It’s incredibly important that we all recognize stroke symptoms. After all, every 40 seconds, someone in the United States suffers a stroke, and every four minutes, someone dies as a result of one (via the CDC). The vast majority of strokes are classified as ischemic strokes, meaning that the brain does not receive any blood. It’s no surprise that more than half of the people who’ve had a stroke and are over the age of 65 struggle with reduced mobility. Black Americans and older Americans are most likely to have a stroke, but they are a leading cause of death for all Americans, and 34% of those hospitalized in 2009 with a stroke were younger than 65.
Sadly, in one study, only 38% of participants were aware of all of the major stroke symptoms and knew to call 911 if someone was having a stroke. Early intervention is critically important during a stroke because those patients who get to the emergency room within three hours of their first symptoms are less likely to be disabled three months post-stroke than patients who wait. One in three US adults is at risk for stroke because of their blood pressure, high cholesterol, smoking, obesity, or diabetes.
Numbness or weakness
Strokes often affect just one side of the brain but can impact both sides (a stroke that affects both sides of the brain is referred to as a bilateral stroke). If someone is experiencing signs of stroke, ask them to lift their arms above their head. If they are unable to complete this motion, get medical attention immediately. Some people having a stroke will stumble or fall because they are experiencing weakness or paralysis of their lower limbs. Others don’t lose all sensation in their limbs but instead experience a sensation of tingling, sometimes described as “pins and needles” (via Healthline). This feeling is akin to what you might expect if your limb “goes to sleep” after sitting too long.
Unfortunately, residual problems with the arms are not uncommon after a stroke. The oxygen deprivation experienced by the brain during a stroke causes cellular death, sometimes resulting in long-lasting paralysis, tingling, or weakness of the arms and shoulders (via Johns Hopkins Medicine).
Imagine this: You’re at work, typing and talking to your co-worker when all of a sudden you can’t speak or understand what others are saying. This terrifying scenario is not uncommon during a stroke. People having a stroke are often confused, disoriented, and unable to understand what is being said to them (via Healthline).
Vascular dementia can result from reduced blood supply to the brain when the blood supply to the brain is reduced because vessels are clogged. A person with vascular dementia may exhibit memory, thinking, and mood problems. The Stroke Association (U.K.) recommends scheduling an appointment with a physician if someone you love seems to have reduced reaction time, has difficulty understanding or remembering things said to them, has trouble finding their words during conversation, or seems depressed. These can be signs that a bigger stroke will occur in the future.
Like many stroke effects, speech problems can occur during a stroke and also last long after the stroke is over. WebMD explains that strokes can cause dysarthria, an inability to enunciate and speak at an appropriate volume, or apraxia of speech, in which a person can’t control their tongue or lips.
Aphasia causes someone to lose the ability to understand or express speech. This language disorder occurs most often with strokes on the left side of the brain. Although many people try to talk louder and more slowly when someone has aphasia, it only frustrates the patient more. They often have no cognitive deficits but cannot express themselves verbally (via the American Stroke Association).
According to the Mayo Clinic, because aphasia can be a symptom of stroke or another serious medical emergency, you should always seek attention if you are having difficulty speaking or understanding others’ speech, encounter trouble remembering your words, or develop issues reading and writing.
The American Stroke Association explains that vision is not just what you see but also how you process what you’re seeing. According to Virtua Health, vision changes can signify an impending stroke or indicate that a stroke has already happened. For instance, if the stroke occurs in the brain stem, the patient may demonstrate altered eye movement, impaired balance, and an inability to recognize common objects. If the right side of the occipital lobe is injured, each eye’s left field of vision will be affected, and vice versa. As discussed, bilateral strokes are rare but can occur and result in total blindness.
Mini strokes or transient ischemic attacks (TIAs) often present with vision loss in one eye. If you can imagine the lights going dim before being turned off completely, that’s what this can seem like to the person having the TIA. After a few minutes, vision returns to normal. Some people having a TIA also describe “monocular blindness,” when everything appears grey and blurry. Bright lights are uncomfortable for people with monocular blindness (via NovaVision).
