Strokes And Their Confusing Similarities: What You Need To Know

A stroke is a medical emergency that occurs when blood flow to a region of the brain is interrupted. If someone is experiencing a stroke, they may exhibit signs of mental confusion and disorientation, not knowing where they are or what they are doing. This may be confused with delirium, which is a state of sudden confusion that is often reversible and caused by a sudden illness, including infection, dehydration, or liver or kidney failure. However, it is important to note that stroke is one of the conditions that may put someone at risk for delirium. Additionally, post-stroke cognitive problems can sometimes be confused with dementia, which is a deterioration of cognition that interferes with daily functioning and is usually progressive and irreversible. While cognitive problems are common after a stroke, they do not necessarily indicate dementia, as post-stroke cognitive issues often improve over time with rehabilitation and brain retraining techniques.

Seizures

A stroke occurs when there is an interruption to the blood flow to the brain. On the other hand, a seizure is caused by a sudden surge of electrical activity in the brain. Both a stroke and a seizure can cause a disruption to normal activities in the brain and can result in attacks that may be mild or severe.

If someone has repeated seizures, they may be diagnosed with epilepsy. However, having a seizure after a stroke does not necessarily mean that a person has epilepsy or will develop it. The risk of having a seizure decreases over time after a stroke.

There are three main types of seizures: focal onset seizures, generalised onset seizures, and unknown onset seizures. Focal seizures happen on one side of the brain and can be motor or physical, or non-motor, affecting senses, awareness, and emotions. Generalised seizures involve the whole brain and body and can cause muscle spasms and loss of consciousness. Unknown onset seizures are those where the point of origin in the brain cannot be determined.

Migraines

A migraine is a neurological condition characterised by moderate to severe headaches, typically felt as a throbbing pain that worsens with movement. The pain is usually localised to one side of the head but can also be felt all over. It is often accompanied by nausea, vomiting, and sensitivity to light, sound, or smells. Some people also experience an "aura" before the migraine, which includes symptoms such as flashing lights, zig-zags, sparks, or blank spots in their field of vision. While the exact cause of migraines is unknown, they are believed to be related to problems with brain activity affecting nerves, chemicals, and blood vessels.

On the other hand, a stroke occurs when there is damage to the blood supply to the brain, resulting in reduced blood flow or bleeding in the brain. This damage can lead to permanent physical, cognitive, and emotional effects. While the symptoms of a stroke may vary, they often include sudden numbness or weakness on one side of the body, trouble speaking or understanding speech, sudden vision problems, and severe headache.

The key distinction between migraines and strokes lies in the underlying cause and the duration of symptoms. Migraines are caused by problems with brain activity, while strokes are due to disruptions in the blood supply to the brain. Additionally, migraine symptoms are temporary, lasting from a few hours to several days, while stroke symptoms can have long-lasting effects and may indicate permanent brain damage.

Although rare, a "migrainous stroke" or "migrainous infarction" can occur when an ischaemic stroke (caused by a blood clot) happens during a migraine with aura. In such cases, the migraine aura symptoms may overlap with those of the stroke, making it challenging to distinguish between the two conditions. However, it is crucial to seek immediate medical attention if stroke-like symptoms are observed, as prompt treatment can significantly impact the outcome.

While migraines themselves have not been shown to cause strokes, it is important to note that people who experience migraines with aura have a slightly higher risk of experiencing an ischaemic stroke in their lifetime compared to those without migraines. This risk is still relatively low, and other factors such as smoking and high blood pressure play a more significant role in increasing stroke risk. Nonetheless, individuals with migraines can work with their healthcare providers to manage their overall stroke risk through lifestyle changes and, if necessary, adjustments to their medication.

High or low blood sugar

Strokes are often mistaken for hypoglycaemic episodes, and vice versa. This is because hypoglycemia can cause behavioural changes, confusion, loss of consciousness, seizures, hemiplegia, and aphasia. These symptoms can mimic those of a stroke, and so it is important to rule out hypoglycemia in all stroke patients.

Hypoglycaemia is a common occurrence in diabetic patients receiving pharmacological treatment. Transient hypoglycaemia can produce a stroke-like picture with hemiplegia and aphasia. Hemiplegia induced by hypoglycaemia usually resolves immediately with the administration of intravenous glucose. However, in rare cases, neuroglycopenia can present as ataxia after a hypoglycaemic episode, and prolonged and potentially irreversible deficits may occur.

