Ask an expert: Can a traumatic event cause a stroke?

Q: "I have an 80-year-old friend who suffered a stroke during a car accident. She was a passenger in a car that rolled over and left her upside down for about 30 minutes. Could the stress of this accident have caused her stroke? How?"

Answered by Amit Kansara, M.D., stroke neurologist, Providence Stroke Center

Although traumatic events such as car accidents can be seriously stressful, no direct link has been found between emotionally stressful incidents and strokes. In your friend's case, it's more likely that the stroke had to do with what happened physically during the accident and her health at the time.

It's possible that your friend had a hemorrhagic stroke – the type of "brain attack" caused by bleeding in the brain. About 15 percent of all strokes are hemorrhagic. Most of these are the result of high blood pressure, which weakens the blood vessels and leaves them susceptible to tears and ruptures. Certain abnormalities, such as aneurysms, also can rupture and cause bleeding in the brain. If your friend's blood vessels were already weak for one of these reasons, the physical trauma of the accident could have been enough to cause a rupture in one of the vessels in her brain. If she suffered significant trauma to her head in the accident, that could have caused bleeding in the brain regardless of how healthy her blood vessels were.

If physical trauma wasn't a factor, your friend might have had an ischemic stroke – the type that is caused by an interruption in the blood supply to the brain. About 85 percent of all strokes are ischemic. These are most often caused by a blockage in a small or large artery in the brain or neck, usually resulting from atherosclerosis, or by a blood clot in the heart that travels to the brain – but there can be other causes. In your friend's case, she was left upside down for about half an hour. This type of situation can increase the brain's demand for blood. Normally, the body has an automatic mechanism to meet higher demand, but if your friend had narrowed blood vessels due to atherosclerosis, or a weak heart due to heart disease, her body might have been unable to keep up with her brain's needs. That could have left her brain with too little blood, bringing on a stroke, or the temporary type of stroke known as a transient ischemic attack (TIA) or mini-stroke.

Regardless of the type, every stroke is an emergency situation that requires immediate attention in an emergency room. I hope that your friend received quick, expert care and is recovering well.

Know the signs of stroke, and act FAST

Now that your friend has had a stroke, you can look out for her by learning to recognize the signs of stroke in case she ever has one again. According to the National Stroke Association, people who have had one stroke are much more likely to have another one.

Sometimes very minor symptoms can be early signs of stroke. An easy way to remember these signs is to act FAST:
  • F = Face: Does the person's face look droopy? Ask her to smile.
  • A = Arm: Is one arm numb or drifting down? Ask her to raise both arms.
  • S = Speech: Is speech slurred or jumbled? Ask her to repeat a simple sentence.
  • T = Time: If you notice any of these signs, call 911 immediately. Do not wait. Some stroke medications can only be given within three hours of the onset of symptoms.

Reduce your own risk of stroke

One lesson you can take away from your friend's experience is to take good care of your heart and blood vessels to reduce your own risk of stroke. While one stressful incident is unlikely to cause a stroke, a lifetime of chronic stress appears to have detrimental effects on blood pressure and blood vessels – and that does increase the risk of stroke. A 2002 study from Japan showed an increased risk of stroke in women, and an increased risk of heart disease in both men and women, from perceived mental stress in their lives.

To minimize your stroke risk, learn how to keep stress under control; see your primary care provider for regular checkups; control your blood pressure and cholesterol; keep your diabetes in check, if that's an issue; exercise regularly; maintain a healthy weight; refrain from smoking; take time to relax, recharge and enjoy life – and drive carefully.