The difficulty with walking that occurs during and after a stroke can have a wide variety of causes (via WebMD). Obviously, the numbness or weakness discussed above can play a huge part. And, of course, the coordination and balance problems that result from brain damage during and after a stroke don’t help matters. The Mayo Clinic adds that it is not uncommon for people to stumble during a stroke. They may also complain of dizziness or loss of coordination.
Most strokes damage the motor fibers that control movement. If the cerebellum is injured, a shakiness will be evident when the patient moves and walks (via HealthDay).
Healthline advises that you call 911 if a loved one is suddenly unable to walk or maintain their balance in a standing position. They may be suffering a stroke, and every minute counts when it comes to getting treatment.
You might have heard the advice that if you develop a headache unlike any other, or more severe than any other, you’ve had before — head to the emergency room. The headaches that develop during a stroke are very sudden and very painful. Somewhere between 7 and 65% of people who have a stroke describe having a headache before it occurred (via Verywell). Once again, the part of the brain that is affected will determine the location of the pain. For example, a stroke that stems from the carotid artery will cause a headache right in the middle of your forehead, while a stroke in the back of the head will produce a headache there.
In a study published in The Journal of Headache and Pain, 17% of 550 patients who had a stroke experienced a headache in the previous week, most often a migraine-like headache. Those participants who experienced a headache were much more likely to have an arrhythmia and angina pectoris (severe chest pain that sometimes spreads to the shoulders and arms), as well. Females and those with a history of migraines or tension headaches were also more likely to experience a headache in the week leading up to a stroke.
One study published in Emergency Medicine Journal revealed that out of 1,968 stroke patients, 14.5% had vomiting. This was most common in those with subarachnoid hemorrhage (vs. cerebral hemorrhage or cerebral infarction). Interestingly, in this study, the patients who vomited were much more likely to die as a result of the stroke. Per another study in Stroke in 2014, more than half of all people experiencing a cerebellar stroke present with nausea and vomiting.
Ischemic strokes, in which the arteries in the brain are so narrowed that blood flow is cut off, or a clot blocks blood flow to the brain, are often preceded by transient ischemic attacks (TIAs) or mini-strokes the week prior. These TIAs generally only last a few minutes and do not cause permanent brain damage. However, the symptoms of TIAs are the same as many people experience during a full-blown stroke.
In one study published in Neurology, of 2,416 people who had an ischemic stroke, 549 of them experienced a TIA first. Nausea and vomiting that occur during a TIA are most often associated with vertigo, the sensation that the room is spinning around you (via the Brain Foundation).
During a stroke, the nerve damage in the brain impacts the control of facial muscles. This nerve damage can occur due to either oxygen deprivation or the pressure from hemorrhage in the brain (via Healthline).
It is common for the weakness to only occur in the lower face on one side. For example, although a stroke patient might not be able to smile or open their mouth to take a bite of food, they will be able to close their eyes and furrow their brow. This pattern is seen when a part of the central nervous system, the cerebral cortex, is damaged during a stroke (via Journal of Emergency Medical Services).
If the facial nerve in the brainstem is damaged, facial weakness of both the upper and lower parts of the face on one side will develop — this causes difficulty blinking or wrinkling the forehead and smiling.
Shortness of breath
The blood supply to the brain is interrupted during a stroke. If you think back to basic biology class, you’ll recall that blood carries oxygen to the brain cells. When those brain cells are robbed of the nourishment they so desperately need, they die within minutes. If the cells that die are in the part of the brain responsible for breathing, you can see why it’s not uncommon for people to gasp for air during a stroke. A study published in Circulation further details that a stroke causes pressure to develop in the brain, affecting the part of the brain that controls respiration.
Altered Mental Status
Although most people recognize that stroke victims often express altered mental status following a stroke, some don’t realize that these symptoms can occur before or during a stroke. According to a 2009 study published in Stroke, 23% of women and 15% of men reported altered mental status during the event. In fact, it was the most common “nontraditional symptom” of stroke. Symptoms reported included drowsiness, unresponsiveness, disorientation, confusion, sudden behavioral change, agitation, and even hallucination.
