Am I Having a Stroke?

~ By Scott London, MD, Neurologist ~

Do I look alright? Is my face crooked? I feel so dizzy do I seem off balance? Why can’t you understand me when I speak?

Scott London, MD

Stroke symptoms are multiple and serious. In fact stroke, the interruption of normal blood flow to the brain, is the presentation of sudden neurologic deficits that can range in severity and duration. Recent advances in acute stroke intervention and treatment have made it imperative for patients’ families and care providers to identify stroke symptoms promptly and accurately. The challenge is being sure that the symptoms one is experiencing are really from a stroke. To answer that question one must consider a number of factors that are difficult to sort out. Often the individual having the cerebrovascular event is not aware of the ongoing neurologic problems (a non-dominant hemisphere stroke) or the symptoms may seem more associated with inner ear difficulties, such as spinning, vertigo, nausea, vomiting, and balance problems (a brainstem or cerebellar stroke). Correct stroke symptom identification lies in understanding that the symptoms experienced are signs of focal brain dysfunction. This means that the part of our brain experiencing oxygen deprivation will determine the symptoms and signs of neurologic abnormality. Given that our brains can do so many amazing things, it can be hard to be sure if certain neurologic symptoms represent a stroke or other problems (fatigue, anxiety, panic attack, migraine, seizure, blood pressure issue, or glucose abnormality).

According to the National Stroke Association, “Time is brain,” and we need to watch for the major stroke warning signs of SUDDEN Facial drooping, Arm weakness and Slurred speech, and then make Time to call 911 or so-called FAST.

When faced with a sudden change in neurologic function that lasts for more than 20-30 seconds and is outwardly obvious to yourself and/or others, it is time to call 911 and you will become a stroke alert patient, and the ambulance will transfer you to a state-of-art stroke center.

Presently, there are several State of the Art Stroke centers within the Denver metro area that will thoroughly evaluate your symptoms with neuroimaging such as Brain CT scan, CT arteriography of the critical blood vessels that flow to your brain, and MRI of the brain, which may also be used. These tests are performed to screen you for appropriateness of intravenous clot buster (tissue plasminogen activator or IV TPA). If a blood clot is seen within a major artery of the brain, further clot extraction intervention may be performed.

All of the above treatments only apply to non-hemorrhagic strokes or so-called ischemic strokes. The initial brain scanning determines whether the stroke occurring is ischemic or hemorrhagic. According to the American Stroke Association, ischemic strokes account for 87% of strokes. Hemorrhagic strokes happen when a weakened artery in the brain ruptures and occur 13% of the time and are excluded from the clot buster treatment.

Stroke is a common and a potentially devastating illness. Stroke represents the leading cause of disability and is the 5th leading cause of death in our society. SUDDEN onset neurologic symptoms need to be addressed and evaluated in a Stroke Center Emergency Department.