How To Recognize the Signs of a Stroke

Note:  Always call 911 as soon as you suspect that a medical emergency has occurred.

The American Stroke Association, a division of the American Heart Association, warns that a stroke is the third leading cause of death in American adults.  Unfortunately strokes occur often, so it's important to know how to recognize one.  

The most important thing to remember when you encounter someone who you suspect has had a stroke is time matters.  If a stroke victim gets to the hospital within 2 hours of the onset of symptoms, doctors may be able to administer a drug that could counteract some of the effects of the stroke and help lead to a more meaningful recovery.

There are two types of strokes and this thrombolytic drug is only effective within 3 hours (hence the patient must arrive at the hospital within 2 hours) of the onset of an ischemic stroke. An ischemic stroke is similar to a heart attack in that one of the brain's blood vessels is clogged with a blood clot.  This clot prevents blood from flowing to the affected area of the brain, thus depriving it of oxygen.  A thrombolytic can disintegrate the clot and restore blood flow, if administered in that 3-hour window.

Thrombolytic drugs are not effective on hemorrhagic strokes, which occur when a blood vessel ruptures and blood begins to pool in or around the brain tissue of the affected area.  If a thrombolytic is administered to a patient with a hemorrhagic stroke, the bleeding could increase and worsen the patient's condition.

It's very difficult to tell which type of stroke a patient has suffered without the appropriate tests.  So it's always important to assume that a stroke victim is suffering from an ischemic stroke and get her to the hospital as soon as possible.  However, if you can collect some information from family members or bystanders at the scene, you may be able to help doctors more quickly determine which type of stroke the patient has suffered.

If the victim was complaining of a severe headache, most often classified as "the worst headache I've ever had," and/or the onset of symptoms was extremely sudden, the likelihood is that he is suffering from a hemorrhagic stroke.  If the onset was gradual, the stroke will more likely be ischemic.  

Regardless of the type of stroke you suspect a victim has suffered, your actions should remain the same: get the victim to a hospital as soon as possible.  Strokes most commonly affect speech, sensation and muscle function.  Some tell-tale signs include:

  1. Paralysis.  Paralysis typically affects either one extremity or both extremities on one side of the body.  If both sides of the body are affected, it is more likely that the patient is suffering from a spinal injury.  Paralysis from a stroke will occur on the opposite side of the body from the area in the brain that is affected.  So if the stroke occurs in the right side of the brain, the paralysis will occur on the left side of the body, etc.
  2. Facial Droop.  Similar to paralysis of the extremities, one side of the stroke victim's face may lose sensation or become paralyzed.  This results in facial droop, or the inability of the stroke victim to move one side of his face.  Have the patient smile to test for facial droop.  If only one half of her face moves, a stroke may have occurred.
  3. Change in Mental Status.  An alteration in a stroke victim's mental status can range from simple confusion and slight dizziness to total unresponsiveness.  Determine whether the patient's current mental status is normal for him.  Is this patient usually somewhat confused, or is this abnormal behavior for him? 
  4. Abnormal Speech.  Often a stroke victim's speech becomes slurred or even absent.  Test the patient's speech by having her repeat a common phrase like, "you can't teach an old dog new tricks".  If the patient uses inappropriate words, the words are slurred or the patient is unable to speak, it is indicative of a stroke.
  5. Duration of Symptoms.  If a patient suffers from what appears to be a stroke, but the symptoms clear up within 15 to 30 minutes, the patient may have suffered a mini-stroke, or transient ischemic attack.  A transient ischemic attack (TIA) is similar to a stroke except that the symptoms fully disappear after 24 hours (usually sooner) and there is no lasting neurological damage. 

    If a patient presents with typical signs of a stroke, but these symptoms gradually disappear, suspect a TIA.  It is still important to recognize a TIA and report it to a doctor.  TIAs are often precursors to full strokes, so it is vital that you or your patient see a doctor if a TIA occurs.

  6. Arm Drift.  Another stroke assessment technique is to have your patient close his eyes and hold his arms outstretched in front of him for 10 seconds.  If one of your patient's arms slowly drifts back down towards his side, it is likely that he has suffered a stroke.  Any asymmetrical movement in the arms may be cause for concern.
  7. Head Trauma.  If you are certain that a patient has not suffered from any head trauma and many of these signs and symptoms are present, you can be pretty sure that a stroke has occurred.  However, many of these symptoms, such as slurred speech, altered mental status and even paralysis can occur with trauma to a patient's head.  If you suspect that there may have been trauma, make sure to ask bystanders what happened and look for any signs of trauma (bruising, bleeding, furniture that has been knocked over etc.).  Remember that head trauma can be caused by a stroke (if the patient fell after suffering the stoke), so don't rule out the possibility of a stroke if trauma is found.

Always call 911 as soon as possible in any emergency situation.  Especially with a stroke victim, getting the patient to the hospital quickly could mean the difference between a meaningful recovery and lasting effects, or worse.


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