Symptoms:

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not know that he or she has had a stroke.

Symptoms usually develop suddenly and without warning. Or, symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:

• Starts suddenly and may be severe
• Occurs when you are lying flat
• Wakes you up from sleep
• Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include:

• Change in alertness (including sleepiness, unconsciousness, and coma)
• Changes in hearing
• Changes in taste
• Changes that affect touch and the ability to feel pain, pressure, or different temperatures
• Clumsiness
• Confusion or loss of memory
• Difficulty swallowing
• Difficulty writing or reading
• Dizziness or abnormal feeling of movement (vertigo)
• Lack of control over the bladder or bowels
• Loss of balance
• Loss of coordination
• Muscle weakness in the face, arm, or leg (usually just on one side)
• Numbness or tingling on one side of the body
• Personality, mood, or emotional changes
• Problems with eyesight, including decreased vision, double vision, or total loss of vision
• Trouble speaking or understanding others who are speaking
• Trouble walking

Signs and tests:

A complete exam should be done. Your doctor will:

• Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
• Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.
• Check your blood pressure, which may be high.

Tests can help your doctor find the type, location, and cause of the stroke and rule out other disorders.

• Angiogram of the head can show which blood vessel is blocked or bleeding
• Carotid duplex (ultrasound) can show if the carotid arteries in your neck have narrowed
• CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards
• Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart
• Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain

Other tests include:

• Lab tests will include:
  • Bleeding time
  • Blood cholesterol and sugar
  • Blood clotting tests (prothrombin time or partial thromboplastin time)
  • Complete blood count (CBC)
• Electrocardiogram (ECG) and heart rhythm monitoring -- to show whether an irregular heartbeat (such as atrial fibrillation) caused the stroke