Signs and Symptoms of a Stroke

A stroke is a serious medical condition. It affects the arteries that lead to the brain and those that are in the brain. It is the fifth highest cause of death in the U.S. and one of the leading causes of disability.

When one of the blood vessels that carry oxygen and nutrients to the brain gets blocked (by a clot) or ruptures, a stroke will likely occur. The brain needs that blood and oxygen and without it, cells in the brain will die.

Types of Stroke

There are several different types of stroke. Each of these is different in its causes and treatments. Those are:

• Ischemic Stroke: 87% of strokes are ischemic. The blood supply to the brain is blocked in one of the blood vessels.
• Hemorrhagic Stroke: A weak blood vessel ruptures. This can be from an aneurysm or an arteriovenous malformation (AVM). Most commonly, this is caused by high blood pressure that is not controlled.
• Transient Ischemic Attack (TIA): Also called a mini-stroke, this is caused by a temporary clot. This is a warning sign and is just as serious as any other stroke.
• Cryptogenic Stroke: This is a stroke with a cause that can’t be determined.
• Brain Stem Stroke: A stroke that occurs in the brain stem. This can affect both sides of the body. It can leave the person in a ‘locked-in’ state. This is when they are locked in their own body, unable to speak or move from the neck down.

Symptoms of a Stroke

It is important to know the signs and symptoms of a stroke. Every single minute counts and getting help quickly is the most important factor.

Generally speaking, you can act F.A.S.T.:

F – Face: Does the person’s face droop to one side when you ask them to smile?

A – Arms: Do their arms drift downward when you ask them to raise both arms?

S – Speech: Is their speech slurred or different when you ask them to repeat a simple phrase?

T – Time: If any of these signs are present, call 911 immediately. Time is of the essence.

Ischemic Stroke

Ischemic strokes can occur over minutes or hours. These are some of the symptoms. These will all have a sudden onset:

• Confusion
• Difficulty speaking
• Numbness or weakness in the arm, face, or leg. This will be especially on one side of the body.
• Trouble seeing (one or both eyes)
• Difficulty walking
• Dizziness; loss of coordination or balance
• Severe headache with no apparent cause

Additional symptoms sometimes found in women:

• Pain in the face, arm, or leg
• Nausea or hiccups
• Chest pain or palpitations
• Shortness of breath

Hemorrhagic Stroke

A hemorrhagic stroke happens when blood leaks into the brain. This happens when a blood vessel ruptures. Symptoms of this are:

• Severe headache at the back of the head that comes on suddenly. It could be described as the worst headache you’ve ever experienced. 
• A loss of consciousness.
• Inability to feel or move. 
• One pupil is larger than the other. 
• Seizures.
• Muscle pain in the shoulders and neck.
• Light sensitivity.
• Irritability and/or confusion.
• Nausea and/or vomiting.
• Problems with vision.
• Drooping eyelids.

Transient Ischemic Attack (TIA)

A mini-stroke or TIA is a temporary period when someone has symptoms similar to a stroke. This usually doesn’t last longer than a few minutes and usually won’t cause permanent damage. Oftentimes, this is a warning that a stroke is coming. Symptoms can include:

• Vertigo
• Loss of balance or coordination
• Blindness (in one or both eyes)
• Double vision
• Weakness, paralysis, or numbness in the face, arm, or leg. This is usually only on one side of the body.
• Slurred speech
• Difficulty understanding other people

*** It is important to note that not everyone’s symptoms will be the same. Everyone will not experience every symptom. If one or more of these symptoms is present in you or someone you know, DO NOT WAIT – get immediate medical attention. This could be a lifesaving decision. ***

Stroke Tests and Treatments

Getting quick, effective treatment for a stroke is the best way to save a life and prevent potential long-term effects. At the hospital, the doctors will run a series of tests. A CT (computerized tomography) scan will be done so the doctor knows the type of stroke it is. This will give the doctor a good picture of the brain to see if anything else is happening. Aside from the CT, they may perform the following tests:

• A physical exam. They will listen to your heart and take your blood pressure.
• Blood tests. This can help test for clots or infections and test your blood sugar.
• MRI (magnetic resonance imaging). This gives a detailed view of the brain.
• Ultrasound of the carotid arteries. These are in the neck and will show fatty deposit buildup.
• Echocardiogram. This can help find the source of a clot.
• Cerebral angiogram. This is not very common.

