Samantha Ballas, of Syracuse, is a fourth-year medical student at SUNY Upstate Medical University in the Rural Scholars Program. She is a NYSARH Research and Policy Fellow in the 2025 cohort. She is interested in neurology, rural medicine, health equity and legislative advocacy.
A woman comes to the emergency department after experiencing some difficulty reading and driving. She was college-educated, had been driving for many years, and suddenly couldn’t easily drive or read. What happened here? While it wasn’t obvious to her or her family, she had had a stroke. Stokes can present with a very broad set of symptoms, everything from vision loss to forgetting the left side of your body. As someone who has seen many strokes, as a fourth-year medical student pursuing neurology, the symptoms are not always obvious but they all need evaluation and a workup.
Many people have heard of FAST, the mnemonic for stroke care. FAST stands for Face (does one side of the face droop?), Arms (does one arm drift downward when held up?), Speech (is their speech slurred or strange?) and Time (if experiencing these signs, time to call 911). However, FAST doesn’t always capture all the signs of a stroke. Other stroke symptoms may be present that are important to look for to make sure you and your loved ones can get critical care.
Strokes are a common condition that affect millions of Americans each year. Older adults with other health conditions are most at risk, but anyone can have a stroke — even young, healthy adults. There are two types of strokes: hemorrhagic and ischemic. Hemorrhagic strokes occur when a blood vessel breaks or leaks into the brain or in the space around the brain. Ischemic strokes happen when a blood clot clogs an artery — a blood vessel — in the brain. This stops blood flow and causes damage to the brain tissue. Ischemic strokes are more common.
In a hemorrhagic stroke, the person may experience the worst headache of their life and various other symptoms, such as changes in vision, weakness, or nausea and vomiting. The headache is often sudden and severe. It will continue to get worse as time goes on because there is bleeding in the brain.
Ischemic strokes present differently depending on the blockage in the brain. Signs of a stroke may include sudden confusion, such as a person not knowing where they are or what is going on; sudden trouble speaking or understanding speech, including slurred speech or jumbled language; or a sudden headache, which can be severe and is often without other cause. Some strokes may cause trouble walking or loss of balance, which may look like someone who is unsteady on their feet, falling or leaning to one side. Some people report numbness and weakness, often only on one side. This may feel like a funny feeling you cannot describe, or pins and needles, like your limb is asleep. Some strokes cause vision changes, such as a sudden loss of vision in the middle of what you are looking at, one whole side or even a spot in the middle of their vision. The National Heart, Lung, and Blood Institute website has even more symptoms.
These changes may be slight or subtle, but they will start out of the blue. If the symptoms go away, you may be experiencing a transient ischemic attack — also known as a mini-stroke — and you should still seek medical attention. Any sudden change in how someone acts, thinks, feels, speaks or moves should be evaluated. Sudden changes are not normal.
People may miss stroke symptoms because they are expecting a major change or a specific change. However, even if a change in your ability to think or perform tasks is subtle, is sudden or worsening, see a doctor as soon as possible.
Stroke care is time sensitive. The earlier your care starts, the better the outcome. The clot-busting medication for an ischemic stroke must be given within four and a half hours, and removing the clot with surgery must be done within 24 hours. The time starts when the symptoms start, not when you arrive at the hospital.
If you suspect you or a loved one are having a stroke, go straight to an emergency department. If you know there is a stroke center near you, go to that hospital. Urgent care and primary care offices will send you to ER if you are showing symptoms of a stroke. If you don’t seek medical attention, you risk not being able to receive the treatment you need and furthering brain damage. The brain is not like your skin. It has a limited ability to heal itself, which is why seeking care as soon as possible is vital.
If in doubt, get checked out. Time is brain!
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