Symptoms of a stroke

introduction

The most common symptoms of a stroke are those that can also be found in the so-called FAST test: a one-sided drooping eyelid or corner of the mouth, one-sided paralysis of an arm or leg and speech disorders. Depending on the severity of the stroke, however, these symptoms can be more or less pronounced.

Not all cardinal symptoms always appear together; other symptoms can also appear. This mainly depends on the area of ​​the brain in which the stroke occurred and which area of ​​the brain is affected and fails.

Read more on the subject at: stroke

These can be typical symptoms

The typical and most common symptoms of a stroke include:

• Hemiplegia (Hemiparesis): Weakness or complete paralysis of one side of the body (arm and / or leg, half of the face)

• Speech disorders: inability to speak, impaired speaking, impaired speech understanding

• Other symptoms can also be:

• Balance disorders, dizziness and unsteady gait

• Visual disturbances (double vision, short-term vision loss, eye flicker)

• Deconsciousness or momentary loss of consciousness

• Confusion and disorientation

• Nausea and vomiting

• Tingling and numbness in arms and legs

• Sudden, severe headache; Neck pain

• Memory loss (amnesia)

• Malfunctions in the control of urination (Incontinence/ Urinary retention)

• Difficulty swallowing

Read more on the subject at: Signs of a stroke

a headache

A common symptom of a stroke is the headache. Around 40% of those affected suffer from headache at the time of the stroke for up to three days afterwards, although this is more common in women than in men. In addition, headaches occur more frequently when the stroke occurs in the bloodstream region of the back of the brain than when it is located in the anterior region of the brain. The headache is usually described as suddenly occurring, very strong (often also devastating) and dull and oppressive; it is often felt especially in the forehead area or on both sides of the head.

The reason for the headache is as follows: the brain tissue itself is not sensitive to pain, but the blood vessels in the brain and the meninges are. If a blood vessel ruptures and then there is bleeding into the brain tissue, the surrounding vessels and also the meninges are irritated by the pressure - headache occurs. If the tissue is insufficiently supplied with blood and oxygen due to the occlusion of a vessel, the blood pressure rises locally to compensate for the insufficient supply - it is also characterized by headache.

Read more on the topic: Causes of headache

Nausea and vomiting

Nausea is a sensation that is generated, among other things, by the central nervous system - i.e. the brain or the spinal cord. If a stroke occurs and certain areas of the brain are damaged, symptoms can include nausea and vomiting. This is not a typical, classically most frequently occurring symptom, rather it is an uncharacteristic additional symptom. In addition, nausea can also accompany stroke symptoms such as dizziness, unsteady gait and headaches.

Speech disorders

The language center in the brain is very often affected by a stroke. If nerve cells in the speech center are damaged by a vascular occlusion or cerebral hemorrhage, this is often very noticeable. Around 30% of all those affected suffer a speech or speech disorder as part of a stroke.

Read more on the subject at: Stroke of the language center

This disorder does not necessarily have to persist forever, many patients return to normal speaking ability within 4 weeks. If this is not the case after 4 weeks, the chance of a permanent disorder decreases.

Depending on the language center involved, different language disorders (Aphasia) differentiated:

• The global language disorder includes a lack of language understanding (content cannot be understood / recorded) and a lack of speaking skills (sentences cannot be formed, words are missing or are incorrectly used)

• Wernicke aphasia mainly involves a lack of speech understanding

• Broca's aphasia, on the other hand, has a lack of speech

• A rather lighter form is amnesiac aphasia, in which word finding disorders are in the foreground, but speech and language comprehension are intact

Half-sided paralysis

In very many cases of a stroke, one-sided paralysis of the muscles occurs. This makes it one of the main symptoms and pioneering the diagnosis.
Depending on which half of the brain is affected by the stroke, the other half of the body is affected by the paralysis: if the stroke happened in the right half of the brain, symptoms occur in the left half of the body and vice versa.

Paralysis is typically found in the arms and legs, but also in the facial muscles of the face. Depending on the extent of the stroke or nerve cell damage, the face, arm and leg do not always have to be affected, sometimes symptoms of paralysis can only be found in the face, only in the arm or only in the leg. Complete paralysis is also not to be expected from the outset; here, too, the extent of the paralysis can vary.

