Could Mikio Date’s Hospitalization Have Been Prevented? A Specialist on Warning Signs, Summer Strokes and Silent Strokes

“I kind of can’t talk.”

Sandwich Man’s Mikio Date (52) reportedly said this to his partner Takeshi Tomizawa (52) at their meeting place before work. At the urging of those around him, he immediately went to the hospital, where he was diagnosed with a stroke. He will be taking time off to recuperate for the time being.

Fortunately, prompt medical treatment prevented the situation from becoming serious, but Date had previously mentioned experiencing unusual symptoms, such as sometimes being unable to focus my eyes.

A stroke can sometimes show warning signs that then disappear.

Before a full-blown stroke occurs, symptoms such as paralysis or numbness in the arms or legs, difficulty speaking, or impaired vision can appear temporarily and then disappear as if nothing had happened. The number of stroke patients begins to increase in their 50s. The stroke that struck Date, who was 51 at the time, is by no means a distant illness for people in their prime working years.

How seriously should we take symptoms that went away once? And what warning signs should we know to avoid overlooking a stroke?

We spoke with Dr. Satoshi Ozaki, director of Ebina Neurological Clinic, operated by NALU Medical Corporation (the following quotations are from Dr. Ozaki).

The countdown begins in your 50s

A stroke occurs when a blood vessel in the brain becomes blocked, cutting off the blood supply.

“When blood flow is interrupted, oxygen and nutrients can no longer reach the brain, causing damage to brain cells. Depending on which blood vessel is blocked, various symptoms can occur, including paralysis of the arms and legs, speech impairment, and visual disturbances.

“Strokes are strongly associated with the image of being a disease of the elderly, but the number of patients begins to increase in their 50s. Once people reach their 50s, conditions such as high blood pressure, dyslipidemia, and diabetes become more common. This is the age when the damage to blood vessels caused by years of lifestyle habits begins to manifest itself.”

A stroke can broadly be divided into three types depending on its cause.

“The first is an atherothrombotic cerebral infarction. This type occurs when an artery becomes narrowed due to atherosclerosis and is then blocked by a blood clot or similar obstruction. It is closely associated with high blood pressure, diabetes, dyslipidemia, and smoking.

“The second is a cardioembolic stroke. A blood clot that forms inside the heart travels to the brain and blocks a blood vessel. A typical cause is an arrhythmia called ‘atrial fibrillation,’ which can cause severe symptoms to appear suddenly.

“The third is a lacunar infarction. This occurs when one of the small blood vessels deep inside the brain becomes blocked. It is closely associated with high blood pressure. The affected area can be small and the symptoms relatively mild, but the condition can recur.”

A stroke is a disease that develops suddenly, but in many cases, underlying factors such as atherosclerosis and lifestyle-related diseases have been progressing for many years.

Don’t overlook TIA

A transient ischemic attack (TIA) can occur before a full-blown stroke.

“Blood flow to the brain is temporarily impaired, causing neurological symptoms similar to those of a stroke. However, since the symptoms disappear afterward, many people mistakenly believe they have recovered.”

The following symptoms require particular attention:

・Sudden weakness or numbness in one side of the arms or legs
・Drooping on one side of the face
・Slurred speech or difficulty speaking
・Difficulty understanding what another person is saying
・Sudden difficulty seeing out of one eye

“What is important is that these symptoms occur suddenly. A TIA is a warning sign that indicates an increased risk of developing a stroke. Even if the symptoms disappear, seek medical attention promptly.”

The inability to speak that Date experienced is also one of the typical symptoms that can indicate a stroke. This is where it is important to remember FAST.

F = Face: When smiling, is one corner of the mouth drooping?

A = Arm: When extending both arms forward, does one arm drift downward?

S = Speech: Is there anything unusual about the person’s speech, such as slurred speech or difficulty getting words out?

T = Time: If even one of the above applies, note the time when the symptoms began and immediately call for an ambulance.

“With a stroke, knowing when the symptoms began is extremely important. The person may have difficulty speaking clearly or may not notice the changes in themselves. It is also important for family members and coworkers to recognize when someone is not acting like themselves.”

Even while you’re sleeping, you’re at risk: Summer strokes

With the lingering summer heat continuing during this time of year, one thing to watch out for is dehydration.

“During hot weather, the body loses water through sweating. If you fail to replenish enough fluids and become dehydrated, your circulating blood volume can decrease, and your blood may become more viscous. People who already have risk factors such as atherosclerosis or lifestyle-related diseases need to be particularly careful.”

Water is lost not only under the scorching sun but also while sleeping.

“Alcohol has a diuretic effect. You should also be careful about habits such as drinking heavily on a hot night and then going straight to bed.”

It is important to make a habit of drinking water frequently. However, people who have been instructed to limit their fluid intake because of heart or kidney disease should follow their doctor’s instructions.

During hot weather, people may also mistake fatigue or dizziness for summer fatigue or heatstroke. If symptoms such as paralysis on one side of the body, facial drooping, or speech abnormalities suddenly appear, a stroke should be suspected.

There are also cases in which a person suffers a cerebral infarction without noticing any symptoms at all. This is sometimes referred to as a “silent stroke.” Medically, it is known as an “asymptomatic cerebral infarction.”

“Even when a person has no noticeable symptoms, traces of small strokes that occurred in the past may be discovered by chance when they undergo an MRI for another reason. An asymptomatic cerebral infarction is an important finding when considering the risk of developing a stroke in the future.”

Overseas studies cited in guidelines from the Japan Stroke Society found that people with asymptomatic cerebral infarctions were approximately twice as likely to subsequently develop a stroke as those without them. Another study reported that people with asymptomatic cerebral infarctions had a 3.9-fold higher risk of developing a stroke later.

“High blood pressure in particular is an important risk factor. When an asymptomatic cerebral infarction is discovered, it is important to assess the risk factors you have, such as high blood pressure, diabetes, and dyslipidemia, and manage them appropriately.”

When a stroke is suspected, doctors use CT scans, MRI, and other tests to examine the condition of the brain. One of the most important aspects of treatment is restoring blood flow to the blocked blood vessel as quickly as possible.

“One of the standard treatments is intravenous t-PA therapy, which dissolves blood clots. If the patient meets the eligibility criteria, treatment is generally started within 4.5 hours of the onset. When a major blood vessel in the brain is blocked by a blood clot, a procedure called mechanical thrombectomy may be performed using a catheter to remove the clot.”

Mechanical thrombectomy may also be considered in some cases where a certain amount of time has passed since onset, provided the patient meets specific conditions based on factors such as their condition and imaging findings.

“A stroke is a race against time. The sooner treatment begins, the greater the possibility of saving brain tissue. It is important to take action as soon as you notice something is wrong. To prevent strokes, first know your own blood pressure, blood glucose level, LDL cholesterol level, and other indicators.

Some people are told they have abnormal results during health checkups but leave them untreated because they have no symptoms. It is important to make lifestyle improvements and seek necessary treatment. Arrhythmias such as atrial fibrillation can also lead to strokes. If you are told during a health checkup that you have an arrhythmia, do not leave it untreated.”

A stroke can happen suddenly one day.

However, the underlying conditions, such as high blood pressure and atherosclerosis, may have been developing over many years. And the warning signs that appear before a stroke can even disappear once they occur. The stroke that struck 51-year-old Date is by no means something that people in their prime working years can dismiss with the thought, “I’m still only in my 50s, so I’m fine.”

Facial drooping, paralysis or weakness in one arm, speech abnormalities—

Whether these fleeting warning signs are recognized and how quickly the person is connected to medical care can make the difference in protecting both a person’s life and their future after a stroke.