Symptoms and signs of a stroke

It is vital not to underestimate the importance of recognising a stroke early, so that medical help can be sought as soon as possible. The features of a stroke may be many and varied; any sudden problem with the nervous system may be caused by a stroke. However, there are several key warning signs to be aware of. These include:[1,2]

  • Paralysis in the face, arms or legs; especially on one side of the body - 'hemiplegiaAlso called hemiparesis. Paralysis of one side of the body.' - also numbness or weakness. Drooping of one side of the face is an important sign
  • Confusion, difficulty speaking or understanding speech - 'aphasiaDifficulty in understanding and generating speech.'
  • Visual disturbance in one or both eyes
  • Dizziness, trouble walking, loss of balance or coordination
  • Severe headache with no known cause
  • Difficulty swallowing - 'dysphagiaPain or difficulty in swallowing.'.

Other possible features include:[3]

  • Abnormal sensations - 'paraesthesiaAbnormal tingling sensations.' - in the arm or leg
  • Failure to identify or respond to stimuli on one side - 'neglectLack of attention or disregard; a condition in which one side of the body or visual field are neglected.'
  • Partial loss of movement - 'paresisMuscular weakness.' - in the arm or leg.

Eye signs

The bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels of the retina The innermost layer of the eye, which is sensitive to light. (the layer at the back of the eye that is sensitive to light) have a close relationship to the brain, so changes there often reflect similar changes in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels of the brain.

Looking at the retina, which is a simple and non-invasiveAny test or technique that does not involve penetration of the skin. The term 'non-invasive' may also describe tumours that do not invade surrounding tissues. test, can therefore give clues as to the underlying causes of a stroke. Examples include changes in the retina consistent with high blood pressure or diabetes mellitusDisordered energy metabolism and high levels of glucose in the blood owing to a lack of insulin, or poor response of the body to insulin..[4]

Clues as to the location of the stroke

A clinical examination can give doctors an impression of where the problem area is, and how big it is. For example:[5]

  • Weakness on one side of the body, or difficulty using or understanding speech (aphasiaDifficulty in understanding and generating speech.), both suggest that the stroke has occurred in one of the cerebral hemispheres, one of the two halves of the brain [5]
  • Lack of coordination (ataxiaDifficulty in the regulation of posture and the movement of limbs.), double vision (diplopiaDouble vision.), dizziness or weakness on both sides of the body suggest that the stroke has occurred in the brain stemThe region of the brain that is continuous with the spinal cord. or cerebellumThe part of the brain that regulates muscle tone and balance., particular regions of the brain.[5] The role of the brain stemThe region of the brain that is continuous with the spinal cord. includes controlling breathing, heartbeat and eye movements, while the cerebellumThe part of the brain that regulates muscle tone and balance. controls coordination and balance.

Differences between ischaemic and haemorrhagic stroke

Key features of an ischaemic stroke include:[3]

  • Neurological symptoms that are noted on waking up in the morning, or that happen abruptly. Examples of neurological symptoms include weakness or numbness in any part of the body, visual disturbance or difficulty swallowing. Learn more about the neurological symptoms of stroke.
  • The most common symptoms are difficulty with speech and weakness over one half of the body.

Key features of a haemorrhagic stroke include:[6]

  • The sudden onset of neurological problems that progress over minutes to hours. These are the same symptoms that are seen with ischaemic strokes. Find out more about the neurological symptoms of stroke.
  • Accompanying sudden severe headache, nausea and vomiting
  • Reduced level of consciousness (reduced awareness and responsiveness) and elevated bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure.

Other possible causes of symptoms

The two conditions that are most often mistaken for a stroke are low bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. (hypoglycaemiaLow blood glucose levels.) and seizureUncontrolled electrical activity within the brain, leading to convulsions or an alteration in mental state..[3]

References: 
  1. Nicol MB and Thrift AG. Knowledge of risk factors and warning signs of stroke. Vascular Health and Risk Management 2005; 1: 137-47.
  2. Pappachan J and Kirkham FJ. Cerebrovascular disease and stroke. Arch Dis Child 2008; 93: 890-8.
  3. Yew KS and Cheng E. Acute stroke diagnosisThe process of determining which condition a patient may have.. Am Fam Physician 2009; 80: 33-40.
  4. Baker ML, Hand PJ, Wang JJ et al. Retinal signs and stroke: revisiting the link between the eye and brain. Stroke 2008; 39; 1371-9.
  5. Boon NA, Colledge NR and Walker BR. 'Davidson's Principles and Practice of Medicine'. Churchill Livingstone Elsevier. 2006; 20th edition.
  6. Sahni R and Weinberger J. Management of intracerebralWithin the brain. hemorrhage. Vasc Health Risk Manag. 2007; 3: 701-9.