Drooping eyelid / drooping corner of the mouth

If the nerve tissue for the facial muscles is damaged during a stroke, this is also referred to as central facial nerve palsy. The facial nerve, which supplies one half of the face, then no longer functions correctly, which is then expressed, for example, in a drooping eyelid or a drooping corner of the mouth.

The entire musculature of one half of the face (with a stroke in the right half of the brain, the left half of the face is affected and vice versa) can then no longer be moved arbitrarily. The exception to this is the forehead muscles, which still remain mobile in the case of central facial paralysis - a frown is still possible.

Read more on the subject at: Facial palsy

Tingling sensation / numbness

A common symptom of a stroke is paralysis of the muscles on one side, especially the facial muscles, the muscles of the arms and legs. However, depending on the extent of the stroke, complete paralysis does not have to occur immediately; numbness or a tingling sensation can often be felt in the affected arm or leg. On the one hand, it can stay that way, but on the other hand, it can also be the harbinger of an upcoming paralysis of the muscles.

Read more on the subject at: Numbness in the arm and Numbness in the leg

Gait disorder

Gait disorders are a symptom that mainly occurs when the rear of the brain and the cerebellum are affected by a stroke. Unsteadiness of gait often occurs together with dizziness and a fear of falling, as well as disturbances in the movement itself (Ataxia) can be accompanying, as well as uncontrollable, rhythmic movements of the eye (Nystagmus). All symptoms together are also known as acute vestibular syndrome and are an absolute warning signal when it comes to stroke diagnosis.

Read more on the subject at: Cerebellar infarction

Eye flicker

Eye flickering during a stroke is the so-called nystagmus, which means uncontrollable, rhythmic movements of the eye at rest. These often occur with dizziness. One speaks here of central eye movement disorders, which can occur in many different neurological diseases.

They are also typical of a stroke in which the rear brain region and / or the cerebellum are affected. The eye trembling is an expression of a faulty coordination between the sense of balance and sight.

Double vision

If the stroke takes place in the area of ​​the visual center, this can manifest itself in various symptoms. One of the symptoms may be double vision, i.e. Objects viewed are seen twice, whereby the objects are then seen twice next to one another, one above the other or diagonally to one another.

The reason for this is that the nerve cells that send impulses to the optic nerves that are responsible for the eye muscles have perished. If the eye muscles in one eye no longer function correctly, the eyes do not move in the same direction, resulting in double images.

Memory loss

Memory disorders (amnesiaSymptoms after a stroke are common. The type of memory impairment also depends on the severity and location of the stroke.

In some cases it is difficult or impossible to retrieve information that has already been saved (from the past) (retrograde amnesia), in other cases it is less or impossible to save new information (anterograde amnesia).

Likewise, only factual knowledge (semantic memory) or knowledge of personal experiences / details (episodic memory) can be affected. In some cases, however, people who have had a stroke “only” suffer from an attention disorder, which is not synonymous with a memory disorder, but in many cases it can appear similar.

dizziness

Sudden dizziness can also be a symptom of a stroke. This can lead to vertigo as well as vertigo: in the case of vertigo, the person concerned feels as if he were driving a carousel, the vertigo is similar to the feeling of being on a ship.

The dizziness can be accompanied by an unsteady gait, which can also lead to fear of falling. Dizziness is most likely to occur when the back of the brain and the cerebellum are affected by a stroke.

Difficulty swallowing

The act of swallowing is controlled by different centers in the brain. If one or more of these areas are damaged by a stroke, swallowing disorders can occur. If this is the case, the normal act of swallowing can no longer be coordinated well, which leads to increased swallowing.

Ingestion means that saliva, liquid or solid food is not transported into the esophagus and further into the stomach as usual, but instead incorrectly gets into the trachea. This is also called aspiration. In the worst case, this can lead to pneumonia (Aspiration pneumonia).

Incontinence

Controlling urination is also one of the brain's tasks - this includes not only urine storage, but also urination. If a stroke occurs and the corresponding brain area is damaged, the bladder control can also be lost: This can result in an overactive bladder with the urge to urinate frequently, urinary retention or an unwanted urine leakage (Incontinence) express. Other symptoms such as gait / movement disorders, paralysis or sensory disorders can make things more difficult.

Neck pain

As already described, a common symptom of a stroke is a sudden, severe headache. These can sometimes be accompanied by neck pain. The neck pain can also occur on one side, often on the side where the headache occurs. Head and neck pain are more typical of a cerebral haemorrhage, a cerebral infarction can also go hand in hand without head and neck pain.

