Stroke Warning Signs: Can You Feel It Coming?

Strokes occur when the blood supply to the brain is interrupted, and they can be fatal if not addressed quickly. While strokes can sometimes seem to occur without warning, there are often warning signs in the lead-up to a stroke, such as a severe or unusual headache, or a transient ischemic attack (TIA), also known as a ministroke. A TIA occurs when the blood supply to the brain is interrupted for a short period, causing symptoms similar to a stroke, such as paralysis or weakness on one side of the body, difficulty speaking, and loss of balance or coordination. These symptoms usually disappear within an hour but can persist for up to 24 hours. It is important to seek immediate medical attention if you are experiencing any of these symptoms, as a more serious stroke could be imminent.

Face drooping

Facial drooping, or asymmetry, is a common symptom of a stroke. It occurs when the facial muscles are not working properly, and can affect one or both sides of the face. The eyelids and corners of the mouth may appear pulled down, and the person may be unable to smile voluntarily or speak clearly.

Facial drooping is often a sign of muscle weakness or paralysis, which can be caused by a stroke when the blood supply to the brain is interrupted. This can be due to a blood clot, blocked artery, or bleeding in the brain. Without a good blood supply, brain cells do not get the oxygen they need to function and can start to die, impairing communication between nerve cells.

The effects of a stroke depend on how long the blood supply is interrupted. A transient ischemic attack (TIA), or mini-stroke, is when the blood vessel is temporarily blocked. Symptoms can go away within minutes as blood supply returns, and there might not be any permanent damage to the brain cells. However, a TIA can be a warning sign of a more serious stroke, so it is important to seek medical help.

If you suspect that you or someone else is experiencing a stroke, it is important to act quickly. The acronym FAST is a helpful way to identify stroke symptoms:

• Face: Ask the person to smile and check if one side of the face droops.
• Arms: Ask the person to raise both arms and check if one arm drifts downward.
• Speech: Ask the person to repeat a simple phrase and check for slurred or strange speech.
• Time: If you observe any of these signs, call emergency services immediately.

Some health educators add two more steps to the checklist, calling it BE FAST:

• Balance: Loss of balance is another possible stroke sign.
• Eyes: The person may lose vision in one or both eyes or experience blurry vision.

If you notice any of these symptoms, do not wait to see if they pass. Call an ambulance right away and do not attempt to drive to the hospital yourself. Minutes matter when treating a stroke, and ambulance workers can judge your situation faster, boosting your chances of getting the treatment you need as soon as possible.

Arm weakness

The signs of a stroke often appear suddenly, and it is important to act quickly if you or someone else is experiencing symptoms. Arm weakness can be a sign of a stroke if it occurs on only one side of the body. To test for this, ask the person to raise both arms; if one arm drifts downward, it could be a sign of a stroke. This is the "A" in the FAST test, a checklist developed by doctors to help identify the most common symptoms of a stroke.

Isolated hand palsy, or fractional arm weakness, is a rare presentation of a stroke, often mistaken for a peripheral lesion. It occurs when there is a discrete cortical infarction in the precentral gyrus, affecting the motor hand area of the cerebral cortex. This results in weakness or numbness in the hand, wrist, or shoulder.

If you or someone else is experiencing arm weakness, especially if it is on one side, it is important to seek medical attention immediately. Call an ambulance and do not try to drive to the hospital yourself, as this will waste valuable time. The faster you seek help, the better the chances of recovery.

Speech problems

Aphasia, a common language disorder caused by strokes, affects your ability to communicate and is experienced by around a third of stroke survivors. People with aphasia may struggle to verbalise their thoughts or understand others. They may also have difficulty reading and writing. Aphasia can be broken down into several categories:

• Broca's aphasia or expressive aphasia: difficulty with spoken and written expression.
• Anomic aphasia: difficulty with word retrieval, which may manifest as slow or halting speech.
• Wernicke's aphasia, receptive aphasia, or fluent aphasia: difficulty understanding speech and producing meaningful speech; the person may be able to speak long, fluent sentences, but the words do not make sense.
• Conduction aphasia: difficulty with repeating words or phrases.
• Global aphasia: difficulties with both speech production and comprehension.

