What are the symptoms of a stroke and which parts of the brain are affected?

From the Guidelines

Stroke symptoms include sudden numbness or weakness in the face, arm, or leg (especially on one side of the body), confusion, trouble speaking or understanding speech, vision problems, dizziness, loss of balance, and severe headache with no known cause. These symptoms occur when blood flow to the brain is interrupted, affecting specific brain regions depending on which blood vessels are blocked or ruptured 1. A stroke in the left hemisphere typically causes right-sided weakness and speech problems, while right hemisphere strokes cause left-sided weakness and spatial awareness issues. Brainstem strokes can affect basic functions like breathing and consciousness, while cerebellar strokes impact coordination and balance. The frontal lobe controls movement and personality, the parietal lobe processes sensory information, the temporal lobe manages hearing and memory, and the occipital lobe handles vision.

The severity and specific symptoms depend on the location and extent of brain tissue damage. Recognizing these symptoms quickly is crucial, as immediate medical attention within 3-4.5 hours can allow for treatments like tissue plasminogen activator (tPA) that dissolve clots and minimize brain damage 1. Some key points to remember when identifying stroke symptoms include:

• Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause Remember the acronym FAST: Face drooping, Arm weakness, Speech difficulties, Time to call emergency services 1.

It is essential to note that community and professional education is crucial in improving stroke recognition and early EMS activation 1. Patients at high risk for stroke, their family members, and BLS providers should learn to recognize the signs and symptoms of stroke and to call EMS as soon as any signs of stroke are present 1. EMS dispatchers should be trained to suspect stroke and rapidly dispatch emergency responders, and EMS personnel should be able to perform an out-of-hospital stroke assessment and establish the time of symptom onset when possible 1.

In terms of management, supplementary oxygen should be administered to hypoxemic stroke patients, and hypertension intervention should not be initiated in the prehospital environment unless the patient is hypotensive 1. The assessment of stroke using stroke scales and the management of stroke is included in Part 11: “Adult Stroke” 1. Overall, prompt recognition and treatment of stroke symptoms are critical in minimizing brain damage and improving outcomes 1.

From the Research

Symptoms of Stroke

• Sudden weakness or numbness in the face, arm, or leg on one side of the body 2, 3, 4
• Sudden confusion, trouble speaking or understanding speech 2, 3, 4
• Sudden trouble seeing in one or both eyes 2, 3, 4
• Sudden severe headache with no known cause 2, 3, 4
• Sudden trouble walking, dizziness, loss of balance or coordination 2, 3, 4

Parts of the Brain Affected

• The brain's blood vessels can become blocked or ruptured, leading to a stroke 2, 3, 4
• The areas of the brain affected by a stroke depend on the location and severity of the blockage or rupture 2, 3, 4
• Common areas affected include the cerebral cortex, basal ganglia, and brainstem 5, 6
• The posterior cerebral artery can also be affected, leading to acute isolated posterior cerebral artery occlusion 5

Treatment and Management

• Mechanical thrombectomy and intravenous alteplase are common treatments for acute ischemic stroke 2, 3, 5, 6
• Tenecteplase is a genetically engineered variant of alteplase that has shown promise in treating acute ischemic stroke 4, 6
• The choice of treatment depends on the location and severity of the stroke, as well as the patient's overall health 2, 3, 5, 6