Symptoms of cerebral stroke and how to detect it early

Detect a stroke early

Also known as cerebrovascular accident, it occurs when blood does not reach the brain due to the obstruction of an artery by a thrombus or the rupture of a blood vessel. Symptoms begin to appear about 10 seconds after the blood supply to the brain is disturbed. There are three main symptoms that you must know to identify it.

Symptom 1: Are you able to smile?

Loss of sensation on one of the two sides of the face is one of the most frequent symptoms. This causes that, when trying to smile, the right or left part of the mouth does not move. This symptom is usually accompanied by other discomforts, such as a sudden tingling sensation in the face, arm, or leg on the affected side.

Symptom 2: Can you repeat a phrase?

The interruption of blood flow to the brain can cause the affected person to have difficulties expressing himself (it is difficult for him to articulate the words or what he says does not make sense). If you think someone is having a stroke, ask them to repeat a simple phrase, such as "Today is Tuesday." It may also be that you do not understand what is being said.

Symptom 3: Do you raise your arms well?

This test is related to the lack of strength and sensitivity that the disorder causes on one side of the body. If trying to raise the arms is impossible or one of the two falls collapsed, it is a clear symptom of a possible stroke.

There are more symptoms that warn

When the blood flow in the brain is altered, other symptoms can also appear, although they are sometimes difficult to identify or relate to the cerebral infarction, because they can be confused with other ailments such as migraine. Knowing them will help you react quickly.

Vision disturbance

It is possible for the affected person to see blurry, double or even lose vision in one or both eyes for a few moments. This symptom can also be due to other causes, such as a migraine with aura. In any case, if vision is lost (in one eye or both), even temporarily, you should go to the emergency room as soon as possible.

Sudden headache

By not receiving blood or oxygen, the brain may complain of a severe headache with no apparent cause. You should ask for help if the pain is very intense, you have difficulty moving a part of the body, nausea, vomiting or drowsiness.

Find out here what the different types of headaches are like.

Imbalance and dizziness

It is common that, when suffering a stroke, the affected person is easily unbalanced or has difficulty walking, by losing strength on one of the two sides of the body.

Hearing, smell, taste problems

Stroke can also cause other senses such as smell, taste or hearing to be temporarily affected. In the case of touch, a certain tingling may be felt.

Suddenly memory fails

A sudden memory loss should also put you on your guard. This type of amnesia has nothing to do with the memory loss that occurs with age but will generally be accompanied by a general feeling of great mental confusion.

Coordination problems

When the heart attack occurs, there is difficulty coordinating movements. Thus, for example, it is difficult to stay upright, you lose your balance easily, and you have a feeling of dizziness, vertigo or problems walking.

Muscular weakness

You feel weakness and lack of strength in one arm or leg. It is most likely to be on the arm and leg on the same side of the body at the same time. This sensation may be accompanied by numbness, tingling, and less sensitivity. This can also affect the face. In this case you can see the stiff face. It should not be confused with the tingling that is felt when an arm or a leg falls asleep after a while in poor posture.

He doesn't go to the hospital, they take you

It is essential that when the first symptoms are noticed, such as paralysis on one side of the face, weakness in a part of the body or speech problems, 112 is called without delay and the symptoms are described. In this way, the 'Stroke Code' will be activated and a health team will transfer the patient to a specialized stroke unit in record time, which is key to survival. This procedure is much more effective than going to the emergency room on our own feet.

While the ambulance arrives

Accommodate the sick person, loosen his clothes and leave space around him for him to breathe well. Make sure that he is lying on his side, with his head slightly raised to avoid choking if there is vomiting. If there is no one who can be with the patient, it is best to first accommodate him and then call 112. Do not give him liquids or food to avoid choking.

By the time you read this post, between one and two strokes will have occurred in Spain. It is estimated that every 14 minutes is given one.

What is a stroke

Also known as a stroke, embolism or cerebral hemorrhage, stroke is one of the most feared acute disorders. It is equivalent to a heart attack but in the brain, and it occurs when not enough blood reaches the head due to a blocked artery or a ruptured blood vessel.

The stroke, in Spain. Stroke is the second leading cause of death in Spain (the first in women, ahead of breast cancer), the leading cause of acquired disability in adults and the second of dementia. According to data from the Spanish Neurology Society (SEN), each year 110,000-120,000 people suffer a stroke in our country, of which 50% are left with disabling sequelae or die. Specifically, more than 16,000 women die each year from a cerebral stroke. Currently more than 330,000 Spaniards have some limitation in their functional capacity due to having suffered a stroke. 90% of stroke cases could be prevented with adequate prevention of risk factors and a healthy lifestyle.

