overheard the intake person talking with someone: "I'm worried about that guy in #68." Why? "He thinks he's got a spider bite, but he's got blood clot written all over him."

I felt pretty good about that; it meant I'd have a place to sleep for a whole night. Then I was suddenly surrounded by 5 or 6 people.

Symptoms, sir?

Sometimes slurred speech, tingling in the extremities, can't spell anymore, confused by the way people talk so _fast_, confused by simple things, excessively paranoid, feels like there's an Ace bandage wrapped around my chest.

You're a junkie. No. You're exclusively vegetarian. No. You're diabetic. No, I've been tested for that. Well, we'll take a blood draw.

I got an ultrasound over my legs -- and they discovered a DVT. Next thing I knew, they'd slapped me in hospital for eight days. I was put on no less than eight medications, the scariest of which was Coumadin (same as Warfarin, I think?) -- scary because they made me watch a video describing it, by which I mean "You follow these instructions to the letter or you gonna die, son." At least that's what it felt like. And I had to sign all kinds of waivers, or something. Two of the residents (very young women) told me that they had had DVT's themselves... possibly as a result of being exclusively vegetarian?

The diagnosis was: Pernicious Anemia. My understanding (which is not to be trusted) is that the myelin sheathing around my nerves has been dissolving for years. Apparently the communicating tissue between the axons in my brain had been going away for quite some time.

I liked this diagnosis because: it's easily treatable; it explains my increasingly weird behavior; I'm not dead from it.

The treatment is: Take B12 every day for the rest of my life.

The highly-abbreviated coda to the story is: My Doctor told I'd had this disease for at least ten years(!); hospital got me a case manager, who got me Disability, Homed, and a Laptop. But it took 2 years or so.

TLDR: Being exclusively vegetarian can cause DVT's

[1]http://www.youtube.com/watch?v=lM6WrqLMJrQ

> Each night, I took the box of Lovenox syringes and carried it to my husband, sobbing. “It’s time for my shot,” I said, tears streaming down my face.

> Each night, he pinched skin on my belly as I screamed like a toddler and he injected the medicine.

Her husband sounds like an awesome guy - taking care of her in that state sounds incredibly difficult.

> My husband and I decided to get a divorce.

> “I think in hindsight, it was your stroke that changed everything for me,” he said.

> I thought it was the affair he’d had. But maybe he had a point. “Maybe that was the year,” I said.

Dang.

Well, I just popped an Aspirin for no reason.
Will smartwatches with heart rate/other health sensors be able to detect strokes right when they happen? Or maybe even slightly before they do?
This is an amazing article and incredible blog

Among many interesting and inspiring themes, of interest to the HN community may be the disassociation of vision and objects. All of the deep learning models succeeding in classification emulate one side of the brain, while perspectives like this present life outside the constraint of rational thinking.

I was terrified after reading this. Reminded me that I should live a bit healthier, not drink more coffee then water, got to sleep earlier, wake up earlier, maybe even exercise. But more important, it got me thinking. The non-routine kind of thinking. Read some old diary entries. Wrote a new one, after almost a year.
My wife had a stroke at the age of 30, seven years ago. It happened in the hospital during an embolization procedure. She was unconscious for 5 days. This event has obviously changed her life, but I wasn't prepared for the ways it would change mine. Thank you for sharing this.
Profound. Thank you for sharing this. It pains me to read though that you had years of abnormal symptoms (severe shortness of breath, migraines, etc) and the medical system was unable to detect the issue early. This seems like the sort of issue that early detection could provide tremendous quality of life / survivability improvements at little risk. If the existing tests are too difficult, then we need more tests.
This was on buzzfeed?? Crazy. Didn't think those soul-less bottom-feeders would turn to quality long-form essays.
This is the best piece I have read in a while. It is amazing how something so small could affect our life. We are so delicate. Do you actually see objects as shapes and colors (as in, was the part of the brain that translates the signal into images lost) or was that you can not figure out what it is that you are looking at?
There is a similar TED Talk worth watching:

Jill Bolte Taylor: My stroke of insight

http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke... (18:19 min, Feb 2008)

Such a well written article. I loved the details with which the incident was described.
I wish Buzzfeed only had articles like this.
Her memory experience was already reminding me of Leonard in Memento and then she writes, "it's time for my shot." That hit me unreasonably hard.
Not sure what this has got to do with programming?
> As a result, my left brain, the expert at numbers and language and logic and reasoning, a part of it suffocated and died. My right brain, the specialist with regard to color, music, creativity, intuition, and emotions, therefore could not talk to my left brain.

This popular myth of broad specialization of the hemispheres needs to die. The author lost credibility there.