What Does a Stroke Look Like?

I've lost my 55-year-old father and an elderly aunt to strokes. A cousin was seriously disabled by a stroke in early middle age and never regained her health and independence. Because of my family history, I take strokes seriously. I know firsthand how devastating they can be to both the individual who suffers the stroke and those who are left behind to pick up the pieces.

What is a stroke? It is a brain event in which the blood supply is either interrupted or a blood vessel bursts. In either case, the result is brain cells dying because they are not receiving oxygen and other nutrients or because of the bleeding. There are two types of stroke. An ischemic stroke is caused by a clot in a blood vessel supplying the brain; a hemorrhagic stroke is caused by bleeding in or around the brain. Symptoms vary, depending on the kind of stroke and the location of the clot or bleeding. For example, in an ischemic stroke, symptoms occur on the opposite side of the body from the clot. In a hemorrhagic stroke, there may be a severe headache, nausea, vomiting, neck stiffness, dizziness, seizures, behavior changes and sometimes unconsciousness.

Another point to keep in mind is that a stroke may occur slowly, over a period of minutes to days with progressive symptoms, or, in the case of a large blood vessel blockage or bleeding, it may happen in seconds.

Strokes have a genetic component, but bad habits like smoking and medical conditions like atherosclerosis, hypertension, diabetes and atrial fibrillation (a heart arrhythmia) make them more likely to occur. They can happen at virtually any age, and if they don't kill you, they can cause severe disability that will force you to become dependent on medical assistance for the rest of your life. You may end up paralyzed or weakened on one side of the body (hemiplegia or hemiparesis) and lose the ability to think clearly or remember events. You may not be able to speak or understand the speech of others. Your emotional control may be lost, your behavior may change radically, and you may become deeply depressed. Other physical damage from stroke includes permanent numbness and pain in the extremities and loss of balance. And once you've had a stroke, you're more at risk for others. A stroke is quite literally a life-changing event. For all these reasons, it's important to recognize the signs that a stroke may be imminent.

According to the American Stroke Association, there are six warning signs of stroke, but not all of them occur in every stroke:

• Sudden numbness, weakness or paralysis 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 (blurring, double vision, loss of vision)

• Sudden trouble walking, dizziness, loss of balance or coordination

• Sudden, severe headache with no known cause

In addition, smaller strokes, also called silent strokes, whispering strokes, or transient ischemic attacks, can presage a major stroke and cause subtle mental and physical impairments that may not be recognized as stroke-induced. As many as 20 percent of people older than 45 may have whispering stroke symptoms, according to a report in "Stroke: Journal of the American Heart Association". And people who have had one stroke are at greater risk for additional strokes. One of the unfortunate results of repeated small strokes is multi-infarct dementia, a form of brain damage that causes permanent intellectual impairment.

For all the reasons cited above, please make sure you're prepared for a stroke in yourself, a family member or friend. If any of the above warning signs of stroke should occur, you can either call 9-1-1 or the local EMS (emergency medical service) number for an ambulance and life support services. Research hospitals in your area that may specialize in stroke treatment. And try to note when the first warning signs of the stroke began, because the time of onset and duration of the stroke are important pieces of the puzzle in stroke treatment.