Stroke

Symptoms and Warnings of Stroke

Stroke Symptoms and Signs

A stroke can cause a variety of symptoms and signs. The most common ones are hard to miss, but they are tempting to ignore if you do not realize how serious they are. The biggest factor in discounting stroke symptoms is not in missing the symptoms themselves, but rather in wishing they would go away on their own. If you ever see or experience any of the following symptoms and signs of a stroke, it's important to get immediate medical help, as a stroke is an emergency.

Common Symptoms and Signs of Stroke

Face Weakness 

This one sounds a bit strange because we don't normally think of our faces as being 'strong' or ‘muscular.’ But face muscles work all the time. Facial weakness as a symptom of stroke manifests as drooping of one eyelid or sagging of one side of the face. Sometimes one side of the face appears to be flat and the mouth may curve down. One may also experience an inability to move the tongue to one side of the mouth.

 

Arm or Leg Weakness 

Weakness of the arm, the leg, or both is a common stroke symptom. When a stroke causes physical weakness of the extremities, the key feature is that, in general, it affects only one side of the body. You may notice partial weakness, which means that you do not have full strength, or complete weakness, characterized by a flaccid limb that you cannot move at all. Arm weakness may cause you to drop items or may make you unable to reach for objects. Sometimes mild leg weakness can cause you to lean toward one side, while severe leg weakness can make you fall down. 

Slurred Speech

Slurred speech may be more noticeable to others than to the person who is having a stroke. Frequently, slurred speech is associated with drooling and is often related to facial weakness.

Falling 

Leg weakness can result in falling—a startling event that may cause injury. Therefore, if you notice someone fall down and there is any chance that he or she can't get up without assistance, or suffered a head bump, it is really important to call for help.

Loss of Vision

Visual loss from a stroke can manifest in a number of different ways that cut off vision in only half of one eye or in one half of both eyes, often referred to as hemianopsia. If you suddenly experience vision loss, you need to get help even if you can see a little bit or if you can see out of the sides of your eyes. Hemianopsia is painless, but it is disturbing and may cause you to blink your eyes as you try to figure out what is going on with your vision. 

Language Problems

Sudden language problems are among the hallmark symptoms of stroke.

Aphasia, a deficit in language, may manifest as trouble producing fluent or coherent words and phrases, trouble understanding written or spoken language, or a combination of any of these problems.

Severe Headache

A severe headache can signal a stroke, particularly a hemorrhagic stroke, but regularly occurring headaches do not. A sudden, severe headache that is different than your usual headaches may be a symptom of a stroke, however, particularly if there are other associated symptoms such as visual changes or weakness. These tips can help you sort out when you need to worry about headaches.

Confusion 

The symptoms of a stroke can be confusing, but stroke itself can cause confusion due to the effect it has on the brain. Sudden confusion, disorientation, or forgetfulness may be a symptom of stroke or another medical emergency. 

Dizziness 

Dizziness, a sense of instability, or wobbliness are all possible symptoms of stroke. If you experience a sense that you cannot hold yourself up or that you or your surroundings are spinning, it is important to get medical attention.

 

Less Common Symptoms and Signs of Stroke

Incontinence 

Bladder and bowel control require a sophisticated interaction between several regions of the brain. Sudden incontinence is not typically the first symptom of a stroke, but it may be the first noticeable indication of a stroke in some instances.

Numbness, Tingling or Sensory Loss 

Sensory problems such as tingling or numbness, or the inability to feel your face, arm, or leg may be the first symptom of a stroke. Typically, a stroke causes more prominent concerns, but sudden sensory problems, while less common, can be the first symptoms that appear.

Strange Sensations 

Unusual sensations may be the first symptoms of stroke. Overall, skin burning or crawling sensations are typically signs of neuropathy, not stroke. However, neuropathy develops slowly over time. Sudden disturbing sensations are concerning and may signal a stroke.  

Change in Vision

Most of the time, visual changes signifying a stroke fall into the category of visual field cuts.

However, there are some other visual change patterns as well, including loss of vision in only one eye and loss of color vision.

Hiccups 

One of the less common and intriguing symptoms of stroke, persistent hiccups, can be the most noticeable and bothersome symptom of a small stroke in the brainstem. The other symptoms of this type of brainstem stroke, called Wallenberg syndrome, include face and limb weakness, and sensory deficits. If the stroke rapidly progresses, the physical symptoms may become disabling, so this is more than just a simple annoyance. 

Coordination Problems 

A stroke does not usually target coordination. However, an uncommon stroke called a cerebellar stroke may produce coordination problems that are more prominent than weakness or other symptoms. 