Another study that appeared in the Journal of General Internal Medicine detailed that of 127 neurology consultations among patients with an average age of 62 and mental status changes believed to be both acute and independent of other physical problems, nine (7%) were found to have suffered an acute stroke. Of those nine patients, one had a subarachnoid hemorrhage, and eight had ischemic strokes. The authors of this study concluded that “stroke was a relatively rare cause of acute confusional syndrome.”
An interesting study published in Disability and Rehabilitation showed that a remarkable 30% of patients admitted to two hospitals in Norway with a stroke described fatigue in the days leading up to the event. After the stroke was over, 24% still complained of fatigue, which was more common among women than men. Those who also complained of fatigue before the stroke, those who had previous depressive symptoms, and those who reported lower physical function were more likely to have post-stroke fatigue.
Dr. Pooja Khatri, a neurology professor at the University of Cincinnati, cautioned the American Stroke Association that “women more frequently have atypical, vague symptoms. They might start with fatigue, confusion or maybe general weakness, as opposed to weakness on one side of the body.” Because women are especially likely to push through these symptoms and carry on as normal, they are also at an increased risk for long-term deficits that could have been prevented by getting timely care.
According to research published in Stroke, strokes account for 130,000 to 220,000 emergency room visits for dizziness and vertigo annually. Frighteningly, of these patients, roughly 45,000-75,000 are misdiagnosed at first, especially people under the age of 50, women, and minorities. Health experts point out that dizziness will rarely, if ever, present as the sole symptom of an infarct.
The American Stroke Association explains that brain stem strokes can be difficult to diagnose compared to other strokes. Although the patient may present with vertigo, dizziness, and an inability to walk or stand in a stable position, they might not have the traditional symptom of unilateral weakness. Some, but not all, people suffering a brain stem stroke will also experience vision problems, be unable to speak clearly, or lose consciousness.
Because the brain stem plays a critical role in the central nervous system and is responsible for basic bodily functions, including breathing and motor control, brain stem strokes can be especially devastating. If the brain stem stroke is not severe, vertigo often resolves after a few weeks.
Hiccups occur when nerves that stimulate the diaphragm trigger muscular spasm. Scientists don’t clearly understand what triggers the normal hiccup attacks we’ve all endured (via Better Health Channel). However, if you suddenly develop painful and continuous hiccups that last for hours or are accompanied by other stroke symptoms, get to the emergency room.
Hiccups are one of those nontraditional stroke symptoms that are more common among women, but when 1,000 women were polled, only 10% of them recognized it as a sign of stroke. In fact, hiccups occur with a specific type of stroke that originates in the back of the brain (via Prevention). The Mayo Clinic recommends seeking medical attention if your hiccups last more than 48 hours or interfere with your ability to eat, sleep, or (gulp) breathe.
A word about silent strokes
We would be remiss if we didn’t provide a little more information about so-called “silent strokes.” According to the American Stroke Association, eight to 11 million Americans probably have silent strokes annually, but many of them will never know. The alarming reality is that a full quarter of people over the age of 80 have survived at least one silent stroke, many with no memory of experiencing traditional stroke symptoms.
If the landmarks left behind from one of these events are seen on a scan, it’s incredibly important that they be treated to help prevent a full-scale stroke down the line. Some people will report mild symptoms like weakness or trouble finding words, but others chalk this up to a natural part of aging or attribute them to something else, like a medication. Anyone who is noted to have a history of a mini-stroke should also be screened for atrial fibrillation (a-fib). This heart arrhythmia significantly increases the risk of developing blood clots, which in turn can cause a stroke.
People with diabetes, high cholesterol, hypertension, or those who smoke are more likely to suffer a stroke of any size, so lifestyle modification is necessary to forestall a bigger event if a small stroke is seen on imaging. In a bit of optimistic news, people who take their mini-stroke seriously and both adopt recommended lifestyle changes and adhere to the medication regimen recommended by their physician can slash their risk of stroke by more than 80%!