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How does someone act before a stroke?

A stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. This can cause brain cells to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can minimize brain damage and potential complications. Knowing the warning signs of an impending stroke and acting quickly to get medical attention can significantly improve the chances of survival and recovery.

Some of the most common signs and symptoms that may precede a stroke include:


Sudden loss of strength or numbness in the face, arm, or leg, even if temporary, is a strong indicator of a stroke as it signifies a disruption in blood flow to a region of the brain. Other warning signs include weakness on one side of the body, being unable to raise both arms and keep them there due to arm drift or leg weakness and balance problems. If someone cannot smile evenly or their smile is crooked, this may be an early sign. Difficulty walking, loss of coordination, and decreased grip strength may also occur.

Trouble Speaking

Speech problems and trouble communicating can manifest as slurred speech and language. The person may be unable to get words out or garble sentences, or they may have trouble understanding speech. Additional symptoms are inability to repeat simple phrases, confusion putting words together or understanding what others are saying and extreme confusion.

Vision Problems

Vision loss, double vision or decreased vision in one or both eyes, or dimness or blacking out of vision can be experienced as retinal cells die and interrupt signals to the brain. Vision can appear blurry or movement can look jerky.


Serious, unusual, or sudden headaches which feel different from other headaches can be a warning sign, especially if accompanied by other symptoms. A throbbing or extremely intense headache or headache that does not subside with medication should be checked urgently.


Dizziness or loss of balance and coordination or the sense that the room is spinning can indicate reduced blood flow. Trouble walking, feelings of being lightheaded, woozy, or unsteady may occur.

Altered consciousness

A person may experience confusion, disorientation or inability to focus or pay attention. Unresponsiveness or lack of alertness may also indicate stroke. Mental status changes like amnesia, memory loss, or delirium point to brain injury.

Weak face muscles

Ask the person to smile, and see if one side droops. Uneven facial expressions and a crooked smile that seems asymmetrical can be early warning signs. One eyelid or side of the mouth may droop when smiles or grimaces. Paralysis, numbness and muscle weakness on one side of the face signals a stroke.

Behavior changes

Mood swings, agitation, irritation, or acting confused, territorial, or combative may indicate an impending stroke. A person may seem depressed or frightened. Acting in a distorted or strange manner unlike themselves can also point to changes in brain function before a stroke.

Trouble swallowing

Difficulty swallowing, chocking, or drooling when eating or drinking may be signs of an impending stroke. Damage to nerves and muscles involved in swallowing indicates a disruption in brain signaling.

Loss of coordination

Sudden clumsiness and trouble buttoning clothes or making precise hand movements are warning signs. Losing control when reaching for things or walking indicates motor and balance control issues related to stroke risk.


Numbness or decreased sensation anywhere in the body can indicate nerve damage from reduced blood flow. Numbness may begin gradually or suddenly on one side of the body or face. Tingling and “pins and needles” sensations are also stroke red flags.

Unusual fatigue

Excessive tiredness and sudden lethargy with no other health concerns may signify an underlying neurological problem like a stroke. Being constantly fatigued or too exhausted for regular activities points to emerging issues.

Common Risk Factors

There are some common risk factors and health conditions that increase a person’s likelihood of having a stroke. Being aware of these can help identify high-risk individuals and the need for emergency care.

High blood pressure

Hypertension or high blood pressure damages arteries, making them prone to fatty buildup (atherosclerosis) which can limit blood flow in the brain. High blood pressure is the most significant controllable risk factor for stroke.

Atrial fibrillation

This irregular heart rhythm allows pooling of blood in the heart, which can form clots and travel to the brain causing a stroke. Many people are unaware they have atrial fibrillation.


Poor blood sugar control and damage to blood vessels makes diabetics susceptible to stroke. High glucose levels affect circulation and may cause arterial blockages.


Smoking doubles the risk of stroke. Chemicals in tobacco smoke damage blood vessel walls. Smoking promotes atherosclerosis and increases risk of blood clots.

Excess weight

Being overweight strains the circulatory system. Obesity and belly fat increase the chance of arterial blockages. Losing weight reduces stroke risk.

