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With a stroke, part of the brain is no longer supplied with enough blood, usually through a blood clot, more rarely through a bleed. Without oxygen, nerve cells die within minutes, and with them abilities such as speaking, moving or seeing are lost. Which function fails depends on which area of the brain is affected. Experts therefore say: time is brain. Any delay can make the difference between recovery and lasting disability. In hospital, a quick imaging, such as a computed tomography, clarifies whether a blocked vessel or a bleed is the cause, because the two are treated differently. Only within a narrow time window can a clot be dissolved with medication or removed with a catheter, which is why every minute gained also helps decide the later extent of disability. The earlier this happens, the more brain is preserved. That is exactly why the fast emergency call is so important and no waiting is justified. Studies show that with a stroke, millions of nerve cells are lost per minute without treatment, which is why even a few minutes can make a big difference.
Not every one-sided weakness is a stroke, but this cannot be said for certain in the moment it happens. The following causes are possible and are often only reliably told apart in hospital or in further assessment. Important: this overview helps with understanding but never replaces the emergency number if the weakness occurs suddenly or you experience it for the first time. The differences listed are only clues and, in an emergency, not reliable enough to base a decision on.
| Feature | Stroke | Migraine with aura | Multiple sclerosis |
|---|---|---|---|
| Onset | Sudden, from one second to the next | Gradual over minutes | Slow over hours to days |
| Type of symptoms | Loss, that is weakness, numbness, speech problems | Often first wandering vision or sensory problems | Weakness, vision or sensory problems |
| Accompaniment | Often facial paralysis and speech problems | Usually headache afterwards | Depending on the lesion, often in relapses |
| Duration | Persists, is an emergency | Usually subsides in under an hour | Persists, partly recedes |
| Important | Always call the emergency number | Treat as a stroke the first time | Assess a first episode urgently |
Sometimes the symptoms recede on their own after minutes to hours, and everything seems to be fine again. That is no reason for relief, on the contrary. Behind it there is often a transient ischaemic attack, a temporary circulatory disturbance of the brain. It counts as an urgent warning sign, because in the days afterwards the risk of a severe stroke is greatly increased. Even if you feel well again, such an episode should be assessed immediately, so also via the emergency number. Many people underestimate this warning sign precisely because the symptoms recede, and thereby lose the chance to still prevent a looming severe stroke.
With a migraine with aura, temporary neurological symptoms can occur, in rare cases also a one-sided weakness, the hemiplegic migraine. Typically the symptoms spread slowly over minutes, often begin with vision problems and are followed by a headache. The symptoms frequently wander, for example gradually up the arm from a tingling in the hand. Nevertheless: at the first occurrence this cannot be reliably separated from a stroke, especially if the headache is missing or the weakness is in the foreground. Read more in our article on migraine. Multiple sclerosis can also trigger a weakness or sensory disturbance, which usually develops more slowly and affects younger people more. Read more in our article on multiple sclerosis. Anyone who already knows they have migraine or MS often knows their typical symptoms, but should still be careful with new or unusual symptoms and act when in doubt.
If only one corner of the mouth droops and nothing else is abnormal, a benign facial palsy, the Bell's palsy, can also be present. One difference can help: with Bell's palsy usually the whole half of the face is affected, the forehead can no longer be wrinkled and the eye cannot be closed completely. With a stroke, by contrast, the forehead often stays movable, but arm or speech problems are added. This distinction is, however, difficult and unreliable for lay people, which is why here too the emergency number applies when in doubt. A Bell's palsy is usually harmless and often recedes on its own, but this reassuring finding may only be established after a medical examination, not by your own guess. Read more about the condition itself in our article on stroke.
Some people have a clearly increased risk of a stroke and should know the warning signs especially well. The most important risk factors include high blood pressure, atrial fibrillation, diabetes, high cholesterol, smoking, severe overweight and lack of exercise. Age also plays a role, and anyone who has already had a stroke or a temporary circulatory disturbance is especially at risk. The good news is that many of these factors can be influenced, which is why prevention is so effective and even small changes in everyday life are worthwhile. Anyone who regularly checks their blood pressure, exercises, does not smoke and takes prescribed medications reliably clearly lowers their risk.
Anyone who has survived a stroke or a precursor can do a lot to prevent another one. This is especially important because the risk of another event is increased after a first stroke. Medications play a central role: blood thinners reduce the danger of new clots, blood pressure and cholesterol lowering drugs fight the most important risk factors. These remedies, however, only work if they are taken reliably and permanently. Just as important are a well-controlled blood pressure, exercise, giving up smoking and a healthy diet. A known atrial fibrillation should also be treated consistently, as it favours clots. Many of those affected take several medications at the same time after a stroke, and precisely then it is important to keep an overview and not to forget any intake.
After a stroke, the reliable intake of medications decides the risk of another event. brite helps you manage your remedies, be reminded of the intake and forget nothing. Especially when several tablets are due at different times, this provides safety in everyday life.
The bottom line: with sudden one-sided weakness, hesitation is the biggest risk. Do not rely on it being harmless, but act as if it were a stroke, because that is exactly what saves life and health in an emergency. Afterwards you will never regret having acted quickly. The FAST test and the fast emergency call are the most important tools here. Other causes can be assessed calmly later, but a stroke cannot. Better to call the emergency number once too often than to miss a stroke, because no one will hold it against you if the suspicion is not confirmed.
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This article is for general information and does not replace medical advice, diagnosis or treatment. With sudden one-sided weakness, paralysis, facial paralysis, speech or vision problems, please call the emergency number immediately, even if the symptoms ease again.