Dysarthria is another condition that can occur after a stroke, resulting in weakness or incoordination of the muscles involved in speech. This can cause individuals to sound like they are slurring their words or mumbling. Their speech may also sound unnatural, robotic, or choppy, and they may speak too loudly, quietly, quickly, or slowly.

Apraxia of speech is a third condition that can affect stroke survivors, where the person cannot move the muscles in their face, mouth, or throat in the correct order when speaking, making it difficult for others to understand them.

If you or someone you know is experiencing any of these speech-related issues, it is crucial to seek immediate medical attention as it could be a sign of a stroke.

Severe headache

A severe headache can be a symptom of a stroke, but it can be hard to distinguish a benign headache from a stroke-related headache. A stroke-related headache is described as a very severe headache that comes on within seconds or minutes. The location of the headache is often related to where the stroke occurs. For example, a blocked carotid artery can cause a headache on the forehead, while a blockage towards the back of the brain can cause a headache towards the back of the head.

It can also be challenging to differentiate a migraine from a stroke-related headache because they share some symptoms, such as disorientation, a general feeling of being unwell, changes in vision, and vertigo. However, a migraine headache often has recognisable triggers and is described as a throbbing pain that gets worse over time, whereas a stroke can happen randomly and cause a sudden, severe pain.

A stroke-related headache is typically associated with a specific type of stroke called a hemorrhagic stroke, which causes bleeding into the brain. This type of stroke is more common in individuals with uncontrolled or poorly controlled high blood pressure. The pressure causes blood vessels in the brain to weaken, rupture, and bleed, resulting in a severe headache.

In addition to a severe headache, other stroke symptoms may include:

• Weakness or numbness of the face, arm, or leg, usually on one side of the body
• Trouble speaking or understanding
• Problems with vision, such as dimness or loss of vision in one or both eyes
• Dizziness or problems with balance or coordination
• Problems with movement or walking

If you or someone else is experiencing a severe headache along with any of these symptoms, it is important to seek immediate medical attention as it could be a sign of a stroke.

Vision issues

One of the main types of vision problems associated with strokes is visual field loss, where individuals experience missing areas in their field of vision. This is often referred to as "hemianopia", where one loses either the left or right half of the visual field in both eyes. This can cause difficulties in daily tasks such as reading, as words or sentences may disappear when they fall within the missing field of vision. Additionally, individuals with hemianopia may struggle with locating objects, navigating crowded environments, or coping with street traffic.

Another common issue is eye movement problems, which can result in both eyes not working together properly. This can lead to blurred vision, double vision (diplopia), or difficulty in maintaining stable focus on objects. The eyes may also wobble, a condition known as nystagmus, or one may be unable to move both eyes together in a particular direction, known as gaze palsy.

Visual processing problems are also prevalent after a stroke. This can manifest as visual inattention or neglect, where individuals are unaware of things on one side of their visual field. This often occurs with strokes on the right side of the brain, affecting the left side of the visual space. Those affected may ignore objects or people on their affected side, bump into things, or have difficulty reaching for objects.

Other vision problems may include increased sensitivity to light, dry eyes, visual balance disorders, and visual hallucinations (Charles Bonnet syndrome). Light sensitivity can cause discomfort in bright lights or glare, which can be alleviated with tinted glasses or eye shields. Dry eyes, on the other hand, can be a result of problems with eyelid nerves or muscles, leading to a slower blink rate or incomplete eyelid closure. This can cause the cornea to dry out, resulting in a gritty and uncomfortable feeling. Lubrication eye drops and ointments can help manage this condition. Visual hallucinations, while not a symptom of mental health issues, can be distressing and usually improve over time as the brain adjusts to the loss of vision.

Frequently asked questions