Stroke Learning Center

Symptoms

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.

Symptoms usually develop suddenly and without warning, or they may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:

• Starts suddenly and may be severe
• Occurs when lying flat
• Wakes you up from sleep
• Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on the severity of the stroke and what part of the brain is affected. Symptoms may include:

• Muscle weakness in the face, arm, or leg (usually just one side)
• Numbness or tingling on one side of the body
• Trouble speaking or understanding others who are speaking
• Problems with eyesight, including decreased vision, double vision, or total loss of vision
• Sensation changes that affect touch and the ability to feel pain, pressure, different temperatures, or other stimuli
• Changes in hearing
• Change in alertness (including sleepiness, unconsciousness, and coma)
• Personality, mood, or emotional changes
• Confusion or loss of memory
• Difficulty swallowing
• Changes in taste
• Difficulty writing or reading
• Loss of coordination
• Loss of balance
• Clumsiness
• Trouble walking
• Dizziness or abnormal sensation of movement (vertigo)
• Lack of control over the bladder or bowels

Signs and tests

A complete physical and neurological exam should be performed. Your doctor will:

• Check for problems with vision, movement, sensation, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or is improving.
• Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by turbulent blood flow.
• Check and assess your blood pressure, which may be high.

Tests can help your doctor determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms.

• A CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards.
• Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain that may have caused the stroke.
• Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart.
• Carotid duplex (a type of ultrasound exam) can show if narrowing of the neck arteries (carotid stenosis) led to the stroke.
• An angiogram of the head can reveal which blood vessel is blocked or bleeding, and help your doctor decide if the artery can be reopened using a thin tube.
• Laboratory tests will include acomplete blood count (CBC), bleeding time, and blood clotting tests (prothrombin time or partial thromboplastin time).
• Electrocardiogram (ECG) and heart rhythm monitoring can help determine if an irregular heart beat (such as atrial fibrillation) caused the stroke.
• A spinal tap (cerebrospinal fluid exam) may also be done.