Stroke is one of the worldwide leading causes as well as the fifth leading cause of death and disability in the United States. According to the AHA (American Heart Association) the incidence of strokes and other related diseases like ischemic heart diseases is increasing day by day due to poor diet (processed and junk food), sedentary lifestyles, and lack of exercise. People over the age of 60 and post-menopausal women are at greater risk of stroke, and the risk also increases as one grows older. Some other risk factors include male gender, belonging to African American origin, high blood pressure, and people who have been already diagnosed with diabetes or IHD (ischemic heart diseases).
Stroke is a serious medical condition, and getting treatment fast should be your first priority. In such a case, every second matters because as the time passes, your brain will get less oxygen, leading to damage and death of brain cells and tissues. A stroke happens when the blood vessels that supply blood to your brain is either blocked or bursts open. These vessels carry oxygen and other important nutrients for optimal functioning of the neurons and other brain cells. Lack of these nutrients and oxygen leads to the damage and, in turn, the death of brain cells and tissues. Due to its high mortality and morbidity risks, it is essential to learn its various types, early signs and symptoms, as well as preventative measures you can take to avoid the life-threatening consequences of strokes.
Before coming towards the warning signs and symptoms of stroke, first, let’s have a brief look at its various types for a better understanding of when and how these signs and symptoms appear.
Types of Stroke
Ischemic stroke and hemorrhagic stroke are the two main types of stroke that causes approximately 95% of all deaths due to a stroke.
A) Ischemic stroke
It is the most prevalent type due to its multiple predisposing risk factors. It occurs due to blockage of blood vessels that carry blood towards the brain. It is further divided into two types; a thrombotic stroke and an embolic stroke. A thrombotic one occurs when a clot of blood (also known as a thrombus) forms in the arteries of the neck or head, especially the coronary arteries. Thrombus can be of various types; a build-up of fatty deposits or plaques (the most common one), or aggregates of platelets. These thrombi occlude the blood vessels of the brain, leading to stoppage of oxygen and resultantly stroke. The second one is an embolic stroke which occurs due to occlusion of blood vessels by a blood clot, a gas bubble, a fat molecule, amniotic fluid embolus (occurs in females), or a tumor embolus. An embolus is usually formed in some distant part of the body, e.g., lungs, heart or legs and then travels through the bloodstream to reach the brain’s circulatory system.
B) Hemorrhagic stroke
Hemorrhage means an escape of blood from a leaked or ruptured blood vessel. It occurs when a blood vessel in the brain or near the brain –such as the neck- bursts or rupture, leading to a lack of proper blood supply to the brain. Similar to ischemic stroke, a hemorrhagic stroke is also further divided into two major types. An intracerebral hemorrhage (the more common type) that occurs due to a rupture of blood vessels in the brain (or cerebrum) itself. The second type is a subarachnoid hemorrhage which happens in the subarachnoid space around the brain.
The leading cause of hemorrhagic stroke is hypertension or high blood pressure while other less common causes include arteriovenous (AV) malformation and weak points or dilatations in the blood vessels, also called aneurysms. The damage to the brain cells or tissues in this type of stroke is due to the leaked blood, inadequate blood supply to areas of the brain, swelling within the brain or increased intra-vessel pressure swelling within the brain.
It is important to understand the aforementioned types of strokes and how they affect brain cells before studying the warning signs and symptoms of stroke. Both signs and symptoms begin suddenly and may also vary from one person to another. Furthermore, as different parts of your body are controlled by different parts of the brain, your signs and symptoms will depend on the affected area of the brain, the extent of the damage it receives, and the time before management. Before going into details, the prominent stroke symptoms can be easily remembered with the word, FAST (Face, Arms, Speech, Time).
Face, arms, speech & time
» Face
The major signs and symptoms and usually the first ones to appear are located in the face. You may experience dropping of the face on one side (to the right side if stroke occurs in the left part of the brain and to the left side if damage occurs in the right brain), patients may be unable to smile, dropping their mouth (Bell’s palsy) or eyelids.
» Arms
You may experience weakness or numbness in one or both arms, and you may not be able to lift the limbs entirely. This is a sign that the part of the brain affected by a stroke is the cerebrum, especially located in an area that controls movement and coordination of the muscles.
» Speech
You may experience slurring of speech or being unable to speak appropriate words. The worst condition could be that you are unable to speak a single word despite appearing to be awake.
» Time
Time in this mnemonic (FACE) is not a real sign and symptom. It rather indicates that you have to quickly seek medical attention to treat the condition promptly and minimize the adverse consequences of a stroke.