8 symptoms to identify a stroke

Symptoms of a stroke or embolism begin to appear about 10 seconds after the blood supply to the brain is disturbed. Although they are sometimes difficult to identify or relate to a stroke, because they can be confused with other ailments such as migraine, knowing them will help us react quickly.

Muscular weakness. You feel weakness and lack of strength in one arm or leg. It is very likely to be on the arm and leg on the same side of the body at the same time. This sensation may be accompanied by numbness, tingling, and less sensitivity. This can also affect the face. In this case, the stiff face is noticeable. It should not be confused with the tingling that is felt when an arm or a leg falls asleep after a while in poor posture.
Sudden loss of vision The affected person may see blurry, double, or may even lose vision in one or both eyes for a few moments. This symptom can also be due to other causes, such as a migraine with aura. In any case, if you lose vision (in one eye or both), even temporarily, you should go to the emergency room as soon as possible.
Hearing, smell, taste problems. Stroke can also cause other senses such as smell, taste or hearing to be temporarily affected. In the case of touch, a certain tingling may be felt.
Suddenly, memory fails. A sudden memory loss should also put you on your guard. This type of amnesia has nothing to do with memory losses that occur with age, but will generally be accompanied by a general feeling of great mental confusion.
Difficulty speaking If suddenly the affected person cannot speak or does so using the wrong words or nothing she says is understood, it may be a sign of a stroke. It may also be that you do not understand what is being said.
Coordination problems. When the heart attack occurs, there is difficulty coordinating movements. Thus, for example, it is difficult to stay upright, you lose your balance easily and you have a feeling of dizziness, vertigo or problems walking. In fact, one of the possible causes of dizziness when getting up is stroke.
Temporary loss of consciousness. Sometimes, stroke can be accompanied by fainting, but without the other symptoms described, it would be difficult to relate fainting to cerebral infarction.
A sudden headache. By not receiving blood or oxygen, the brain may complain of a very severe headache with no apparent cause. You should ask for help if the pain is very intense, you have difficulty moving a part of the body, nausea, vomiting or drowsiness.

Do you doubt the symptoms? Take this test to find out if it is stroke

If you still have doubts, with these four simple checks you can quickly know if the symptoms that a person presents are really of a stroke.

Let him raise his arms. Ask him to extend his arms in front. You should be especially suspicious if you can't lift one of your arms or if one is lower than the other. If one of the arms falls down, it is a very clear symptom.
Make him smile. An asymmetrical smile is a symptom of stroke. If when asked to smile, you cannot move your lip or only raise one side of your mouth, that is also indicative.
Tell him to repeat a phrase. Choose a very simple and consistent phrase. For example, "Today is a good day." If you find it difficult to repeat it, it is time to act.
Ask him where he is. Ask him something as easy as if he knows where he is or what year. If you can't answer, it could also be a stroke.

Activate the stroke code

If everything we have told you makes you suspect that it is a stroke, even if you still have some doubts, do not wait and raise the alarm. It is always better to make the call and then have the doctors rule out the embolism, than not to call and have to regret it later.

How to activate the Ictus Code. Call the emergency room immediately (the phone number is 112) and describe the symptoms. If the healthcare professional you are speaking with considers that there is a risk of stroke, they will activate the Stroke Code, an internal alert system that allows the hospital to be notified immediately of what is happening. Thus, the patient can be transferred to a specialized stroke unit and the neurologist will attend to him in record time, which is key to his survival.

He doesn't go to the hospital, they take you

Speed is everything. If the stroke is not caught in time it can be fatal or cause damage that leaves serious sequelae, such as paralysis, speech disorders, cognitive deficits … But if you act quickly, they can be completely or largely avoided. In the last 10 years the prognosis of stroke has changed and it has become a treatable disease. But we insist, this requires fast action and specialized attention, and timely activation of the Stroke Code is the best way to achieve this. Think that according to data from the Spanish Neurology Society (SEN), early treatment could save the lives of more than 6,000 people a year. And to give you an idea of the importance of acting quickly, see what happens depending on how quickly you get to the hospital:

If you get to the hospital before 4 hours. It is possible that there are no sequelae, although it will depend on the intensity of the attack, the affected area in the brain and the type of stroke.
If you arrive after 4 hours. Brain damage can be serious and difficult to resolve with drugs. But the option remains of introducing a catheter through the right femoral artery (in the groin) and making it reach the brain to undo the thrombus.
Beyond 8 hours. Treatment to unclog the brain from the groin can only be applied up to 8 hours after symptoms start. Thereafter brain damage is likely to be irreversible.

