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People at risk and partners or caretakers of people at risk for stroke should be aware of the general symptoms, and the stroke victim should get to the hospital as soon as possible after these warning signs appear. In people who have had Transient Ischemic Attacks or small strokes, it is important to determine the source of these attacks in order to prevent a major stroke.
What are the Symptoms of a Stroke?
People at risk and partners or caretakers of people at risk for stroke should be aware of the general symptoms, and the stroke victim should get to the hospital as soon as possible after these warning signs appear. It is particularly important for people with migraines or frequent severe headaches to understand how to distinguish between their usual headaches and symptoms of stroke.
Transient Ischemic Attacks (TIAs)
TIAs are mini-ischemic strokes, usually caused by tiny emboli that lodge in an artery and then quickly break up and dissolve. The mental or physical disturbances resulting from TIAs generally clear up in less than a day, with nearly all symptoms resolving in less than an hour. There is no residual damage.
Transient ischemic attacks, however, are the warning signals of ischemic stroke as angina is the red flag for a heart attack. About 5% of those who experience TIAs go on to suffer a stroke within a month, and without treatment, a third will have strokes within five years. (In fact, because of the relationship between atherosclerosis, coronary artery disease, and stroke, TIAs are also warning signs for a heart attack.)
One of two major arteries is usually involved in a transient ischemic attack, either the carotid or basilar arteries:
Symptoms of TIAs in the Carotid Arteries. The carotid arteries start at the aorta and lead up through the neck around the windpipe and on into the brain. They are the more commonly involved sites. When TIAs occur here, they may cause symptoms in either the retina of the eye or the cerebral hemisphere (the large top part of the brain):
- When oxygen to the eye is reduced, people describe the visual effect as a shade being pulled down. People may develop poor night vision.
- When the cerebral hemisphere is affected by a TIA, a person can experience problems with speech and partial and temporary paralysis, tingling, and numbness, usually on one side of the body.
Symptoms of TIAs in the Basilar Artery. The other major site of trouble, the basilar artery, is formed at the base of the skull from the vertebral arteries, which run up along the spine. When TIAs occur here, both hemispheres of the brain may be effected so that symptoms occur on both sides of the body. Some include the following:
- Temporarily dim, gray, blurry, or lost vision in both eyes.
- Tingling or numbness in the mouth, cheeks, or gums.
- Headache in the back of the head.
- Nausea and vomiting.
- Difficulty swallowing.
- Inability to speak clearly.
- Weakness in the arms and legs, sometimes causing a sudden fall.
Symptoms of Major Ischemic Stroke
Speed of Onset. The onset of symptoms in a major ischemic stroke may vary depending on the source:
- If the stroke is caused by a large embolus that has traveled to and lodged in an artery in the brain, the onset is sudden. Headache and seizures can occur within seconds of the blockage
- When thrombosis, a blood clot that has formed in a narrowed artery, causes the stroke, the onset usually occurs more gradually, over minutes to hours. On rare occasions it progresses over days to weeks.
Symptoms. The symptoms for a major ischemic stroke are extremely variable:
- Early symptoms can be identical to those of a transient ischemic attack, since, in both cases, the clot can produce a blockage in a branch of the carotid or basilar arteries. [ See above. ] (In the case of a TIA, however, the symptoms resolve.)
- The blood clot usually affects the opposite side of the body from its location in the brain, with possible loss of feeling on one side of the face, in an arm or leg, or blindness in one eye.
- Speech problems can occur if the left hemisphere of the brain is involved. (In some people, mostly those who are left-handed, speech can be affected by a clot on the right side of the brain.)
- The stroke victim may be unable to express thoughts verbally or to understand spoken words.
- They may experience major seizures and possibly coma.
Symptoms of Hemorrhagic Stroke
Cerebral Hemorrhage Symptoms. Symptoms of a cerebral, or parenchymal, hemorrhage typically begin very suddenly and evolve over several hours and include:
- Nausea and vomiting.
- Altered mental states.
Subarachnoid Hemorrhage. When the hemorrhage is a subarachnoid type, warning signs may occur from the leaky blood vessel a few days to a month before the aneurysm fully develops and ruptures. Warning signs may include:
- Abrupt headaches.
- Nausea and vomiting.
- Sensitivity to light.
- Various neurologic abnormalities.
When the aneurysm ruptures, the stroke victim may experience the following:
- A terrible headache.
- Neck stiffness.
- Altered states of consciousness.
- The eyes may become fixed in one direction or lose vision.
- Stupor, rigidity, and coma can result.
Silent Brain Infarctions
As many as 31% of the elderly experience silent brain infarctions, which are small strokes that cause no apparent symptoms but are major contributors to mental impairment in the elderly. Smokers and people with hypertension are at particular risk.