After the tests are finished, the doctor will have a better idea of how to treat you.

Ischemic Stroke

The treatment for an ischemic stroke must be done quickly. The doctors want to restore blood flow to your brain. They may do some of the following:

• Emergency IV medication: Medicines to break up clots should be given intravenously(IV) within 4.5 hours after the first symptoms appear. Doctors may give a TPA such as Activase (Alteplase).
• Emergency endovascular procedures: This is when a doctor treats the stroke directly in the blocked blood vessel. This can include:
  • Delivering medications directly to the brain.
  • Using a stent retriever to remove the clot.
• Procedures that open up the artery:
  • Carotid endarterectomy.
  • Angioplasty and stents.

Hemorrhagic Stroke

The main focus of a hemorrhagic stroke is to control the bleeding and reduce pressure in the brain. Some of the treatments can include:

• Emergency measures: Stopping or reversing effects of certain medications (such as anticoagulants). Medications to lower pressure in the brain, blood pressure and prevent seizures.
• Surgery: This can remove blood from a large area. It will also repair a blood vessel.
• Surgical clipping: The use of a clamp at the bottom of an aneurysm to stop blood flow to it.
• Coiling (endovascular embolization): Tiny coils are placed in the aneurysm to block blood flow to it.
• Surgical AVM removal.
• Stereotactic radiosurgery: Radiation beams are used to repair a blood vessel. This is minimally invasive.

Medications For Strokes

There are different types of medications that doctors will prescribe for a stroke, depending on the type of stroke it is.

Anticoagulants

These medicines help keep your blood from clotting. They are used to help prevent an ischemic stroke and a TIA. Some examples are:

• Warfarin (Coumadin, Jantoven)
• Apixaban (Eliquis)
• Dabigatran (Pradaxa)
• Edoxaban (Savaysa)
• Rivaroxaban (Xarelto)

Antiplatelets

These medicines help prevent blood clots from forming. They work by making it harder for the platelets in your blood to stick together. Examples are:

• Aspirin
• Clopidogrel (Plavix)
• Dipyridamole-Aspirin (Aggrenox)
• Ticagrelor (Brilinta)
• Prasugrel (Effient)

Statins

These medications will help lower high cholesterol. High cholesterol can build up in your arteries which can lead to blockage. Examples include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Altoprev)
• Pitavastatin (Livalo)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Blood Pressure Medications

Lowering blood pressure can greatly decrease the chances of a stroke. There are different types of blood pressure medicines:

• Angiotensin-Converting Enzyme (ACE) inhibitors
  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Zestril)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Trandolapril (Mavik)
• Beta-Blockers
  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Bisoprolol (Zebeta)
  • Esmolol (Brevibloc)
  • Metoprolol (Lopressor, Toprol XL)
  • Nadolol (Corgard)
  • Nebivolol (Bystolic)
  • Propranolol (Inderal LA)
• Calcium Channel Blockers
  • Amlodipine (Norvasc)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc)
  • Nicardipine (Cardene)
  • Nifedipine (Adalat CC)
  • Nimodipine (Nymalize)
  • Verapamil (Verelan)
  • Diltiazem (Cardizem CD)

Stroke Prevention

Strokes can be deadly if they are not treated immediately. 80% of strokes are preventable. You can best prevent a stroke by leading a healthy lifestyle. This includes:

• Eating healthy foods
• Keeping a healthy weight
• Getting regular exercise
• No smoking or quit smoking
• Minimal alcohol
• Keep cholesterol under control
• Keep blood pressure under control
• Control diabetes, if applicable
• Treat heart disease, if applicable
• Take your medicine
• Get regular physicals and see your doctor if you think something is wrong.