Poor diet

An unhealthy diet high in fat, salt, and sugar leads to obesity, high blood pressure, diabetes – all stroke risk factors. A diet low in nutrients also elevates risk.

Cholesterol levels

High LDL and low HDL cholesterol indicates plaque buildup in arteries. High cholesterol increases chances of blockages that impair blood flow to the brain.

Excess alcohol

Drinking too much alcohol regularly raises blood pressure. Binge drinking can trigger atrial fibrillation. Both effects heighten stroke risk.

Physical inactivity

Lack of exercise is associated with stroke risks like obesity, high blood pressure, diabetes and heart disease. Being active improves circulation.

Ethnic background

African Americans, Hispanics, and Asians are at higher risk for stroke compared to Caucasians. Reasons are unclear but may involve higher rates of diabetes, hypertension and obesity.

Family history

If a parent, grandparent, or sibling had a stroke, chances increase of having one too since you may share genetic or lifestyle factors. African Americans with a family history have the highest risk.

Prior stroke

Someone who has already had a stroke is at greater risk of having another one. One-third of people who recover from a first stroke will have another stroke within 5 years if not treated properly.


Stroke risk is higher in men under 75 years old. Women face increased risk as they age due to pregnancy complications, migraines, atrial fibrillation, and hormone therapy.


After age 55, risk of stroke doubles every decade. The chance of stroke by age 65 is 1 in 6. After 85, risk is 1 in 2. Aging arteries and health conditions explain the increase.

When to Seek Emergency Help

At the first signs or symptoms of a stroke, emergency medical care should be sought immediately. Calling 911 or the local emergency number swiftly activates the medical response to get life-saving treatment as fast as possible. Timely intervention is critical, as stroke causes permanent brain damage within minutes. Reaching the hospital quickly improves outcomes.

The American Stroke Association uses the acronym F.A.S.T to promote stroke awareness and what to watch for:

Face Drooping – One side of the face droops or is numb. The smile is uneven.

Arm Weakness – Arms drift downward when raised. Weakness on one side of the body.

Speech Difficulty – Slurred speech, hard to understand, or confusion.

Time to call 911 – If any of these symptoms are present, even if temporary, immediately call 911.

Other warning signs requiring emergency care include sudden:

– Severe headaches with no known cause
– Dizziness or loss of balance and coordination
– Vision problems or loss
– Numbness or tingling
– Difficulty walking or standing
– Problems swallowing

When experiencing signs of a stroke, note the time the symptoms started. Paramedics will want to know when symptoms first began to determine treatment windows. While waiting for the ambulance, the person should rest comfortably and avoid moving around. If consciousness is altered, they should be placed on their side to avoid choking.

Diagnostic Tests and Evaluation

Doctors use a combination of tests and evaluations to diagnose a stroke, pinpoint the type and location, and guide treatment. They will work quickly to determine if a stroke occurred and the extent of injury to the brain.

Physical exam

The doctor will check for signs of stroke symptoms like weakness or numbness, trouble speaking, visual issues, balance and walking problems. They will evaluate the neurological exam to identify the region of the brain impacted.

Medical history

Information about the patient’s health, risk factors, and medications will help determine stroke probability and type. Family history of stroke will be noted.

Blood tests

Blood work can help rule out other medical events like low blood sugar or infections. Tests measure electrolytes, kidney function, blood cell counts and cholesterol levels.

Computed tomography (CT) scan

This uses X-rays and computer imaging to get cross-sectional views inside the head. It shows bleeds, blockages, brain tissue death and subsurface brain injuries.

Magnetic resonance imaging (MRI)

Powerful magnetic fields create detailed images of organs and tissue. MRIs can identify damaged brain areas and locate blockages in neck and brain arteries.

Carotid ultrasound

Sound waves produce images of the carotid arteries in the neck that supply blood to the brain. It detects clots, plaque buildup and narrowed arteries.

Cerebral angiogram

Contrast dye is injected into blood vessels to highlight arteries on X-ray images. Angiograms show aneurysms, blockages, narrowed spots and malformed arteries.


Ultrasound images look at the heart structure and function to identify sources of clots like thickened heart valves or atrial fibrillation.