What to do while the ambulance arrives

Accommodate the sick. While help arrives, loosen the patient's clothes and leave space around her for her to breathe well. Make sure that he is lying down and comfortable, either in bed, on a sofa or - if there is no other choice - on the floor, to prevent him from falling. It is best to lie on your side, with your head slightly raised on a pillow to avoid choking if vomiting occurs. If there is no one who can be with the patient while another person calls the ER, it is best that you first accommodate him and then call 112.
Do not give him liquids or food. To prevent the person suffering from a stroke from choking or having trouble breathing, do not feed or drink.

What will happen in the hospital?

Once in the ER, a whole medical protocol is implemented to treat the patient, which usually consists of the following:

Initial check. When the patient arrives at the hospital, a rapid examination is carried out and if the suspicion that it is a stroke is confirmed, a brain CT scan will be performed. This imaging test is the one that will confirm if there has been damage in any area of the brain.

If the tests are positive, the stroke is treated quickly to avoid possible sequelae.

Types of stroke and their treatment

The stroke can be ischemic or hemorrhagic. Accordingly, you will receive one treatment or another.

If it is ischemic, that is, if it has been produced by a significant decrease in blood flow that a part of our brain receives, the most urgent thing is to restore blood flow to the affected area as soon as possible. To treat it, drugs are usually administered to dissolve the clot or use other techniques that allow the vein or artery to be opened more and to restore the blood supply.
Hemorrhagic stroke is caused by the rupture of a cerebral vessel, an urgent surgical intervention may be required to repair the damaged artery and contain the hemorrhage. They are less frequent, but their mortality is considerably higher.

After discharge. Pharmacological treatment with antiplatelet drugs, antihypertensives and statins is usually administered to avoid another crisis. Also, if there are sequelae, the patient may need to undergo rehabilitation to recover.

What are the aftermath of a stroke

Ischemic stroke, which is the most common since it represents 85% of cases, is the third cause of mortality in Spain. In addition, among the survivors, 48% have some type of sequela: mobility problems, language problems, cognitive impairment, etc.

Hemorrhagic stroke is less frequent but has a better prognosis, since it usually causes fewer sequelae, according to the Group of Cerebrovascular Diseases of the Spanish Society of Neurology.

What are the causes of an ischemic stroke

Arteriosclerosis. When the fats that circulate in the blood are deposited inside the arteries, the internal diameter of the arteries is reduced, which makes it difficult for the blood to circulate. If, in addition, that plaque accumulates platelets, it can give rise to a thrombus that obstructs blood circulation and leaves vital organs without oxygen. Cerebral strokes are caused by the thrombus stopping the blood supply to an artery in the brain.
Atrial fibrillation This arrhythmia is responsible for about 35% of all strokes.
Alterations in the heart. Dilatation of the heart chambers or valves can cause blood clots (thrombi) within the heart that then travel to the brain.
Trauma A blow can cause the wall of an artery to rupture, generate clots that can travel to the brain and cause a stroke. The rupture may be spontaneous, but it is most common as a result of trauma
Cerebral venous thrombosis. Although most strokes are due to an occlusion of an artery, they can also be caused by a vein.

What are the causes of a hemorrhagic stroke

Hypertension. High blood pressure may be the source of a brain hemorrhage.
Cerebral amyloid angiopathy. When the beta-amyloid protein accumulates in the cerebral arteries, it can not only lead to degenerative diseases such as Alzheimer's, but also cause brain hemorrhages.
Breakage of abnormal blood vessels. It is another cause of hemorrhagic stroke.

