- Sudden numbness or weakness of face, arm or leg, often one side of the body.
A lack of muscle strength in any group of muscles, most commonly those on the face, hand, arm and leg on one side (called hemiparesis). At least half of patients suffer some form of hemiparesis, some with a mild form that involves difficulty in controlling movement, rather than weakness.
A loss of sensation or feeling in any part of the body. Numbness of the skin of the face, hand, arm, and leg on one side (hemiananaesthia) is most common.
- Sudden confusion, trouble speaking or understanding.
Difficulty in speech - slurring of speech (from weakening of face, mouth, throat muscles) may be accompanied by swallowing difficulty. There may be difficulty understanding others’ speech, finding the right words, understanding written words or in writing (aphasia).
- Sudden trouble seeing in one or both eyes.
Difficulty with vision - may take the form of total loss of vision in one eye, or loss of vision in half the visual field of each eye, or double vision.
- Sudden trouble walking, dizziness loss of balance or co-ordination.
Dizziness - injury to inner ear nerves may cause loss of balance, a spinning feeling, of the world moving (vertigo). May cause nausea, unsteadiness on the feet, a tendency to veer to one side or the other, or an unexplained fall.
- Sudden severe headache with no known cause.
Headache - stroke and TIA do not usually cause headache, but headache may result from stretching or irritation of the membrane covering the brain (meninges) or the blood vessels in the brain.
Subarachnoid haemorrhage may be preceded by the sudden (within seconds) onset of an extremely severe ‘thunderclap’ headache (the most intense the patient has ever felt), together with neck stiffness. Irritation from light may also be a problem. After minutes to hours the headache spreads to the back of the head, neck and back as blood tracks down the spinal subarachnoid space. Subarachnoid hemorrhage may be associated with drowsiness or loss of consciousness and with other stroke symptoms.
- Less common symptoms include:
Nausea and vomiting- can be associated with vertigo or involvement of the ‘vomiting centre’ (the medulla) of the brain; common at the outset of subarachnoid haemorrhage.
Drowsiness or unconsciousness - also not common, but may occur, often briefly, depending on the location of the injury in the brain.
Epileptic seizures (10% of patients with subarachnoid haemorrhage).
Symptoms of Transient Ischaemic Attack (TIA)
The symptoms of TIA are not easily distinguished from those of stroke, except that they do not last as long. They may include:
- Short term blindness, blurred vision, double vision, other visual disturbances
- Speech disturbance – often an inability to put thoughts into words, or the substitution of a similar word for another of different meaning (‘I bent on the ball’ for ‘I leant on the wall’), or slurring of speech
- Vertigo – a spinning sensation – usually in conjunction with other symptoms
- Facial numbness or weakness
- Swallowing difficulty
- Arm or leg weakness or paralysis
- Loss of balance
- Nausea and vomiting
A TIA is significant and must not be ignored. Advice must be sought immediately.
A TIA may be the start of a stroke that can follow the TIA within hours.
A TIA can warn of a future stroke and rapid investigation and treatment can reduce the risk of having a stroke.
If the symptoms disappear quickly, a TIA may be diagnosed and the patient discharged with appropriate instructions for medical follow-up, investigation and treatment to minimise the risk of recurrence.
If the symptoms persist, tests to determine the nature, precise location and extent of the injury to the brain will be started. These are likely to include Brain scans (Computer Tomography) and MRIs (Magnetic Resonance Imaging).
Treatment to may be started to rescue damaged brain tissue, to prevent complications such as difficulty swallowing, and to minimise the chance of further strokes.
Reviewed by Professor Alastair Corbett, Consultant Neurologist, Concord Hospital, Australia
Date created: 26 September 2003
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