The six symptoms and warning signs of a stroke

More than 10,000 strokes are experienced by New Zealanders every year. Photo / Getty Images

One in four people will suffer from a ‘brain attack’, but noticing these early signs will avert the more serious long-term effects.

Every day in NZ more than 27 people suffer the catastrophic impact of a stroke. More than 10,000 strokes are experienced every year. Sometimes seen as “brain attacks”, these happen when blood flow to part of the brain is interrupted, cutting off the oxygen and nutrients our brain cells need to survive.

As brain cells (neurones) can die within minutes, strokes are right up there with heart attacks for being the medical emergencies we most dread.

They can cause profound life-altering disabilities, such as losing the ability to speak or use certain parts of your body. And sadly, one in four of us will suffer one at some point in our lives.

How to think FAST and recognise the signs of a stroke

There are two main types, ischaemic strokes (accounting for around 87% of all cases) are caused by a blockage (eg a blood clot) in an artery that supplies blood to the brain.

Haemorrhagic strokes (account for 13%) are when a blood vessel in the brain ruptures, causing bleeding and damage to the surrounding brain tissue. The signs of both are the same.

“Early recognition of a stroke is crucial – it can save lives and prevent long-term disability,” says Dr Branimir Nevajda, a consultant in neurology and stroke medicine at Basildon University Hospital.

He explains how the FAST acronym serves as a quick guide to identifying the signs of a stroke and taking action. “Seek immediate medical attention if you notice any symptoms of a stroke, even if they seem to come and go or they disappear completely.” Do the following:

Face

Ask the person to smile, can they manage to? Does their face droop on one side?

Arms

Ask them to raise both arms. Check if one arm drifts downwards? Or cannot be raised? You can also check legs.

Speech

Ask them to repeat a simple phrase. Do they sound slurred, garbled or incoherent speech, or find speaking difficult?

Time

Act swiftly – if you see any of these signs call emergency services immediately.

This FAST method has remained unchanged for years, though in some regions around the world, this has been expanded to BE-FAST – which includes additional early warning signs related to balance issues and eye problems:

Balance

Check for sudden loss of balance or co-ordination.

Eyes

Check for blurred or loss of vision in one or both eyes.

Stroke is New Zealand's second single biggest killer and a leading cause of serious adult disability. Photo / 123rf

“During a stroke, the brain is deprived of oxygen, and neurones die at a staggering rate – approximately 1.9 million neurones are lost every minute,” says Dr Nevajda. “This is why acting quickly is so important in stroke treatment. People need to recognise the signs and get help faster. This expansion of the acronym helps identify strokes that may not show the classic ‘FAST’ signs, and thereby increase the chances of getting timely medical intervention.”

Symptoms

Nevajda explains that each stroke symptom, listed below, gives a clue about what’s happening in the brain:

1. Sudden numbness or weakness

This occurs when a stroke disrupts blood flow to areas of the brain that control muscle movement or sensation. As a result, the affected area of the brain can no longer send or receive proper signals to the corresponding body parts.

2. Trouble speaking or understanding speech

Strokes that affect the brain’s language centres, such as Broca’s area (responsible for speech production) or Wernicke’s area (responsible for speech comprehension), disrupt communication pathways, leading to difficulties in speaking clearly or understanding others. This can result in slurred speech or inability to find the right words.

3. Vision problems

If a stroke occurs anywhere along the visual pathway (ie. the occipital lobe, the optic nerve, optic pathways or the eye itself) it can cause blurred or double vision or even partial or complete loss of vision in one or both eyes.

4. Severe headache

This is commonly associated with haemorrhagic strokes. It occurs because bleeding in the brain increases the pressure inside the skull.

5. Dizziness or loss of balance

When a stroke affects the posterior regions of the brain (such as the cerebellum or brainstem) that control balance and coordination, it can lead to symptoms of dizziness and vertigo.

6. Difficulty walking

Strokes can impair movement in legs, either through weakness or paralysis in the leg muscles themselves (because of damage in the motor cortex) or because of balance problems stemming from affected cerebellar function.

Severe headaches are commonly associated with haemorrhagic strokes. It occurs because bleeding in the brain increases the pressure inside the skull. Photo / 123rf

What causes strokes?

