What Are the Five Signs of Stroke?

Stroke is a medical emergency. If you or someone you know has any signs of a stroke, call 9-1-1.

A stroke occurs when a part of the brain is damaged because a blood vessel in the brain is blocked, leaks, or bursts. When blood and oxygen do not reach parts of the brain, that part is damaged and does not function properly. The effects of a stroke depend on which part of the brain is impacted, how much of the brain is affected, and how promptly treatment occurs. 

Types of strokes include:

• Ischemic stroke, the most common type of stroke, occurs when a blood vessel is blocked by a blood clot in the brain
• Hemorrhagic stroke occurs when there is bleeding into the brain tissue
• Transient ischemic attack (TIA), also called a “mini-stroke,” in which blood flow to the brain is blocked for a short time. It is often a warning sign of a future stroke.

Stroke is a medical emergency. If you or someone you know has any signs of a stroke, call 9-1-1 and get to a hospital’s emergency department immediately. 

Stroke signs occur suddenly. Five main signs of stroke include:

• Numbness or weakness in the face, arm, or leg, usually only on one side of the body
• Confusion, trouble speaking or understanding speech
• Difficulty seeing in one or both eyes
• Problems walking, dizziness, loss of balance, or lack of coordination
• Severe headache with no known cause

The American Heart Association and the American Stroke Association suggest the word "FAST" as an easy way to remember signs of a stroke. Each letter in the word stands for important signs to look for and what to do about it:

• Face – Does the person's face look uneven or droop on one side?
• Arm – Does the person have weakness or numbness in one or both arms? Does one arm drift down if the person tries to hold both arms out?
• Speech – Is the person having trouble speaking? Does his or her speech sound strange?
• Time – If you notice any of these stroke signs, call for an ambulance (in the U.S. and Canada, dial 9-1-1) and get to a hospital immediately. You need to act FAST. The sooner treatment begins, the better the chances of recovery. 

Ischemic stroke occurs when a blood vessel is blocked by a blood clot in the brain. The main causes of ischemic stokes include:

• Hardening of the arteries (atherosclerosis), which may be caused by:
  • High blood pressure (hypertension)
  • High cholesterol 
  • Obesity
  • Smoking
  • Diabetes
  • Excessive alcohol intake
• Atrial fibrillation (AFib), a type of irregular heartbeat 

Risk factors for ischemic stroke include:

• Age over 40 years
• Heart disease
• High blood pressure (hypertension)
• High cholesterol 
• Smoking
• Diabetes
• Recent childbirth
• Previous history of transient ischemic attack (TIA)
• Sedentary lifestyle/lack of exercise
• Obesity
• History of blood clots
• Family history of heart disease and/or stroke
• Illegal drug use

Hemorrhagic stroke occurs when there is bleeding into the brain tissue. The main causes of hemorrhagic strokes include:

• High blood pressure (hypertension). Factors that increase the risk of developing hypertension include:
  • Smoking
  • Sedentary lifestyle
  • Being overweight/obese
  • Excessive alcohol intake
  • Stress
• Brain aneurysm, which is the rupture of a balloon or bulge in a blood vessel in the brain
• Abnormally formed blood vessels in the brain

Risk factors for hemorrhagic stroke include:

• High blood pressure
• Smoking
• Illegal drug use (especially cocaine and "crystal meth")
• Use of blood thinners

Stroke is a medical emergency. If you or someone you know has any signs of a stroke, call 9-1-1 and get to a hospital’s emergency department immediately. Most doctor’s offices are unable to perform the tests required to diagnose stroke, or the treatments needed to prevent or minimize brain damage.

In a hospital, testing for stroke includes:

• Imaging tests of the brain and of the blood vessels in the neck and head that supply the brain with blood
  • Computerized tomography (CT) scan 
  • Magnetic resonance imaging (MRI) 
  • Magnetic resonance angiography (MRA)
• Heart testing
  • Electrocardiogram (ECG)
  • Echocardiogram (“echo”) 

Treatment for stroke depends on the kind of stroke that is occurring. This is why it’s so important to get to a hospital quickly. 

Early treatment for ischemic stroke includes:

• Thrombolytic therapy – medication called alteplase or "tPA" is administered intravenously (IV) to break up the clot blocking blood flow to the brain
• Mechanical thrombectomy – involves placing a catheter in the blocked artery and removing the clot using a "stent retriever device" or suction to reopen the blocked artery
• Antiplatelet medications such as aspirin
• Blood thinners (anticoagulants) 

Long-term treatments to prevent recurrence of another ischemic stroke include:

• Blood pressure medications
• Cholesterol-lowering drugs
• Antiplatelet therapy such as aspirin, clopidogrel, and the combination of aspirin plus extended-release dipyridamole and cilostazol 
• Anticoagulants such as warfarin (Coumadin), Ddabigatran (Pradaxa), apixaban (Eliquis), edoxaban (Savaysa, Lixiana), and rivaroxaban (Xarelto)
• Lifestyle changes 
  • Quitting smoking 
  • Avoiding or limiting alcohol intake
  • Eating a healthy diet, including a plant-based diet and low salt diet
  • Exercising regularly
• Carotid artery revascularization to re-establish blood flow in a narrowing in the carotid artery

Treatment for hemorrhagic stroke includes:

• Surgical treatment to prevent or stop bleeding or reduce the pressure inside the skull
• Aneurysm treatment such as a clamp, coil embolization, or stents called flow diverters 
• Arteriovenous malformation treatment that may include surgery, radiation to shrink blood vessels, or embolization techniques
• Decompressive craniotomy 

Rehabilitation following a stroke may include: 

• Physical therapy
• Occupational therapy
• Speech therapy 

Complications of stroke include:

• Paralysis or weakness on one or both sides of the body
• Problems with speech
• Problems thinking, learning, or remembering
• Numbness, tingling, or strange sensations 
• Blood clots
• Difficulty swallowing or chewing, which increases the risk of pneumonia and malnutrition
• Seizures
• Urinary tract infection (UTI)
• Bladder or bowel control problems
• Gastrointestinal bleeding 
• Heart attack or heart failure
• Irregular heartbeat (arrhythmia)
• Pressure sores
• Falls
• Depression
• Pain in hands and feet that gets worse with movement or changes in temperature

Some strokes may be prevented by managing risk factors. 

• Take medicines exactly as directed, especially: 
  • Blood pressure medicines
  • Statins which lower cholesterol
  • Medicines to prevent blood clots such as aspirin or blood thinners
  • Medicines to control blood sugar if you have diabetes
• Don’t smoke
• Exercise regularly 
• Lose weight if you are overweight 
• Eat a healthy, balanced diet, including a plant-based diet
• Reduce sodium (salt) intake
• Limit alcohol intake