Can You Have a Stroke and Not Know It? Signs of a Silent Stroke

More than 795,000 people have a stroke each year in the United States. Regardless of whether a stroke is silent, minor or major, the factors that lead to it are generally the same.

A stroke occurs when blood flow to part of the brain is interrupted. Without oxygen-rich blood, brain cells begin to die within minutes, potentially causing permanent damage.

Devin Smith, MD, UnityPoint Health explains how mini and silent strokes differ from a regular stroke and how to tell if you've had a stroke without knowing.

Can You Have a Stroke and Not Know It?

Yes, you can have a stroke without noticeable symptoms. Known as a silent stroke, it can still cause permanent brain damage and increase your risk of future stroke events. Repeated silent strokes can lead to cumulative damage over time.

"If a stroke affects an area of the brain that doesn't control movement or speech, symptoms may be so subtle they're easy to miss," Dr. Smith says.

Some silent strokes have no noticeable symptoms; others cause subtle symptoms that are easily overlooked, such as:

• Brain fog
• Feeling wobbly or intoxicated
• Headache
• Memory problems
• Mood changes

Silent strokes often go undiagnosed, and brain tissue damage from a silent stroke is typically only found incidentally during an MRI or CT scan. So, it's hard to know just how common they are.

Can You Have a Stroke in Your Sleep?

Strokes can happen while you're asleep. Some people wake up with symptoms, while others don't realize one occurred until brain imaging later reveals evidence of a past event.

Warning Signs & Symptoms of a Mini Stroke

Dr. Smith says the term "mini stroke" is misleading. "It's not a precise medical diagnosis," Dr. Smith says. "The phrase is generally used by patients to describe a stroke with milder symptoms."

However, milder symptoms don't necessarily mean less damage. A stroke affecting a small but critical area of the brain, such as the region responsible for speech, can still have lasting effects.

The symptoms of a mini stroke and a regular stroke are similar. Remember the acronym B.E.F.A.S.T.

• Balance lost: Sudden loss of balance, coordination or dizziness
• Eyesight changes: Sudden loss of vision in one or both eyes
• Face drooping: One side of the face is drooping or looks uneven
• Arm weakness: Sudden arm or leg weakness or numbness
• Speech difficulty: Speech is slurred or mumbled
• Time to call 911: Call 911 immediately if you see any of these symptoms

A mild stroke may feel like sudden weakness, numbness, dizziness, vision changes or difficulty speaking. Many people only experience one of the BEFAST symptoms during a mild stroke, which makes it easy to dismiss.

What to Expect After a Mini Stroke

After a TIA or mini stroke, doctors often recommend additional testing to identify the cause and reduce the risk for another stroke.

The recovery process after any stroke depends on the type, symptoms, area of the brain affected and the impact to brain tissue.

To treat a stroke, you may receive Tenecteplase (TNK), a medication that breaks up the blockage. Some patients see improvement within a few hours.

Long-term treatments after a mini stroke may include:

• Diet changes
• Increasing physical activity
• Medications to control blood pressure, blood sugar or cholesterol
• Physical, occupational or speech therapy
• Smoking cessation

Transient Ischemic Attack (TIA) vs Stroke

Many people use the terms "TIA" and "mini stroke" interchangeably, although "mini stroke" isn't a formal medical term. A transient ischemic attack (TIA) occurs when blood flow to the brain is temporarily blocked. The symptoms are the same as a stroke, but blood flow is restored before significant brain damage occurs.

"A TIA is another version of a stroke," Dr. Smith says. "In the moment, a person can't tell the difference between a TIA and a stroke, so a TIA, or any stroke symptoms, are a medical emergency."

What Triggers a Transient Ischemic Attack (TIA)?

A TIA and stroke share many of the same risk factors:

• Diabetes
• Heart rhythm disorders like AFib
• High blood pressure
• High cholesterol
• Obesity
• Physical inactivity
• Smoking

Even though symptoms resolve, a TIA should never be ignored. It's often a warning sign that a more serious stroke could happen in the future. Risk for a second stroke is highest in the days and weeks after a TIA, so it's important to seek medical attention immediately.

How Can You Tell if You Had a Stroke?

In the emergency department, doctors perform a neurological physical exam. This may include questions about your symptoms and when they started. Doctors will look at your strength, sensation, coordination and ability to make different facial expressions.

The most reliable way to tell if you had a stroke is through CT or MRI brain imaging. MRI is often better at detecting small or silent strokes that may not be obvious on a CT scan.

If you experience stroke symptoms, call 911 and get to an emergency department as soon as possible.

How to Tell the Difference Between a Stroke and Other Conditions

Some conditions mimic stroke symptoms, such as:

• Bell's Palsy
• Complex migraines
• Drug or alcohol intoxication
• Low blood sugar
• Seizures

Because several conditions can closely resemble a stroke, it's not always possible to tell what's causing symptoms on your own. Dr. Smith says a medical exam and brain imaging may be necessary to determine the cause

"Any new, sudden neurological symptoms should be treated as a possible stroke until a doctor determines otherwise," Dr. Smith says.

When to See a Doctor

Stroke symptoms are a medical emergency.

If symptoms are caused by another issue, doctors can evaluate your symptoms and provide appropriate education on stroke symptoms.

"No one will be upset with you if you come in, and it's not a stroke," Dr. Smith says. "Calling 911 is always the right thing to do." Talk with your doctor about understanding your risk of stroke.

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