Risk factor's

Age. The incidence of stroke is higher after 55 years of age, but… Cases under the age of 55, which a few years ago were the exception and only occurred in relation to congenital diseases, have increased the cases in the range of 35 to 55 years due to obesity, tobacco, high cholesterol, sedentary lifestyle, stress, or hypertension. Age also explains why women suffer more strokes, since we live longer than men on average. As Dr. Gállego explains, “age is the main non-modifiable risk factor for stroke, so an increase in stroke is expected. incidence and prevalence of this disease in the coming years and, especially in Spain, which will have, according to the WHO, the oldest population in Europe in 2040 ”.
To be a woman. Stroke is the leading cause of death in women, ahead of breast cancer, and is more common after menopause, when we are less protected by the action of female hormones. This is so among other things because we suffer more hypertension, one of the main risk factors for stroke. We also have more atrial fibrillation, a type of arrhythmia that multiplies the risk of cerebral infarction by 5. In addition, after menopause, the levels of female hormones that protect against stroke decrease.
Take oral contraceptives. Taking oral contraceptives may slightly increase your risk of having a stroke. But if contraceptives are associated with smoking, then the risk skyrockets and more in women over 35 years.
Having a family history of stroke. If you have family members who have a stroke or cerebrovascular disease, you have a higher risk of suffering a stroke. If the relative is the father, the risk of suffering a stroke is multiplied by 2.4. And if it is the mother, 1.4.
Smoke. Smoking is one of the main risk factors for stroke. Why? Well, because tobacco causes fatty substances to accumulate in the carotid, which makes it difficult for blood to reach the brain. Also, nicotine causes hypertension. Carbon monoxide in cigarettes decreases the amount of oxygen that reaches the brain. Also, tobacco smoke thickens the blood and makes it clot more easily. In addition, it weakens the walls of the blood vessels in the brain and there is a greater risk of them breaking. The good news is that after 5 years of quitting, the risk of a former smoker is the same as a non-smoker.
Have a migraine People with migraine and especially if they have aura have a higher risk of stroke. And if they are women who in addition to suffering from migraines take contraceptives, the risk is even higher. If you doubt about what headache you have and what to take to take it, do not miss this article.
Do you snore? If, in addition to snoring, you stop breathing for a few seconds, that is, you suffer from sleep apnea, your risk of suffering an ischemic stroke multiplies by 2.5%. Many times the treatment consists of losing weight, although other times it is even necessary to get to the operation. Here we tell you how to avoid snoring.
Sedentary lifestyle. The heart needs exercise to be healthy. Sport helps prevent arteriosclerosis, keep weight at bay (obesity is another risk factor), improve blood pressure figures, etc.
Obesity. The extra kilos also predispose you to suffer a stroke. According to a study by the Hospital del Mar in Barcelona published in the European Journal of Neurology, abdominal obesity increases the risk of stroke, especially in women. If you have weight problems and you want to know which is the best diet for you, don't miss our test.
Diabetes. When blood sugar is high, blood vessels in the brain (and throughout the body) are damaged. In addition, if you have high glucose levels when you have a stroke, the damage is usually more serious.
High tension. It can be behind an ischemic stroke as well as a hemorrhagic one. In the first case because it is related to arteriosclerosis and this causes a thrombus to trigger the stroke. On the other hand, hypertension also affects the blood vessels, and may be the cause of cerebral hemorrhage.
High cholesterol. Cholesterol sticks to the inside walls of the blood vessels (arteriosclerosis) and this puts a higher risk of a thrombus causing a stroke.

What to do to try to prevent a stroke

Your lifestyle greatly influences your risk of having a stroke. In fact, it is estimated that up to 80% of cases could be prevented just by making a few small changes in your habits.

Take whole grain cereals. Cereals and derived products are usually refined, an industrial process that removes much of the fiber, vitamins and minerals. Eating whole grain products has been shown to be associated with a lower risk of stroke in women.
Include vegetables. Taking 5 servings of fruit and vegetables protects the arteries from deterioration thanks to the antioxidants they contain, thus preventing strokes. Cruciferous vegetables (broccoli, cauliflower, cabbage, turnip and watercress, among others), green leafy vegetables and citrus fruits are the ones that seem to be most beneficial.
Exercise. Exercise prevents arteriosclerosis and speeds recovery from stroke. Walking more than 2 hours a week will reduce your risk by about 40%, says a recent American study.
Have coffee and tea. Drinking 1 cup of coffee a day and 2 of green tea reduces the risk of brain hemorrhage by 32% because it helps prevent blood clots.

Habits that increase the risk of having a stroke

Overdoing the salt. Having high blood pressure can increase the risk of having a stroke up to 5 times. If this factor were controlled, deaths from stroke could be reduced by almost half. Eat foods low in sodium and limit the use of salt in cooking as much as possible.
Too many sweets. In terms of stroke, having diabetes is the equivalent of aging 15 years. To prevent it, try to stay close to your ideal weight and try to limit refined (sweet) sugars.
Many fats. Bad cholesterol increases the risk of stroke. Limit foods that provide bad cholesterol such as red meat or whole dairy and increase that of blue fish, flax seeds or olive oil, which raise the good.
The alcohol. Limiting alcohol removes the risk of stroke. Alcohol, as well as tobacco, causes hypertension and alterations in blood clotting.
Smoke. Tobacco favors the accumulation of fatty substances in the carotid, which makes it difficult for blood to reach the brain. In addition, nicotine increases blood pressure, carbon monoxide from cigarettes reduces the amount of oxygen reaching the brain, and tobacco smoke thickens the blood and makes it more prone to clotting. No more reasons are needed to quit.

With the advice of:

Doctor Jaime Gállego Culleré. Coordinator of the SEN Cerebrovascular Diseases Study Group.