- It is imperative for you to be aware of FAST and other signs and symptoms of strokes, especially if you care for somebody or live with somebody in a high-risk group such as those with diabetes, high blood pressure, ischemic heart disease or above the age of 60. Some other important signs and symptoms are as below:
1) Trouble with speaking or understanding
Slurring of speech or difficulty understanding what others are saying is the classic and the hallmark feature of most strokes. You may also experience confusion due to inability to speak properly. It mainly occurs with ischemic stroke, but it may also happen in hemorrhagic stroke. Slurring of speech, and confusion indicates that your recent stroke attack was in the speech center in the brain, i.e., temporal lobes. The most affected blood vessel, in this case, is the middle meningeal artery that supplies blood to this particular area. Furthermore, the temporal lobes of the brain control short-term memory as well, some degree of smell recognition and musical rhythm, so you may also experience difficulties with these functions.
Aphasia is a medical term used to describe the condition in which a patient is unable to speak correctly or start speaking inappropriate words, but understands speech, writing and reading. Speech therapy would be best to deal with this condition and regain lost facial activities.
2) Paralysis
When you think of a classic picture of a stroke patient, paralysis of the limbs could be the first picture in your mind; and it could be true, in most cases. When there is a stroke due to ischemia or rupture of the blood vessels, you may develop sudden weakness, numbness or paralysis in your face, legs or arms. Interestingly, it often happens to one side of the body, a term medically known as hemiplegia. The reason behind hemiplegia is that your half body functions are controlled by half and contralateral part of the brain, i.e., the left body is controlled by the right brain and vice versa. The side of the body affected also points out which part of the brain is affected by the stroke. In rare cases, both sides of your body get affected by the stroke when it attacks both sides of your brain.
Try to raise both of your arms over your head or flex your legs at the same time. If one arm or leg begins to fall or you feel numbness or weakness in it, this might be a sign of stroke. Also, try to smile and if one side of your face droops, it may also point out you’re having a stroke. In this case, seek immediate medical attention without delay. Physical therapy may help you regain the motor functions you may have lost after a stroke, such as smiling, walking, eating or dressing.
3) Difficulty talking or swallowing
If a stroke affects the part of your brain that controls and coordinate muscle movement in your face, you may experience loss of movement in your mouth and throat. It makes it difficult for you to talk, swallow or even open your lips to eat. The common part of the brain affected in such strokes is the primary motor cortex, or M1, which is located in the frontal lobe of your brain. It is difficult to treat and causes partial or total dependency of a patient on his caregivers.
4) Difficulty seeing in one or both eyes
It is a characteristic feature of occipital lobe stroke that controls vision. In this case, you may experience trouble seeing, have blurred or blackened vision or diplopia (double vision).
5) Headache
You may experience a headache depending on the affected part of the brain. However, frontal headache is more common. It can also be accompanied by dizziness, vomiting and altered consciousness. Some patients may experience a specific type of headache called migraine (also called pain of half head).
6) Memory loss or thinking difficulties
Memory loss and cognitive problems may not appear immediately after a stroke. However, the majority of people who have had a stroke in the recent past may develop dementia or some sort of memory loss. It can be either short-term or long-term memory loss. Some people may also experience difficulty in reasoning and understanding concepts, thinking, and making judgments.
7) Emotional problems
People with stroke may have more problems with expressing and controlling their emotions. Some may also develop depression and anxiety disorder.
8) Pain
You may feel pain during a stroke depending on the location of the blood vessels involved. Additionally, you may also experience numbness or tingling sensations in the affected regions of the body, e.g., in the face, arms, or legs.
Besides common painful symptoms, many people also complain of experiencing certain strange sensations all over the body like temperature changes, especially extreme cold, after a stroke. Some doctors describe such condition as central pain syndrome or central stroke pain. It usually develops several weeks after an attack and may also improve with time. As this pain or extreme temperature sensation has no physiological origin and it is caused by a problem within the brain, there are very limited treatment options available to treat this condition.
9) Transient ischemic attack and its associated signs and symptoms
Contrary to a full-blown stroke attack, a transient ischemic attack (TIA) or also known as a mini-stroke is a condition in which there is a temporary lack of blood supply towards the brain. This condition also causes signs and symptoms similar to stroke, but they are not as severe and may last for less than 24 hours without causing permanent disabilities. Sometimes, this condition may present with a specific visual disturbance known as amaurosis fugax or transient monocular blindness (TMB). It is characterized by a sudden dimming or obscuring of the visual field in one eye leading to blurring and the grayish appearance of the surrounding objects. Exposure to direct sunlight or bright light may aggravate the condition.
Often these symptoms are gone by the time you seek medical attention, and you may not have active signs and symptoms by the moment you’re in front of your doctor.
Although its signs and symptoms are of shorter duration and may not cause major discomfort, most doctors believe that a mini-stroke can be a predisposing factor that leads to ischemic stroke later in life (1 in 3 patients may experience a stroke after having a mini-stroke). Knowing the above-mentioned warning signs and symptoms of stroke or mini-stroke can help you seek quick medical intervention and treatment you need as early as possible. Your doctor will determine what type of stroke you experienced depending on the clinical assessment and investigations.