Stroke is the number one combined disabler and killer in the world the number three leading cause of death in America and the number one cause of adult disability. And the patients aren’t just elderly people as many people assume. The average age of stroke is 65.

Strokes are serious; that much most people know. But what exactly happens when you get one? A stroke is sometimes called a “brain attack” because that’s where the action takes place: When there’s a blockage or rupture of an artery to the brain it results in a lack of blood flow and oxygen — which can lead to the death of brain cells causing permanent damage. You can also think of it in terms of plumbing.

“A stroke is an interruption to the blood flow” explains Dr. Steven R. Levine who is a professor of neurology and emergency medicine as well as vice chair of neurology at SUNY Downstate Medical Center in Brooklyn. “Imagine kitchen pipes that are blocked so the water can’t flow through the pipe. A blood clot can block blood flow and cause a stroke. Or you know how water can leak out of a pipe and flood under the sink? That’s hemorrhagic stroke when blood oozes into the lining of the brain.”

When someone suffers a stroke their symptoms — such as difficulties with speech or movement — are often connected to the part of the brain that was “attacked” and how much damage occurred there.

In Yitzchak’s case the symptoms were primarily connected to movement. First there was hand numbness which then led to paralysis on the entire right side of his body. He was too weak even to leave bed — and still is to a large extent.

Patients can also suffer from a lack of coordination from sudden problems with walking and/or from trouble remaining balanced and steady. They might experience numbness as Yitzchak did or a severe case of pins and needles in the face arm or leg. Also common is a sudden severe headache or an instantaneous change of vision whether it’s blurred or double.

At least 25 percent of all stroke survivors experience language impairments involving the ability to speak write and understand spoken and written language according to the National Institute of Neurological Disorders and Stroke. Patients’ speech might be garbled slurred or might not make sense at all.

The loss of speech is especially dangerous for stroke victims because they cannot call for help after an attack occurs. And a delay of a few hours (or even a day or longer) in getting emergency medical attention can determine whether someone recovers — or faces severe disability or death.

Because time is of the essence when dealing with a potential stroke Dr. Levine urges family members (and Hatzalah) to immediately take victims to the emergency room ideally to a designated stroke center. The patient should see a doctor within ten minutes of arrival and possibly be given FDA-approved medicine within three hours of an attack to help stop or slow down the stroke’s progression.

While a stroke can be deadly (15 percent fall into this category) the remaining 85 percent will survive. That’s the good news. The downside is that a full 90 percent experience some disability reports Dr. Levine.