Stroke Symptoms and Signs

A stroke results from impaired oxygen delivery to brain cells via the bloodstream. According to the U.S. National Institute of Neurological
Disorders and Stroke, the five major signs of stroke are the sudden onset of:

1. Numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or
sensation may be complete or partial. There may also be an associated tingling sensation in the affected area.

2. Confusion, trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling.

3. Trouble seeing in one or both eyes

4. Trouble walking, dizziness, loss of balance or coordination

5. Severe headache with no known cause

Reference: U.S. National Institute of Neurological Disorders and Stroke

What is a stroke?

Brain cell function requires a constant delivery of oxygen and glucose from the bloodstream. A stroke, or
cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die.
Blood flow can be compromised by a variety of mechanisms.

Blockage of an artery

 Narrowing of the small arteries within the brain can cause a lacunar stroke, (lacune means "empty
space"). Blockage of a single arteriole can affect a tiny area of brain causing that tissue to die (infarct).

 Hardening of the arteries (atherosclerosis) leading to the brain. There are four major blood vessels that
supply the brain with blood. The anterior circulation of the brain that controls most motor  activity, sensation,
thought, speech, and emotion is supplied by the carotid arteries. The posterior circulation, which supplies the
brainstem and the cerebellum, controlling the automatic parts of brain function and coordination, is supplied by the
vertebrobasilar arteries.

If these arteries become narrow as a result of atherosclerosis, plaque or cholesterol, debris can break off and float
downstream, clogging the blood supply to a part of the brain. As opposed to lacunar strokes, larger parts of the brain
can lose blood supply, and this may produce more symptoms than a lacunar stroke.

 Embolism to the brain from the heart. In some instances blood clots can form within the heart and the
potential exists for them to break off and travel (embolize) to the arteries in the brain and cause a stroke.

Rupture of an artery (hemorrhage)

 Cerebral hemorrhage (bleeding within the brain substance). The most common reason to have bleeding
within the brain is uncontrolled high blood pressure. Other situations include aneurysms that leak or rupture or
arteriovenous malformations (AVM) in which there is an abnormal collection of blood vessels that are fragile and
can bleed.
 What causes a stroke?

Blockage of an artery

The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. The part of the
brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. As a result of the deprived
blood and oxygen, the cells of that part of the brain die and the part of the body that it controls stops working.
Typically, a cholesterol plaque in a small blood vessel within the brain that has gradually caused blood vessel
narrowing ruptures and starts the process of forming a small blood clot.

Risk factors for narrowed blood vessels in the brain are the same as those that cause narrowing blood vessels in the
heart and heart attack (myocardial infarction). These risk factors include:

 high blood pressure (hypertension),

 high cholesterol, 

 diabetes, and 

 smoking.

Embolic stroke

Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque (cholesterol and calcium
deposits on the wall of the inside of the heart or artery) breaks loose, travels through the bloodstream and lodges in
an artery in the brain. When blood flow stops, brain cells do not receive the oxygen and glucose they require to
function and a stroke occurs. This type of stroke is referred to as an embolic stroke. For example, a blood clot might
originally form in the heart chamber as a result of an irregular heart rhythm, such as occurs in atrial fibrillation.
Usually, these clots remain attached to the inner lining of the heart, but occasionally they can break off, travel through
the blood stream, form a plug (embolism) in a brain artery, and cause a stroke. An embolism can also originate in a
large artery (for example, the carotid artery, a major artery in the neck that supplies blood to the brain) and then travel
downstream to clog a small artery within the brain.

Cerebral hemorrhage

A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue.
A cerebral hemorrhage (bleeding in the brain) causes stroke symptoms by depriving blood and oxygen to parts of the
brain in a variety of ways. Blood flow is lost to some cells. As well, blood is very irritating and can cause swelling of
brain tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage increases pressure
within the skull and causes further damage by squeezing the brain against the bony skull further decreasing blood
flow to brain tissue and cells.

Subarachnoid hemorrhage

In a subarachnoid hemorrhage, blood accumulates in the space beneath the arachnoid membrane that lines the
brain. The blood originates from an abnormal blood vessel that leaks or ruptures. Often this is from an aneurysm (an
abnormal ballooning out of the wall of the vessel). Subarachnoid hemorrhages usually cause a sudden,
severe headache, nausea, vomiting, light intolerance, and a stiff neck. If not recognized and treated, major
neurological consequences, such as coma, and brain death may occur.

Vasculitis

Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed causing decreased
blood flow to brain tissue.

Migraine headache

There appears to be a very slight increased occurrence of stroke in people withmigraine headache. The mechanism