Can a nosebleed be a sign of a stroke?

Nosebleeds are not a direct symptom of a stroke. However, frequent nosebleeds can be a warning that should be taken seriously: frequent nosebleeds can have many causes. Two major causes, also important for a stroke, are high blood pressure and coagulation disorder. If high blood pressure persists, this can include express in nosebleeds. However, it is also a clear risk of a stroke, because if the blood pressure is permanently too high, the brain vessels are also damaged over time and cerebral hemorrhage can occur.

If there are congenital or acquired coagulation disorders, this means that bleeding cannot be stopped as quickly: the clumping of blood platelets and the closure of damaged blood vessels to stop the bleeding is slowed. This, too, can manifest itself in frequent and prolonged and intensified nosebleeds. If there is damage in a brain vessel, this would also mean easier, stronger and longer bleeding into the brain tissue.

Read more on the subject at: Causes of nosebleeds

This is how symptoms express themselves in men

The symptoms of a stroke in men are usually more typical than in women. Accordingly, the most common symptoms already listed here, such as hemiplegia and speech disorders, usually apply. This means that, on average, the stroke diagnosis is made faster in men and the time until therapy is initiated is shorter.

This is how the symptoms express themselves in women

The symptoms in women who suffer a stroke often differ from those in men in that the symptoms are atypical and thus make diagnosis more difficult.

In addition to the classic typical symptoms such as paralysis, speech and vision disorders and dizziness, unspecific symptoms such as headache and body aches, nausea and vomiting, chest pain, difficulty swallowing, shortness of breath and confusion occur in women.

If these unspecific symptoms occur on their own, it is sometimes not that easy to raise suspicion of a stroke in good time or in the shortest possible time and to initiate the appropriate diagnosis and therapy.

This is how symptoms express themselves in the child

In children too, the symptoms depend on the location of the brain damage, but also on the age of the child.

The most common symptoms in children under 1 year of age include seizures; in children aged 5-10 years, paralysis on one side is the most common. Hemiplegia in newborns is usually only noticed from 6 months. The children mostly become noticeable through disturbances in movement sequences, for example through the sudden dragging of a leg, the inability to walk or incorrect crawling.

If the children are already speaking, a step backwards in language or even a classic language disorder as a symptom is possible. Because the brain is not yet fully developed in children, the damage and thus the symptoms sometimes only appear months or years later. The actual stroke then proceeds silently. Viewed the other way around, the chance of recovery is greater than with adults.

Test for a stroke (FAST test)

The FAST test is a way of making a quick initial diagnosis of a stroke. It is a test for an initial assessment based on clinical symptoms to confirm an initial suspicion of a stroke. FAST stands for face (face), arms (arms), speech (language) and time (time) and combines all major symptoms of a possible stroke: a drooping corner of the mouth or a drooping eyelid (due to a paralyzed facial muscles) on the face, Unilateral paralysis of the arm (which can no longer be lifted (well)), slurred speech or even the inability to speak can be clear indicators of a stroke that has occurred. The T for Time stands as a reminder that in the event of a possible stroke, every minute counts and a doctor must be called immediately - Time is Brain!

Read more on the subject at: Test for stroke symptoms

It is then primarily important that the exact cause of the stroke is clarified, because this is also the basis for emergency therapy. With the help of a CT or MRT in the event of a stroke, it can then be shown visually whether the cause is bleeding into the brain tissue (cerebral haemorrhage) or a blockage of a brain vessel (cerebral infarction).

Read more on the subject at: Actions in the event of a stroke

What other diseases can the symptoms indicate?

The symptoms listed here do not only apply to a stroke, some other - more or less life-threatening - diseases can be associated with the same or similar symptoms. This makes it all the more important to confirm the diagnosis quickly through appropriate imaging using CT or MRI.

If paralysis or sensory disturbances occur, a disease of the spinal cord such as paraplegia or autoimmune diseases such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) must always be considered. Brain tumors, infections such as meningitis or brain abscesses can also trigger some of the symptoms.

The same applies to various metabolic diseases or disorders in the blood composition such as hypo- / hyperglycaemia (low / high blood sugar), hypokalaemia (too little potassium in the blood) or uremia (too much urea in the blood). A severe headache, possibly accompanied by neck pain, nausea, and visual disturbances can also indicate a migraine attack with aura.