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Stroke : Symptoms
Western Medicine Chinese Medicine

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The symptoms experienced by someone having a stroke depend on which part of the brain is being deprived of oxygen. Sometimes people get early warning signals that they may soon suffer a stroke when they suffer "mini-strokes" otherwise known as "transient ischemic attacks (TIA's)." People who suffer from mini-strokes have all the symptoms of stroke, but recover completely within a few hours or days. If a clot is slowly forming or a small hemorrhage has developed, early signs may give enough warning for effective medical treatment to be started. These signs should be taken seriously and qualified medical help should be immediately sought.

The most common warning signs of a stroke are:

Weakness down one side of the body. Depending on how much of the brain is affected, this can range from "clumsiness," where weakness makes it hard to lift the arm or leg and to hold or carry things, to complete paralysis down one side of the body. If this weakness occurs as part of a transient ischemic attack (TIA) or "mini stroke", the sufferer often thinks they are just getting old, are a bit tired or perhaps slept in the wrong position.
A numbness/ loss of feeling in a part of the body.
Sudden inability to tell hot from cold.
A sudden problem with vision-blurred vision, double vision or loss of part of the visual field (part of the picture just disappears).
Dizziness, nausea, or feeling unsteady when standing or walking.
Difficulty walking and sudden `clumsiness': leaning to one side or falling to one side and bumping into objects when walking.
Sudden problems remembering words or actually speaking. Speech may (understood from last sentence) become slurred.
Sudden problems understanding what people are saying.
Episodes of loss of consciousness.
Difficulty swallowing

Less common symptoms include sudden, very severe headaches, described by neurologists as an intensely painful headache, which comes on 'like a thunderclap'. This symptom, when it occurs, is most often felt when the stroke is being caused by hemorrhage.

Because a stroke often sees a sudden onset and rapid change in clinical symptoms, the symptoms' degree of seriousness can differ greatly. In TCM, stroke symptoms are differentiated according to what area the stroke affects. Strokes affecting the meridians mainly impair superficial parts of the body. Individuals, who suffer from this kind of stroke, usually have symptoms that are not too serious and their prognosis is favorable. On the other hand, strokes involving the internal organs (viscera) deeply impair normal body functioning. These individuals usually experience serious and severe symptoms and have a less favorable outcome.

Strokes Involving the Meridians

Meridian System

Meridians are pathways in which the qi and blood circulate and through which the organs and limbs are connected, allowing the upper-lower and interior-exterior portions of the body to communicate.

Channels run in straight fixed courses

Collaterals run crisscross in the body

Stroke involving the meridians is considered to be minor. Symptoms include numbness of the muscles, skin and limbs, difficulty in walking, an appearance of a crooked mouth, difficulty speaking and hemiplegia (paralysis on one side of the body).

If the individuals suffering from this type of stroke have a lack or stagnation of qi and blood flow in the small collaterals of the meridian system, other symptoms may be present such as an aversion to cold temperatures, fever, muscular stiffness, and joint soreness. On physical exam, there may be a thin white film covering the tongue and the presence of a floating and rapid pulse.

If this type of stroke is caused by either a liver-yin or kidney-yin deficiency, wind and phlegm evils that result from these conditions will flow upwards in the body and cause symptoms of dizziness, blurred vision, headache, tinnitus (ringing in the ears), irritable sleeping, and deep yellow-colored urine. On physical exam there may be the appearance of a red tongue with a stringy, thready and rapid pulse.

Strokes Involving the Viscera (Organs)

A serious stroke is usually associated with symptoms of a sudden collapse or loss of consciousness and usually involves the muscles, limbs or joints. It can be differentiated into stroke bi-syndrome and collapse syndrome.

1. Stroke of Bi-syndrome
This is due to an accumulation of wind-phlegm evils inside the body, leading to an obstruction of the orifices (openings to the body such as the mouth). The general clinical manifestations are sudden coma, unconsciousness, trismus (persistent contraction of the masseter muscle which helps close the jaw and chew food), clenching of fists, constipation and no urination.

Additional symptoms such as fever, flushed face, irritability, rough breathing sounds, and halitosis (bad breath) belong to the yang bi-syndrome of stroke. On physical examination, these individuals may have a red tongue with a yellowish and greasy covering, and a stringy and rapid pulse.

Symptoms like sleepiness, snoring, pale facial appearance, purple lips, and cold limbs belong to the yin bi-syndrome of stroke. On physical examination, there may be a white and greasy tongue covering and a deep, moderate and rolling pulse.
2. Stroke Collapse-syndrome
This condition occurs when there is a dissociation of yin and yang in the body, meaning these two forces are unable to work together and create balance to maintain a healthy state. It is a life threatening condition that can be caused by a severe and prolonged deficiency of vital qi. The main symptoms are a sudden collapse, unconsciousness, weak and superficial breathing, cold limbs, and a loss of control of urination and defecation (ability to stool). The eyes appear shut and the mouth is open.

When symptoms such as the appearance of a red face, profuse greasy sweating, cold limbs, faintness and the presence of a thready pulse start to diminish, it indicates the exhaustion of true-yang and that a person is dying.

Stroke Sequelae
After obtaining emergency treatment for a stroke, many individuals regain consciousness, resume eating and drinking, and regain control of normal urination and defecation (stooling). However, some symptoms may not return to normal and remain as stroke sequelae. Symptoms such as hemiplegia (paralysis on one side of the body), difficulty in speech, an appearance of a crooked mouth, puffy and weak limbs, stiffness, limb contraction and spasm, or muscle wasting (atrophy) can be present long after the stroke occurs and may not be able to be reversed back to normal functioning. For these individuals, rehabilitation such as physical, speech and occupational therapy are used by western doctors to help regain some amount if not all of the lost body functions. TCM practitioners can also assist in this process by using techniques such as Chinese medicine, acupuncture, acupressure, massage, moxibustion and tai chi exercises to help strengthen the muscles, relieve lingering pain and restore the normal flow of qi throughout the body.

Differentiating a Stroke from Epilepsy and Syncope (Fainting)
When there is a loss of consciousness or the presence of a coma, it is important to differentiate whether the cause is from a stroke, syncope (fainting), or epilepsy since the treatment for each of these conditions will be different.

When a person experiences a major stroke, there are usually other accompanying symptoms such as facial distortion, the presence of a crooked mouth or paralysis down one side of the body. After the stroke has occurred and a person regains consciousness, these symptoms usually remain and may not get better over time without other medical interventions.

This condition is a temporary sudden loss of consciousness caused by a lack of blood flow to the brain. This condition usually lasts for a short amount of time, and the person may have a pale complexion and cold limbs while unconscious. Stroke symptoms such as paralysis on one side of the body and facial distortion are not present. Individuals generally return to normal functioning once consciousness is regained.

Epilepsy is a chronic disease where the brain cells do not function properly this causing seizures. Typically, an epileptic seizure is characterized by an altered state of consciousness and may involve convulsions of one part or the entire body. Other symptoms that can occur with a seizure include drooling, foaming at the mouth, making abnormal sounds and having abnormal eye movements. An epileptic seizure generally lasts only for a short period. When individuals regain their normal conscious state, the symptoms experienced during the seizure are gone. They may have a headache and feel extremely tired, but otherwise have normal functioning.