The underlying cause depends on the type of stroke it is, says Nevajda, but they generally relate to problems affecting the blood circulation or blood vessels. Key causes include:

Causes of ischaemic stroke

• Atherosclerosis – the narrowing of arteries because of cholesterol build-up into plaques.
• Blood clots – often originating from the heart and especially common in individuals with an irregular heart rhythm called atrial fibrillation.

Causes of haemorrhagic stroke

• High blood pressure – longstanding hypertension can lead to the weakening of blood vessel walls, making them more susceptible to rupture.
• Aneurysms – these are weak or thin areas in the walls of the blood vessel that can bulge and rupture.

“Up to 80 to 90% of all strokes are preventable and evidence shows that acting to lower blood pressure can significantly reduce the risk it poses to health,” says Maeva May, an associate director at the Stroke Association.

High blood pressure contributes to around half of all strokes, making it the single biggest risk factor. Hypertension also affects the heart and causes atrial fibrillation (AF or AFib). This can lead to blood clots forming in the heart, which can often cause strokes. The best way to check for atrial fibrillation is to monitor your pulse; it’s normal for occasional beats to be irregular, but if it is continually inconsistent then let your GP know.

Check your blood pressure regularly with a monitor at home, at a pharmacy or at your doctor’s surgery. If you are consistently getting readings over 140/90, it is important to let your GP know. For most people, simple lifestyle changes, and sometimes medications, are enough to lower the reading.

Smoking and excessive alcohol consumption contribute to stroke risk. Photo / 123rf

Who is most at risk of a stroke?

The following factors strongly affect your chance of having a stroke:

• Age: Strokes are more frequently seen in individuals over 55.
• Gender: Men are more likely to have a stroke than women.
• Race: People of Afro-Caribbean descent are at an increased risk.
• Medical conditions: Chronic conditions such as high blood pressure, diabetes, high cholesterol, and atrial fibrillation all increase the risk of strokes.
• Lifestyle factors: Smoking, excessive alcohol consumption, obesity, diabetes and lack of physical activity all contribute to the risk.

How are strokes usually treated?

Treatment for strokes depends on the type of stroke and how quickly the patient receives medical attention. Here are the primary treatment approaches:

Ischaemic stroke:

• Clot-busting medications (thrombolytics): These drugs can dissolve blood clots and restore blood flow. They are only effective when given within a few hours of symptom onset, usually up to 4.5 hours.
• Mechanical thrombectomy: This procedure involves using a catheter to physically remove the clot, depending on the patient’s condition and the location of the clot itself. It’s worth mentioning that this pioneering procedure is recognised as one of the most beneficial procedures in medicine currently.

Haemorrhagic stroke:

• Surgery: In cases of significant bleeding, surgery may be required to repair the damaged blood vessels or remove excess blood from the brain to relieve pressure within the skull.
• Endovascular procedures: These minimally invasive techniques can be used to seal off the bleeding vessel or to repair an aneurysm to reduce the risk of future aneurysmal ruptures.
• Rehabilitation: After the initial treatment, many stroke survivors require rehabilitation to recover lost functions. This may involve physical therapy, occupational therapy, and speech therapy to help regain strength, mobility, co-ordination, and communication skills.
• Lifestyle changes: Long-term treatment often involves lifestyle modifications to reduce the risk of future strokes. This involves adopting a healthier diet, increasing physical activity, managing stress, and adhering to prescribed medications for conditions like diabetes, atrial fibrillation, high blood pressure and cholesterol.

Stroke symptoms FAQs

How do you know a stroke is coming?

Strokes often strike suddenly, but sometimes there are warning signs. The BE-FAST acronym can help recognise early signs of stroke. In addition to these signs, sometimes individuals may experience mini-strokes also known as transient ischaemic attacks (TIAs) before a major stroke. These episodes are temporary, causing stroke-like symptoms that appear suddenly and resolve within a few minutes to a few hours. TIAs serve as critical warning signs, indicating that a full stroke may be imminent (especially in those with pre-existing risk factors). Seeking immediate medical attention can help reduce the risk of a major stroke.

What does a mini-stroke look like?

A Transient Ischaemic Attack (TIA) presents with similar symptoms to a full stroke. The key difference is that these symptoms are temporary and completely resolve within minutes to a few hours. More importantly, TIAs do not cause permanent brain damage; however, they are strong indicators of an increased risk for future strokes and provide a window of opportunity for medical interventions.