One minute, a person is talking, smiling and rushing about. Suddenly, he has difficulty speaking and understanding you. He has trouble walking, is dizzy, loses his balance or has lost coordination. Half of his body – the face, an arm or a leg – may be numb or paralyzed. He may have trouble seeing in one or both eyes or see double. A sudden, severe headache explodes in his head.

These, unfortunately, can be symptoms of a stroke – a real medical emergency. There are two main types of stroke – one caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke).

But although strokes always comes by surprise, the health problems that trigger it are not sudden. High blood pressure, smoking, overweight or obesity, excessive consumption of alcohol, lack of physical activity, high levels of “bad cholesterol” (LDL) in the blood, uncontrolled diabetes, obstructive sleep apnea (stopping breathing momentarily during sleep), a personal or family history of stroke, a history of cardiovascular disease and chronic stress have been percolating for months or years, causing the “brain attack” to appear.

In addition, being over the age of 55 or having a family history of stroke raises the risk.

Every half hour, an Israeli suffers a stroke. There are at least 20,000 cerebrovascular accidents (CVAs, or the medical term for a stroke) each year in this country. The Israel Neurological Society has just announced that 75% of all strokes can be prevented.

“The addition of neurologists will help prevent 2,000 stroke cases in Israel,” said Prof. David Tena, the society’s chairman director of the Center for Prevention and Treatment of Stroke at Sheba Medical Center at Tel Hashomer near Tel Aviv.

But there are only 20 vascular neurologists in the country who specialize in treating strokes. Their specialty is performing brain catheterization with tPA (tissue plasminogen activator) for “melting” clots in the event of ischemic stroke (it should not be used in hemorrhagic stroke).

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. Prompt treatment is crucial, as early action can minimize brain damage and potential complications.

If you notice a person showing any signs or symptoms of a stroke, as listed above, even if they seem to fluctuate or disappear, think FAST:

FACE – ask the person to smile. Does one side of the face droop?

ARMS – Ask the person to raise both arms. Does one arm drift downward or is he unable to raise it?

SPEECH – Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?

TIME – If you observe any of these signs, call for an ambulance immediately.

Don’t wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.

The ischemic type of stroke is by far the more common; about 80% of them are of this type, which occur when the arteries to the brain become narrowed or blocked, causing severely reduced blood flow (ischemia).

Of ischemic stroke, there are two kinds: A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions. An embolic stroke occurs when a blood clot (embolus) or other debris forms outside of the brain – usually in the heart – and wanders through the bloodstream to lodge in narrower brain arteries.

Hemorrhagic stroke occurs when a blood vessel in or near the surface of the brain ruptures or leaks. This results from weak spots in the blood vessels of the brain (aneurysm); uncontrolled high blood pressure (hypertension); or over-treatment with anticoagulants (blood thinners).

Some people get a warning of a fully-fledged stroke when they suffer from a transient ischemic attack (TIA or mini-stroke), in which stroke symptoms appear only for a short time, even a few minutes or less than an hour, and then go away. But they should not be ignored. Always go to an emergency room if TIAs occur.

As it’s impossible to know only from his symptoms if a person is having a TIA or a fully-fledged stroke – so get to the hospital emergency room immediately.

Given the risk factors, the steps for lowering the risk are logical. Control hypertension by exercising, losing weight, reducing your salt and alcohol intake. Adopt a more healthful lifestyle by exercising and managing stress. Reduce the amount of saturated fat and cholesterol in your diet. Eat vegetables, fruit, fish and minimize your intake of processed “junk food.”

Give up smoking, both your own and being exposed to secondhand smoke of others. If you are a diabetic, seek medical advice with medications and other lifestyle changes to control blood sugar.

Drinking alcohol in moderation, if at all. Alcohol can be both a risk factor and a protective measure for stroke. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol, such as one drink a day, may help prevent ischemic stroke and decrease your blood’s clotting tendency. Alcohol may also interact with other drugs you’re taking. Talk to your doctor about what’s appropriate for you.

If you suffer from sleep apnea, go to a sleep expert. Losing weight reduces the risk of this condition, as does wearing a device on the nose during sleep that forces air into your lungs.

The Israel Neurology Society has adopted the new goals of a program published by the European Stroke Association to reduce strokes. The program was recently approved by Israel’s Health Ministry, which must invest money in its implementation.

The major aim is to send 90% or more of patients with acute brain stroke for treatment is specially designated hospital stroke units, which are equipped with trained personnel and special equipment. As of 2018, fewer than four out of 10 of Israeli patients in Israel with cerebral hemorrhages are hospitalized in general neurological departments that are less able to cope with stroke. The Health Ministry says its five-year plan to improve stroke treatment will eventually lead to the 90% target.

In addition, the Israeli society recommends increased prevention and treatment of stroke by experts in vascular neurology, a specialty that should offer significant incentives to medical graduates. “Many more doctors should be trained in neurology and vascular neurology,” Tena said.

According to the Israel National Stroke Registry, more than half of those diagnosed with stroke did not undergo the necessary rehabilitation or physiotherapy, occupational therapy, speech therapy and psychological therapy.

Pnina Rosenzweig, the CEO of Ne’eman (the voluntary Israeli organization for preventing strokes, increasing public awareness and improving treatment), concluded: “Dedicated stroke units are needed in every Israeli hospital, offering a team of stroke and catheter specialists in every hospital and improved services that will allow patients to be transported to hospitals where brain catheterizations are carried out.”