4 subtle stroke warning signs that should never be ignored

A 63-year-old stroke survivor whose only symptom was an inability to read is urging others to be aware of less common warning signs of this potentially life-threatening medical emergency.

Gordon Robb had a bleed on his brain and suddenly found that words – including emails, text messages, and even the display on a cash machine – appeared to be written in a foreign language.

Specialists say that difficulty recognising written words on its own, without any other symptoms, occurs in fewer than 1% of people at the time of their stroke.

Now Mr Robb, who lives in Bonnyrigg in Midlothian, Scotland, is taking part in a new clinical trial funded by the British Heart Foundation and led by researchers at the University of Edinburgh, in hopes of preventing further strokes.

The study is investigating whether clopidogrel or aspirin – medications that reduce the risk of blood clotting – can help prevent future strokes, heart attacks, and early death in people who have experienced a haemorrhagic stroke. Mr Robb is receiving clopidogrel as part of the trial.

There are still many misunderstandings about strokes, so we spoke to Professor Deb Lowe, medical director at Stroke Association, to find out what actually causes a stroke, the subtle warning signs to look out for, and when it’s the right time to seek medical attention.

What causes a stroke?

“A stroke is caused by a sudden interruption to the blood supply to the brain, which is either due to a blockage in a blood vessel, called an ischaemic stroke, or due to bleeding in or around the brain, called a haemorrhagic stroke,” explains Lowe.

Around 85% of strokes in the UK are ischaemic strokes, according to Stroke Association.

What are the typical warning signs most people would associate with a stroke?

The FAST acronym (Face, Arms, Speech, Time) is a test to quickly identify the three most common signs of stroke, according to the Stroke Association website.

“There are some typical features that are identified in the majority of people, which includes drooping of the face, weakness of the arm and/or leg, or loss of sensation in one side of the body,” says Lowe.

Difficulty speaking is also very common and a major warning sign of a stroke.

“Either your speech can become slurred, or you can have something called word-finding difficulty, which means it’s hard to get your words out, or in some cases, you also lose the ability to understand what people are saying to you, as well as your ability to actually speak,” says Lowe.

What are some more subtle, less-commonly known signs to look out for?

1. Visual disturbances

Don’t ignore sudden blurred vision or loss of sight in one or both eyes.

“Sometimes people experience visual disturbances too and can lose visual fields, and can lose either all their right-side field of vision or all of their left-side field of vision,” says Lowe.

2. Dizziness or confusion

Sudden memory loss or confusion, sudden dizziness, unsteadiness or a sudden fall are also listed as other signs to take seriously.

“Some people also experience loss of balance, loss of coordination, and that can sometimes be associated with nausea, vomiting and dizziness,” says Lowe.

3. Struggling to read

“If a tiny specific bit of the brain is affected, it can take what we call ‘higher executive functioning’ away, which makes it difficult to read, count numbers, or use phones or computers normally,” says Lowe. “But it’s very unusual that this would happen just in isolation if it was a stroke, and there’s lots of other things that go on within our brains that can cause similar symptoms.”

4. Headache

A sudden, severe headache can be another sign of a stroke, according to the Stroke Association website.

How long do symptoms last?

Symptoms vary between different people but often come on suddenly.

“By definition, stroke has a very sudden onset, and if these symptoms come on suddenly and go relatively quickly (within a few minutes to an hour), that could be something called a TIA, which stands for transient ischaemic attack,” explains Lowe.

This is often referred to as a ‘mini stroke’, and according to the Stroke Association website this is still a medical emergency and a warning that you are at risk of having a stroke, so it’s still vital to call 999 and get urgent medical attention.

When should you seek medical attention?

“If you’ve not got any ongoing symptoms, but you’re just worried about some fleeting symptoms that you’ve had, you need to discuss it with your GP,” advises Lowe. “If you’ve got ongoing symptoms that are relatively minor, you can ring 111. However, if you’ve got sudden onset of facial weakness, speech disturbance, or are unable to move your arm or your leg, or have a sudden loss of sensation, that is a medical emergency and you need to ring 999 so that you can be seen and assessed in a hospital that is a stroke centre.

“We’ve got over 100 stroke centres across the country that have trained doctors, nurses and therapists there to make a stroke diagnosis as rapidly as possible, and it usually involves, after an initial assessment, a brain scan and then review by stroke specialist nurses and doctors.”

What can the consequences be if somebody does ignore the symptoms and doesn’t seek medical advice?

“Assuming that the symptoms are related to a blockage in a blood vessel or a leaking from a blood vessel, then if you don’t get quick medical attention, you lose the opportunity for either having rapid brain imaging to see what’s going on and a formal diagnosis,” says Lowe.

“Then you wouldn’t necessarily then have the opportunity to be started on medication to reduce the risk of it happening again, and also to receive the rehabilitation that you need if you’ve got ongoing symptoms. So essentially, time is brain and the sooner that a diagnosis can be made, the better.”