
Strokes are a life-threatening condition that occurs when there is an interruption in blood flow to the brain, resulting in brain cells dying due to oxygen deprivation. While some strokes present with noticeable symptoms such as face drooping, arm weakness, and speech difficulties, others may go undetected, known as silent strokes. These silent strokes typically occur in parts of the brain that do not control visible functions, and their symptoms may be subtle or mistaken for ageing. However, they can still cause significant brain damage and increase the risk of a major stroke in the future. To identify an old stroke, advanced brain imaging techniques such as MRI and CT scans can be used, which can detect signs of past strokes even decades later.
Characteristics | Values |
---|---|
Loss of movement | Face, body, arm, leg |
Loss of speech | Slurred speech, aphasia |
Loss of vision | Blurred vision, double vision, blindness in one eye |
Loss of balance | Dizziness, clumsiness, loss of coordination |
Loss of consciousness | Fainting, coma |
Severe headaches | No known cause |
Vomiting | With or without nausea |
Confusion | Memory problems, disorientation |
Emotional instability | Laughing or crying at inappropriate times |
What You'll Learn
Face drooping
A stroke is a life-threatening medical emergency that occurs when there is a disruption in blood flow to a part of the brain, either due to a blocked artery or bleeding in the brain. As a result, the brain cells in the affected area are deprived of oxygen and begin to die, leading to potential brain damage or death if not treated promptly.
One of the most well-known methods for identifying a stroke is the F.A.S.T. acronym, which stands for Face, Arms, Speech, and Time. Here is a detailed explanation of the "Face" part of the acronym:
In addition to facial drooping, other signs of a stroke include numbness or weakness on one side of the body, sudden confusion or difficulty understanding speech, vision problems, trouble walking, loss of balance and coordination, and a sudden severe headache.
It is important to note that facial paralysis or palsy does not occur in all cases of stroke. However, if you observe any of these signs, it is crucial to seek immediate medical attention by calling for emergency services. The faster a person receives treatment for a stroke, the better their chances of recovery without disability.
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Arm weakness
To identify arm weakness associated with a stroke, ask the person to raise both arms. If they have had a stroke, one arm will be weak or numb and will drift downward. This is because a stroke occurs when there is an interruption to the blood flow to the brain, which can cause muscle weakness or paralysis on one side of the body. If blood flow to the left side of the brain is interrupted, the person may have trouble lifting or controlling their right arm. Conversely, if blood flow to the right side of the brain is interrupted, they may have difficulty lifting or controlling their left arm.
The ability to lift both arms can be affected if the frontal lobe, which is responsible for motor control of voluntary muscles, is impacted during a stroke.
The American Stroke Association's F.A.S.T. acronym can help you remember the warning signs of a stroke:
- F: Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is their smile uneven?
- A: Arm Weakness – Is one arm weak or numb?
- S: Speech Difficulty – Is their speech slurred?
- T: Time to call 911 – Every minute counts. Note the time when any symptoms first appear.
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Speech difficulty
There are many types of aphasia, with different symptoms:
- Broca's aphasia (expressive aphasia): difficulty with spoken and written expression
- Anomic aphasia: difficulty with word retrieval, may demonstrate slow, halting speech
- Wernicke's aphasia (receptive aphasia or fluent aphasia): difficulty understanding speech and trouble producing meaningful speech; the person is 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 and apraxia are also speech issues that can occur after a stroke. People with these conditions understand language and know what they want to say, but their bodies don't cooperate. The muscles in their tongue, lips, and other parts may be too weak for speech, or their brains can't send the right messages to get those muscles to work in sync.
Dysarthria may cause individuals to sound like they are slurring their words or mumbling. Their speech may be incomprehensible, unnatural-sounding, too loud or quiet, too fast or too slow, breathy, hoarse, or nasally. They may also have difficulty moving their lips, jaw, and/or tongue.
Apraxia of speech occurs when the brain has difficulty telling the muscles how to move when speaking. Individuals with apraxia may have trouble producing or repeating desired sounds, make inconsistent speech errors, or speak slowly or not at all.
