The dangerous stroke symptoms everyone ignores


John Foxx | Stockbyte | Thinkstock

Auntie Jo has news for everybody: Most people who have strokes, whether transient ischemic attacks (TIAs, where the blood flow to a part of your brain is restricted temporarily) or non-transient ones, ignore the symptoms, hoping they’ll go away.

This is bad for a couple of reasons: First, you never know when the symptoms are going to worsen from inconvenient to life-threatening; second, if you show up at an emergency room with a stroke early enough, we can prevent a lot of permanent damage.

So: If you have weird symptoms including (but not limited to) weakness or numbness on one side of the body, difficulty balancing, vision or speech changes, or anything that just doesn’t feel right, call 911.

Don’t go to bed and sleep it off; don’t drive yourself to the ED (geez m’knees). Don’t have a shot of Beam and hope it goes away, don’t take six aspirin and call your doctor for an appointment next week. Got it? Good.

When you do show up at the ED, you’re probably wondering what we’re going to do to you. Listen up and be enlightened so things won’t seem so scary:

Once you describe your symptoms to the triage nurse, he or she will (if she or he is in possession of a reasonable number of brains) get you back to the treatment area pretty quickly. You’ll have a neurological exam that tests, among other things, your ability to speak, move all your limbs, see things all over your field of vision and interpret situations.

You’ll have to have a head CT scan, I’m afraid. This is because those of us in the brain business want to know, sticklers that we are, whether or not you’re bleeding into your brain or have a clot in it. If your head CT doesn’t show anything exciting, we can assume that you’re not bleeding (’cause blood shows up like gangbusters on a CT) and can treat you for a presumed clot.

If you’ve presented to the ED soon enough (within three hours of the onset of symptoms in most places), we can start you on a clot-busting drug called TPA. It’s given IV in a drip and schlorps around your body for several hours, hopefully knocking out the clot that’s in your brain without doing any other damage. Yeah, there are risks, which usually involve unpleasant bleeding we don’t want, but it’s generally a case of less risk than potential benefit.

You might get an MRI as well, probably sooner rather than later, if you have any symptoms of bleeding or if things aren’t cut-and-dried.

You’ll also get, at some point, a couple of exams to be sure your heart is doing what it ought to. This is because one of the biggest causes of stroke is a clot that travels from the heart thanks to something called atrial fibrillation.

Atrial fibrillation (or “A-fib,” if you’re cool like me) is a condition in which the top half of the heart, rather than beating regularly, sits there and vibrates, wagga-wagga-wagga. This allows blood to pool in there and clot, and then, if and when your heart actually manages a good solid beat, those clots go flying up into your unhappy brain.

We would do an EKG to check the rhythm of your heart, as well as an echocardiogram. The latter is basically a sonogram of your heart that lets us know for sure that you don’t have any holes in your ticker or weird shunts or craziness like that.

All of this is necessary because neurology is primarily done by exclusion: We knock out all the things that could be wrong with you (like neurosyphilis, alien abduction or a bleed) and end up, we hope, with something that really is wrong with you. Incidentally, this is also how neurology differs from neurosurgery: Neurosurgeons have you hop up on the table so they can root around in that ol’ brain box and find something definite.

Anyway: If you’re not feeling normal, and it’s not a hangover, go to the bloody ED, okay? It’ll make both of our lives easier in the long run. It’ll also mean I haven’t wasted my valuable time by typing all this shizznit out.

This post originally appeared in The Head Nurse blog.

Agatha Lellis
Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at

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