Symptoms and signs

Symptoms and Signs of Stroke

Stroke symptoms usually start unexpectedly, over seconds to minutes. In most cases, they do not progress further. The symptoms vary from the different areas of the brain affected. The more extensive the area of brain is affected, the more functions patients are likely to lose. Some of stroke may cause additional symptoms: the affected area may compress other structures in intracranial hemorrhage, for example. Most forms of stroke are presented without headache, but subarachnoid hemorrhage, cerebral venous thrombosis and occasionally intracerebral hemorrhage are exceptions.

Early recognition
All kinds of systems have been applied to increase recognition of stroke by patients, relatives and emergency first responders. A systematic review, which updated a previous systematic review from 1994, paid attention at a number of trials to evaluate how well distinctive physical examination findings are able to predict presence of stroke. It was noted that sudden-onset face weakness, arm drift, and abnormal speech are findings that most likely indicate the right recognition of a stroke; it added the likelihood ratio of 5.5. On the contrary, when all three above are absent, the likelihood of stroke is significantly decreased, and it minuses the likelihood ratio of 0.39. Even these findings are not very reliable for diagnosing stroke; they are still considered relatively rapidly and easily evaluated the stroke case especially in the acute ones.
The recommended systems include FAST, which means face, arm, speech, and time. It is advocated by the Department of Health in United Kingdom and The Stroke Association, the Los Angeles Prehospital Stroke Screen, shorted as LAPSS, and the Cincinnati Prehospital Stroke Scale, known as CPSS.
Early recognition of stroke is considered significant for people who referred to the emergency room, for this can expedite diagnostic tests and treatments. A scoring system called ROSIER, recognition of stroke in the emergency room, is recommended based on this purpose; and it is based on properties from the physical examination and medical history.

Subtypes
The following symptoms may appear if the area of the brain affected includes one of the three prominent central nervous system (CNS) pathways: the corticospinal tract, dorsal column (medial lemniscus), and spinothalamic tract:
* hemiplegia, muscle weakness of face
* numbness
* vibratory sensation or reduction in sensory
Usually, the symptoms affect only single side of the body, which is called unilateral. The defect in the brain is mostly on the opposite side of the body. However, any one of these symptoms above does not certainly suggest a stroke, for these pathways travel through the spinal cord as well and any lesion there can also lead to such symptoms.

Besides the above CNS pathways, the brainstem is also formed with the 12 cranial nerves. A stroke affecting the brain stem may lead symptoms relating to deficits in the cranial nerves:
* altered smell, hearing, taste, or vision, can be total or partial
* balance problems and nystagmus
* altered breathing and heart rate
* muscle weakness of the face and decreased sensation
* weakness of ocular muscles and drooping of eyelid
* decreased reflexes: swallow, gag, pupil reactivity to light
* weakness in tongue, inability to protrude and/or move from side to side
* weakness of the sternocleidomastoid muscle, inability to turn head to one side

If the cerebral cortex is affected, the CNS pathways can be involved again, and produce the following symptoms:
* memory deficits, involvement of temporal lobe
* hemineglect, involvement of parietal lobe
* hypersexual gestures, confusion, disorganized thinking, with involvement of frontal lobe
* anosognosia, persistent denial of the existence of a, usually stroke-related, deficit)
* aphasia, inability to understand or speak language from involvement of Broca’s or Wernicke’s area
* apraxia, altered voluntary movements
* visual field defect

If the cerebellum is get involved, the patient may have the following:
* vertigo and or disequilibrium
* trouble in walking
* altered movement coordination

Other associated symptoms includes:
Headache, loss of consciousness, and vomiting usually occurs more often in hemorrhagic stroke than in thrombosis. This is because of the increased intracranial pressure by the leaking blood compressing on the brain.

If symptoms are maximal at onset, the cause is more likely to be an embolic strokea or a subarachnoid hemorrhage.
Arcticle Source : http://bodycountry.com/stroke/2009/symptoms-and-signs-of-stroke.html

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