Speech and language therapy can help with many types of communication problems caused by a stroke. Speech-language pathologists can evaluate speech, language, and communication skills, and develop a customized treatment plan. This may include tongue and lip exercises, naming therapy, family education, singing therapy, and learning to compensate for speech and language difficulties using non-verbal techniques or augmentative and alternative communication.
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Time to call emergency services
A stroke is a life-threatening medical emergency, and immediate medical attention is critical to prevent permanent damage or death. If you or someone you know is experiencing the following symptoms, it is time to call the emergency services:
- Face drooping: One side of the person's face droops or is numb. When asked to smile, their smile appears uneven.
- Arm weakness: One arm feels weak or numb. When asked to raise both arms, one arm may drift downward.
- Speech difficulty: The person's speech may be slurred, or they may have trouble speaking or understanding speech.
- Time to call 911: It is critical to act fast and call the emergency services immediately if any of the above symptoms are present. Note the time when the symptoms first appear, as this information is important for healthcare providers.
It is important to remember that stroke symptoms can vary and may happen suddenly. Other possible signs of a stroke include:
- Weakness or numbness in the face, arm, or leg, usually on one side of the body.
- Problems with vision, such as blurred or double vision, or partial or total loss of vision.
- Dizziness, loss of balance, or coordination issues.
- Severe headaches with no known cause.
- Nausea or vomiting.
- Emotional instability and personality changes.
- Confusion or agitation.
- Memory loss.
- Fainting or seizures.
If you or someone you know is exhibiting any of these symptoms, do not hesitate to call the emergency services. The faster a person receives treatment for a stroke, the more likely they are to recover without disability.
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Loss of vision
About one-third of stroke survivors experience vision loss, and most will not fully recover their vision. However, some recovery is possible, especially in the first few months after a stroke. Strokes typically affect one side of the brain, and since nerves from both eyes travel together in the brain, both eyes are usually affected.
Types of Vision Loss
There are several types of vision loss that can occur after a stroke:
- Homonymous hemianopia is the loss of one half of the visual field in each eye. People may feel like they are unable to see out of one eye, but in reality, both eyes are affected. When reading, words and sentences disappear when in the missing visual field, and people may appear to have only half a face.
- Quadrantanopia is the loss of either the upper or lower quarter of the visual field.
- Eye movement control issues can develop if the nerves that control eye movement are damaged. This can lead to eye turning (strabismus) or double vision (diplopia). It can also cause an eyelid to droop (ptosis) or the pupil to become bigger.
- Nystagmus is the constant, unsteady movement of the eyes, which can be side to side, up and down, or circular.
- Visual neglect occurs when people are not aware of, and do not respond to, things on their stroke-affected side.
- Visual agnosia is when people have difficulty recognising familiar faces and objects due to damage to parts of the brain that perceive and interpret vision.
Management and Treatment
While most people with vision loss after a stroke will not fully recover their vision, early intervention and management can help. Ophthalmologists, orthoptists, doctors, and occupational therapists can advise on the best course of treatment, which may include:
- Therapy and training to compensate for vision loss, including scanning techniques to make better use of existing vision.
- Prism lenses to shift images from the non-seeing to the seeing visual field.
- Eye patches to block one image in cases of double vision.
- Eye drops for dry eyes.
- Sunglasses to reduce light sensitivity (photosensitivity).
- Training to help people live as independently and safely as possible.
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Frequently asked questions
An old stroke will look different on medical imaging scans than a recent stroke, consisting of small white spots that indicate damaged tissue. MRI scans can detect old strokes for decades after they happen, and CT scans can also detect old strokes.
Signs of a stroke include face drooping, arm weakness, and speech difficulty. Other symptoms include sudden loss of balance, loss of vision in one or both eyes, severe headaches, nausea, and vomiting.
Anyone can have a stroke, but certain factors increase the risk. These include high blood pressure, high cholesterol, Type 2 diabetes, history of stroke or heart attack, irregular heart rhythms, and old age. Strokes are more common later in life, with about two-thirds occurring in people over 65.