Cognitive Deficits 

A stroke can interfere with concentration, memory, and learning. A deficit in thinking skills and dementia-like symptoms are usually more long-term effects of a stroke, rather than symptoms of a new one. However, a new stroke can cause sudden cognitive problems, particularly if silent strokes have already had a quiet impact on brain reserve.  

Other Conditions That Can Be Confused With Stroke 

Neuropathy 

Neuropathy is disease of the nerves. Neuropathy is the condition most frequently confused with stroke because it is fairly common. The symptoms of neuropathy, like the symptoms of stroke, are bothersome and often unsettling. However, symptoms of neuropathy arise gradually, predominantly involve pain, and typically involve both sides of the body, while sensory stroke symptoms affect one side of the body and are characterized by abrupt onset, numbness, and loss of sensation. 

Dementia 

There are several types of dementia. What they have in common is that they are characterized by gradually progressive cognitive and behavioral deficits. Generally, cognitive and behavioral problems caused by a stroke are not as gradual, but, instead, are more abrupt. However, repeated strokes can sometimes produce symptoms that appear to resemble progressive dementia, making the distinction confusing. Vascular dementia is a dementia caused by recurrent strokes and can be easily confused with other types of dementia, such as Alzheimer's disease. 

Parkinson's Disease 

Parkinson's disease symptoms primarily include movement abnormalities, such as tremors and stiffness. Generally, the symptoms of Parkinson’s disease are gradual and affect both sides of the body, in contrast to the one-sided and sudden symptoms of stroke. 

Migraine Headaches 

Migraine headaches are headaches that are characterized by more than just a feeling of head pain. Migraines typically involve dizziness, photophobia (distress in response to light), and phonophobia (distress in response to noise). However, sometimes migraines also cause symptoms such as visual changes or weakness, with or without accompanying painful headaches. These episodes, often referred to as complicated migraine, are typically quite alarming. Migraine headaches associated with neurological deficits almost always improve. However, it is not possible to know for certain whether neurological symptoms associated with migraine are the sign of an impending stroke. There is a slightly increased risk of stroke among people who experience these types of migraines, so if you have been diagnosed with complicated migraines, is advisable to be under the care of a physician. 

Myasthenia Gravis 

Myasthenia gravis is an uncommon condition that is characterized by droopy eyelids at the onset. As the condition progresses, it causes generalized weakness and can affect respiratory muscles. Myasthenia gravis is a neuromuscular disorder, as it affects the communication between the nerves and the muscles they are meant to control, in contrast to a stroke, which is a brain injury caused by vascular interruption. Myasthenia gravis is also typically equal on both sides of the body, and its symptoms can be treated with medication. 

Multiple Sclerosis 

Multiple sclerosis (MS) is a relatively common disease that affects the brain, the spine, and the optic nerves of the eyes. MS, like stroke, usually produces sudden symptoms that typically include weakness, vision changes, and sensory deficits. The biggest difference between MS symptoms and stroke symptoms is that the symptoms of stroke correspond with regions of the brain that are supplied by the same blood vessels, while symptoms of MS do not follow this characteristic vascular distribution of stroke. MS is a lifelong illness characterized by exacerbations and remissions. There are a number of effective medications that can reduce the severity, the frequency, and the lasting impact of multiple sclerosis exacerbations. 

TIA

Another type of stroke-like episode called a transient ischemic attack (TIA) is a temporary vascular interruption in the brain that resolves before causing permanent damage. If you experience stroke symptoms that get better on their own, then that could be a TIA. But a TIA is not a reason to breath a sigh of relief and forget about your symptoms. Most people who experience a TIA go on to have a stroke if they don't start taking medication to prevent one—and no one can predict whether a TIA means that a stroke will happen within an hour or within a few months.

A Word From Verywell

It's important to know the signs and symptoms and signs of a stroke in the event you may experience one or witness someone who is. That said, what you feel or see may be scary. If you suspect that you may be having a stroke, it would be overwhelming for you to try to sort out whether the symptoms are truly due to a stroke, a TIA, or something else while you are having them. If you see someone who may be having a stroke, you may feel the same way.

If you at all think that what you are seeing or feeling may be due to a stroke, call for emergency help and try to report as much detail as you can to the medical team. Take in the above information, but always trust your gut.

The long-term effects of a stroke are usually similar to the initial symptoms, though not identical. After a stroke, symptoms typically stabilize and often improve. New symptoms such as seizures, spasticity, muscle atrophy, depression, and swallowing problems may develop. The sooner care is received, the better the outcome typically is.

Source:

Patient behavior at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms, Mellon L, Doyle F, Williams D, Brewer L, Hall P, Hickey A, Emergency Medicine Journal, June 2016.

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