Acute Stroke Treatment

Once a stroke is diagnosed, treatment starts immediately to restore blood flow and oxygen to the brain and prevent further loss of brain cells. The sooner treatment begins, the greater the chance of recovery with less permanent disability. There are two main emergency stroke treatments.

Tissue Plasminogen Activator (tPA)

This potent clot-busting drug must be given within 4.5 hours of stroke start. It dissolves the clot blocking the artery to restore blood flow to the brain region involved. Patients must arrive at the ER and receive tPA promptly for best results.

Endovascular thrombectomy

This clears big clots by threading a special catheter through the artery to grab and remove the clot blocking blood flow. This helps severe strokes and is done within 24 hours of symptoms. It restores blood supply to salvage threatened tissue.

Other therapies started urgently include:

– Medications to reduce swelling and pressure
– Surgery to remove blood from the brain or repair arteries
– Devices to remove clots from big arteries
– Controlling blood sugar levels
– Managing high blood pressure
– Preventing secondary strokes

The goal is to intervene quickly during the emergency window to prevent extensive permanent neurological damage.


After emergency stroke treatment, comprehensive rehabilitation helps patients regain abilities and function. Stroke rehabilitation aids the brain in developing new connections to recover lost skills. Services may include:

Physical therapy

Exercises improve strength, balance, coordination and mobility for movement and walking. Therapy helps restore activities of daily living.

Occupational therapy

Re-developing fine motor skills, visual perception, and cognitive skills allows patients to perform personal tasks like eating, bathing, dressing, and using the toilet or phone.

Speech therapy

For problems with language, reading, writing, and swallowing, speech therapists assist with improving communications and swallow function.

Psychological support

Behavioral assessments and mental health services help treat depression, anxiety and emotional regulation issues resulting from a stroke.

Support groups

Sharing experiences with other stroke survivors provides motivation and practical tips for coping with specific disabilities.

Nutritional counseling

Dietitians make dietary recommendations for optimal nutrition tailored to co-existing conditions like diabetes or hypertension. Healthy eating further aids recovery.

Starting rehabilitation as early as possible improves long-term outcomes and helps patients adjust to post-stroke disabilities. Ongoing rehabilitation and lifestyle changes are key to regaining independence and preventing subsequent strokes.


While some risk factors for stroke like age, gender and heredity cannot be changed, many can be managed to reduce stroke chances.

Monitor blood pressure

Check blood pressure regularly and work with your doctor to keep levels consistently below 140/90 or lower. Take blood pressure medications as directed.

Control cholesterol

Modifying diet and exercising helps raise good HDL and lower bad LDL cholesterol. Cholesterol-lowering medications like statins may be needed.

Lower blood sugar

People with diabetes should diligently monitor blood sugar and take medications that prevent spikes and drops.

Eat a balanced diet

Choose vegetables, fruits, whole grains, lean proteins, nuts, fish and healthy oils. Limit sodium, red meat, sweets, saturated fat and processed foods.

Exercise regularly

Get 2.5 to 5 hours per week of moderate activity like brisk walking. Daily exercise strengthens the heart and circulation.

Avoid smoking and limit alcohol

Smoking cessation programs and support groups can help quit smoking. Heavy drinking should be reduced to moderate intake.

Maintain healthy weight

Work towards BMI in ideal range through diet changes and activity. Consult a nutritionist or doctor for weight loss advice.

Treat atrial fibrillation

Medications can regulate heart rhythm. Blood thinners prevent clots that cause strokes. Procedures may correct abnormal heartbeats.

Know your risk factors

Discuss your risk profile and screening tests appropriate for age and health conditions with your doctor. Being aware of susceptibility allows prevention.


Stroke can substantially impact quality of life, so knowing signs of an impending stroke and seeking urgent care promptly are critical steps for reducing permanent effects. Controlling modifiable risk factors lessens the likelihood of having a stroke. Rehabilitation and lifestyle changes optimize recovery in stroke patients. While strokes can be life-threatening events, many people survive strokes and regain functioning through comprehensive treatment, therapy and prevention measures.