Smile, you’re having a stroke

It might sound funny (even slightly sadistic) to ask someone to smile while having a stroke, especially since it is one of the leading causes of death for people in Australia.

Smiling is one of the fastest ways to recognise signs of stroke that threaten all areas of your brain. Image by Laura Dahl via flikir

Smiling is a complex movement requiring many different muscles and the coordination from many different brain cells (neurons). Posing the question “can you smile?” might actually help you work out if someone is suffering serious brain injury like a stroke.

Billions of brain cells  

The brain is filled with billions of cells, some of which are called neurons. These cells are responsible for keeping you alive. Chatting to people, playing your favourite sport, trying to remember 12 weeks of content for 4 subjects in SWOTVAC and even smiling are all made possible, thanks to neurons.

Your neurons are very fragile and require other cells to keep them functioning at all times, except when you take an exam that is. Any changes in the environment can cause significant stress, compromising the ability for neurons to work correctly. This is what can happen when you have a stroke. Asking someone to smile isn’t a joke, but it can suggest if your neurons are being impaired.


Hippocrates was the first person to account cases of stroke; describing it by using the Greek word ‘apoplexy’, meaning ‘struck down with violence’. And he’s not wrong. There are different forms of stroke with varying outcomes/severities, but in all cases the risks are massive.

There are two types of stroke. The first is like the heart attach of the brain, blood vessels feeding the brain cells are blocked by a clot; this is called an ischemic stroke. The second is a leakage of blood from the vessels into the brain; this is called a haemorrhagic stroke.

When you have a stroke, your brain cells go into stress that causes a cascade of events. These events are rapid, interconnected and synergistic that ultimately lead to one main outcome…NEURONAL DEATH.

When your neurons get stressed  

You may be familiar with the term ‘Hangry’- when lack of food can cause stress, madness and irrational anger. Well, a similar phenomenon occurs in our brain when we have a stroke. A blood clot or leakage interrupts the nourishment of glucose and oxygen to the brain cells needed to survive, and just like me when I haven’t eaten in 4 hours, the neurons start to freak out. This is the first sign of stress in stroke.

When I am without proper nourishment, my energy wavers and feelings of lethargy cause me to act out- like shouting unnecessarily at my sister (sorry Tayla). Luckily for me, my sis might pull out the ‘you’re not you when you’re hungry’ line and hand me a Snickers, but for our neurons it just gets worse. Drastic changes begin to occur like the opening of salt channels. Sodium and calcium rush into the cell, disrupting intricately balanced internal environment.

If you’ve ever eaten too much vegemite by accident, you’ll know that the only fix is a big gulp of water. Excess salt entering the neuron can only be followed by water characterising the formation of edema. Neurons begin to swell, creating the pressure and pain you feel might feel in a stroke.

Eventually it all becomes too much. A stress overload would usually cause me to emotionally and, sometimes, physically blow up. Well it’s the same for neurons in stroke, except it’s not a metaphor- our neurons start to implode. Cells break down its functioning proteins properly and chop up its DNA. This series of unfortunate events, among others, cause the neuron to self destruct in a process called apoptosis.

Time is of the essence 

1 in 6 people will suffer some form of stroke in their life time, but what’s worse it there is little that can be done. Years of research into stroke prevention and treatment has lead to just a few advances. Over 700 chemicals have been tried and tested to inhibit the event cascade causing neuronal death in stroke. Not one has been successful.

Unfortunately, targeting the neuronal death event cascade only leads to failure. Inhibiting just one event in the cascade will not prevent the others from taking place to cause ultimately cell death.

The only pharmacological therapy to treat stroke that currently exists is the ‘clot buster therapy’, used to disintegrate blood clots causing ischemic stroke. Developed in the 90’s, this treatment is effective, but only in the first 4.5 hours of stroke. In reality less than 10% of stroke patients actually receive this treatment.

The situation with stroke might sounds dire, but that’s all the more reason to smile. Time is currently the most important tool to minimise the effects of stroke. Asking if someone can smile, could be the fastest way to identify the condition and ultimately save a life.

For more info

2 Responses to “Smile, you’re having a stroke”

  1. Georgia says:

    Thanks for your comment Abigail, Im glad you liked the post! Unfortunately there isn’t any pharmacological therapies for hemorrhagic stroke just yet! In a hemorrhagic stroke blood vessels can begin to break down and so ‘the clot buster therapy’ is really dangerous to give as it might amplify the bleeding in the brain. The only real treatment is to reduce pressure by performing a cranioscopy (removal of a small piece of skull to release the pressure build up). There is still hope for stroke therapies, new research is looking at using electrical stimulation or stem cells to treat the loss of brain function and neurons respectively.

  2. Abigail says:

    This is a really well written piece good job :). I never even realised there was more than one type of stroke, in the way of treatment you mentioned the clot buster therapy for ischemic strokes. Is there anything similar (well it would be the reverse) that is in the works for haemorrhagic strokes?