Stroke is an emergency, and needs medical attention right away. The best treatments available for stroke, such as TPA, are most effective the sooner they are given, and after a few hours they may no longer be useful at all. For this reason, it's critical that people recognize the symptoms of stroke and go to an emergency room immediately.
Stroke symptoms begin suddenly, and include any of the following:
• Difficulty walking. This may be due to lack of balance, weakness, clumsiness or dizziness.
• Difficulty communicating. You may not understand what other people are saying. You may not be able to form the words you would like to say, and lose your ability to write. Your speech may become slurred and difficult to understand.
• Numbness or weakness on one side of the body or face. This may range from total paralysis to a more subtle difference between keeping your left and right arms raised high. Weakness of your face may give one side a drooping appearance.
• Loss of coordination on one side of the body. While your limb may be strong, you may not have the coordination to do something you were before, such as hold a spoon or button a clasp. In rare cases a body part may develop abnormal, spontaneous movements.
• Difficulty with vision. This may include vision loss in one or both eyes, or seeing double.
• Severe headache. Most strokes do not cause headache, but if the headache has sudden onset, is severe, or is associated with vomiting or decreased consciousness, it may be due to stroke.
• Seizure. Most of the time, seizures are not due to stroke. On the other hand, strokes are the most common cause of new seizure in someone over the age of 50 who has no history of prior seizures.
How long will the symptoms last?
Symptom duration depends on the size and severity of the stroke. Symptoms may last less than an hour, but can also remain for a lifetime. Even if the physical damage left by a stroke is permanent, sometimes the brain can "re-wire" itself to find new pathways for information to travel in order to regain function. The longer a symptom lasts, the more likely it is that the symptom will remain permanent. It is usually best to address problems caused by stroke as soon as possible.
What if the symptoms go away?
You still need an evaluation as soon as possible. This may have been a transient ischemic attack (TIA), which is caused by a temporary loss of blood flow to part of the brain. For example, a clot may have lodged in an artery and blocked blood flow, but has now broken up and passed through. Although blood flow has been restored for now, you are at an increased risk of having another episode with permanent symptoms.
What should I do if I think I'm having a stroke?
Dial 911. If you are unable to speak clearly, get someone to help you. The sooner you get to the emergency room, the better the chances that your stroke will not have long-term consequences.
Should I take an aspirin or other medication?
Not immediately. It is more important that you get to an emergency room right away. About 85% of strokes are ischemic, meaning that a clot has stopped blood from moving to part of the brain. These strokes are helped by medications like aspirin. However, 15% of strokes are caused by bleeding into the brain, in which case aspirin makes things worse. It's best to be evaluated to know what type of stroke you might be having before taking medicine.
What information will they want in the emergency room?
When you arrive to the emergency room, doctors will want to quickly decide if you are likely having a stroke and if it is safe to give you a blood thinner like TPA. They will need the following information.
• When were you last feeling normal? Did you wake up with these symptoms, or do you remember the exact time they started?
• Do you have a bleeding or clotting disorder?
• Have you had bleeding in your brain before? Have you had recent surgery or physical trauma?
• What medications do you take?
• Do you have metal anywhere in your body, such as surgical clips or hardware? Are you claustrophobic? These questions are important to determine the safety of an MRI.
Remember, stroke is an emergency, and every minute counts. It is best if you are seen in the emergency room within an hour of your first symptoms. If you have any doubts about whether you might be having a stroke, you need to speak with a medical professional right away.
Ropper AH, Samuels MA. Adams and Victor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009.
Rothwell PM, Giles MF, Flossmann E, et al. (2005). "A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack". Lancet 366 (9479): 29–36.