In one case, a 55-year-old female with diabetes experienced sudden onset unilateral cerebellar symptoms during a hypoglycaemic episode. She had difficulty maintaining posture and impaired coordination in body movements. A provisional diagnosis of cerebellar stroke was made, but after administering intravenous dextrose, there was a complete resolution of cerebellar signs. This case highlights hypoglycaemia as a potential mimic for cerebellar stroke.

Cerebellar dysfunction due to hypoglycaemia is uncommon, and most reported cases have shown some myelination abnormalities on MR imaging. However, this case demonstrates that unilateral cerebellar dysfunction without any systemic features suggestive of hypoglycaemia is possible. Therefore, blood glucose measurement must be considered in all patients who present with features suggestive of cerebellar stroke. Prompt correction of blood glucose in hypoglycaemic patients may completely resolve the symptoms and prevent further neuronal damage.

How to Recognise a Stroke

A stroke is a life-threatening condition that occurs when part of the brain doesn't have enough blood flow, usually due to a blocked artery or bleeding in the brain. It is important to recognise the signs of a stroke and seek immediate medical attention to prevent permanent damage or death. To remember the warning signs of a stroke, think BE FAST:

• Balance: Watch for a sudden loss of balance.
• Eyes: Look for a sudden loss of vision in one or both eyes, or double vision.
• Face: Ask the person to smile and look for a droop on one or both sides of the face, indicating muscle weakness or paralysis.
• Arms: Ask the person to raise their arms; if they have one-sided weakness, one arm will stay higher while the other will sag.
• Speech: Strokes often cause a loss of the ability to speak, slurred speech, or trouble choosing the right words.
• Time: Time is critical; call emergency services immediately if you observe any of the above signs.

Bell's Palsy

The main sign of Bell's palsy is facial muscle paralysis, which can cause a droopy appearance on one or both sides of the face. Symptoms typically come on suddenly and reach their peak within 48 to 72 hours. Some people experience mild facial muscle weakness, while others suffer total muscle paralysis. It can be difficult for those with Bell's palsy to make full facial expressions, and they may have difficulty wrinkling their forehead, blinking, or grimacing on the affected side. The face may also feel numb or heavy, but touch and temperature sensitivity are usually unaffected.

Other symptoms of Bell's palsy include difficulty speaking, eating, or drinking, ringing in the ears (tinnitus), and sensitivity to sounds (hyperacusis). In rare cases, Bell's palsy can also cause loss of taste on the front two-thirds of the tongue and hypersensitivity to sound in the affected ear. It is important to note that while Bell's palsy is not typically a serious condition and often resolves on its own within a few months, its symptoms can be similar to those of more severe conditions, such as a stroke. Therefore, anyone experiencing muscle weakness or paralysis in the face should seek medical attention as soon as possible.

Healthcare providers typically diagnose Bell's palsy based on symptoms, a physical examination, and the patient's history of symptoms. In some cases, additional tests may be recommended to rule out other conditions or determine the extent of nerve involvement. These tests may include blood tests, electromyography (EMG), and magnetic resonance imaging (MRI) or computed tomography (CT) scans. While there is no known cure for Bell's palsy, most cases improve without treatment, and up to 80% of people fully recover within three months. However, healthcare providers may recommend various therapies to relieve symptoms and speed up recovery, such as eye care, oral corticosteroids, and antiviral medications.

Brain tumours

Firstly, in terms of speed of onset, stroke symptoms tend to occur suddenly, within hours or minutes, whereas brain tumour symptoms tend to develop more slowly, over days, weeks, or months. This is because brain tumours typically grow slowly.

Secondly, the types of symptoms experienced can differ. While both conditions can cause weakness or paralysis on one side of the body, changes in vision, seizures, and difficulty with language, stroke symptoms often include difficulty following instructions, performing routine tasks, and reading and writing. On the other hand, brain tumour symptoms can include personality or behavioural changes, loss of balance, dizziness, and confusion.

Thirdly, the underlying causes are distinct. A stroke occurs when there is a blockage or bleeding in the blood vessels of the brain. In contrast, a brain tumour is a growth of abnormal cells in the brain that can develop in any part of the brain or skull and can be cancerous or non-cancerous.

Finally, the diagnostic process and treatment approaches differ. Diagnosing a stroke typically involves physical examinations, medical history, vital sign assessments, blood tests, and imaging techniques such as CT scans and MRIs. Treating a stroke may involve surgery, medication, and rehabilitation. Diagnosing a brain tumour usually involves a neurological exam, brain scans, and, if safe, a biopsy. Treatment options for brain tumours include surgery, chemotherapy, and radiation therapy.

While strokes and brain tumours can present with similar symptoms, accurate diagnosis and differentiation between the two conditions are crucial to determine the appropriate treatment plan and patient management.

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