What are the symptoms of a stroke?

Symptoms of Stroke

The most common symptoms of stroke include sudden unilateral weakness (face, arm, and/or leg), speech/language disturbance, hemibody sensory symptoms, monocular vision loss, hemifield vision loss, binocular diplopia, dysarthria, dysphagia, and ataxia. 1

Primary Stroke Symptoms

High-Risk Symptoms

• Unilateral weakness affecting the face, arm, and/or leg (contralateral to the brain lesion) 1, 2
• Speech or language disturbance (aphasia, dysarthria) 1
• Visual disturbances (monocular vision loss, hemifield vision loss) 1
• Hemibody sensory symptoms 1
• Posterior circulation symptoms (binocular diplopia, dysarthria, dysphagia, ataxia) 1
• Sudden severe headache with no known cause (particularly with subarachnoid hemorrhage) 1

Symptom Patterns by Stroke Severity

• Major strokes typically present with multiple symptoms simultaneously (97.5% of cases) 3
• Minor strokes may present with only a single symptom (26.4% of cases) 3
• Transient ischemic attacks (TIAs) often present with isolated symptoms (58.9% of cases) 3

The FAST Acronym

The FAST acronym is recommended for public education to help recognize stroke symptoms and respond appropriately 1:

• Face: Facial droop or uneven smile 1
• Arm: Arm weakness or drift when both arms are raised 1
• Speech: Slurred speech, difficulty speaking, or trouble understanding 1
• Time: Time to call emergency services immediately 1

The FAST acronym captures 98.3% of major strokes but only 73.2% of minor strokes and 62.2% of TIAs 3. Adding visual symptoms and vertigo to FAST increases sensitivity for TIA/minor stroke from 66.4% to 86.1% 3.

Neuroanatomical Correlation

• Strokes typically cause contralateral weakness due to the crossing of the corticospinal tract in the medulla oblongata 2
• Right hemisphere strokes cause left-sided weakness and sensory deficits 2
• Left hemisphere strokes cause right-sided weakness and sensory deficits 2

Stroke Types and Specific Presentations

Ischemic Stroke (85% of strokes)

• Abrupt onset of focal neurological deficits 4
• Most commonly presents with speech disturbance and unilateral weakness 4
• May awaken with symptoms 4

Hemorrhagic Stroke (15% of strokes)

• Can present with similar focal deficits as ischemic stroke 5
• Often has more severe headache 5
• May have more rapid progression of symptoms 5

Subarachnoid Hemorrhage

• Typically presents with sudden onset of severe headache 4
• May have associated neck stiffness and photophobia 4

Importance of Rapid Recognition and Response

• Stroke is a medical emergency requiring immediate attention 1, 6
• Public education should emphasize that stroke is a medical emergency 1
• Patients should call emergency services (911) immediately when stroke symptoms occur, even if symptoms resolve 1
• Time-sensitive treatments can significantly improve outcomes if initiated promptly 7
• "Time is brain tissue" - delays result in progressive, irreversible loss of brain tissue 6

Common Stroke Mimics

• Seizure 4
• Conversion disorder 4
• Migraine headache 4
• Hypoglycemia 4

Proper history taking and diagnostic studies can usually exclude these stroke mimics 4.

Risk Stratification Based on Symptoms

Very High Risk (symptoms within 48 hours)

• Unilateral weakness (face, arm, and/or leg) 1
• Speech/language disturbance 1
• Other focal neurological symptoms 1

High Risk (symptoms between 48 hours and 2 weeks)

• Unilateral weakness or speech disturbance 1

Moderate Risk (symptoms between 48 hours and 2 weeks)

• Symptoms without motor weakness or speech disturbance 1

Lower Risk (symptoms more than 2 weeks ago)

• Any stroke symptoms occurring more than 2 weeks prior 1