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My hemorrhagic stroke (there are two prominent ones: hemorrhagic and ischemic) was evident: facial paralysis (especially the eye slightly closing and the crooked lip), one-sided weakness (little movement or none al all), and trouble talking at first (I didn’t speak for 5 weeks). But not everyone experiences those symptoms. Welcome to the Silent Stroke. 

I started falling a lot, thinking it was just clumsiness, or wearing shoes to go to the law firm that were fashionable, albeit ill-fitting. Don’t do what I did–have yourself checked out.

Wed MD says some people have a stroke–the Silent Stroke–without comprehending it, without easy-to-recognize symptoms, but they do cause permanent damage in your brain.

Insist on an MRI or CTscan because brain scans are seen through those machines, especially if they’re giving you very subtle clues, like slight memory problems or a little difficulty getting around.

A study of middle-aged people with no apparent signs of stroke found that about 10% had brain damage from silent strokes.

Yes, the damage that happens is permanent, but therapy might help revive other parts of the brain so you regain abilities. 

Heidi Moawad, MD, a neurologist, author, and editorial board member of Neurology: Clinical Practice, says, “A stroke is such a significant event that it is hard to believe that some strokes actually go completely unnoticed. In fact, many patients can be completely caught off guard and are shocked to learn that they have been living with an ‘old stroke’ that did not cause any handicap at all, which is referred to as a ‘silent stroke.”

Being told that you have had a previous silent stroke certainly may sound like shocking news, but it is not cause for alarm. If you have had a silent stroke, that simply means that it is time for a new strategy for taking care of your health.

As with most things, there is good and bad news about silent strokes. 


The good news is that silent strokes are generally easily ignored. Also, they are silent because they take place  in regions of the brain that control functions that are also powered by other areas of the brain. So this means duplicate brainpower which allows some strokes to happen without any consequences. Studies have shown that people who are mentally and physically fit essentially have ‘spare brain power’ with fewer or no symptoms or handicaps at all.

The bad news is having had a silent stroke indicates that you have or have had one or more of the risk factors of stroke,  including cerebrovascular disease, heart disease, diabetes,
high cholesterol and/or blood pressure, a blood clotting disorder, drug use, and/or smoking. Also, you might begin to experience neurological symptoms if you have another stroke in the future if you had silent strokes in the past. Several small strokes can suddenly cause serious symptoms, such as vascular Parkinson’s or vascular Dementia, often due to the effect of damage to multiple areas of the brain cumulatively, even if they are small areas.

A mini stroke describes a transient ischemic attack (TIA). A TIA is a stroke that causes noticeable symptoms that reverse and all always improve without any permanent brain damage. It is a warning, but it does not appear on a Brain MRI or Brain CT scan. Not so with a Silent Stroke, which causes permanent brain damage. 

From the blog of parkridge health system, “every 40 seconds, someone in the US has a stroke, according to the Centers for Disease Control and Prevention. Every four minutes, someone dies from one. But there’s a related condition that’s even more common, which gets little attention: Silent Stroke. Some experts estimate that for every stroke that causes symptoms, there are about 10 silent strokes in the US.”

Parkridge define a stroke as “a sudden onset of neurologic impairment following a vascular insult. ‘Vascular insult’ means a vessel in your brain is bleeding or being blocked by a clot or sticky plaque buildup. Both bleeds and blockages can damage or destroy healthy brain tissue, causing serious neurological symptoms.”

Silent strokes are caused by brain bleeds or blockages also, but they tend to take place in a part of the brain called the white matter and produce subtle effects like memory and reasoning losses. 

Parkridge goes onto say that we should be concerned about silent strokes because they can have “subtle, long-term effects that could interfere with your daily life and independence. Over time, people who have had a silent stroke may notice difficulties with reasoning, gait changes, mild-to-moderate memory loss, and psychiatric disorders like depression.

This statement is from Harvard Medical School: there is also another type of stroke—one that is harder to determine. 

“Termed a silent stroke, it creates areas of damage in the
brain. These areas of dead brain cells are smaller than with a
traditional stroke and they impact less-functional areas of the brain, but researchers are finding that they can still have a significant and lasting impact on memory. Researchers estimate that more than one-third of people over age 70 have had a silent stroke. For people of all ages, every person who has a stroke with symptoms, there are about 14 others have a silent stroke.”

MRI

A silent stroke, as seen on an MRI, involves small spots of damage to areas of the brain that are not directly associated with functions such as vision or speech. Researchers, however, are finding these silent strokes can have an impact on memory.
During a silent stroke, blood flow that is interrupted  destroys areas of cells in a part of the brain that is “silent, meaning that it doesn’t control any vital functions. Although the damage will show up on an MRI or CT scan, it’s too small to produce any obvious symptoms.”

A blood vessel can get blocked off, the tissue supplied by that vessel can die, but the person doesn’t experience symptoms so they don’t know they’ve had a stroke,” explains Karen Furie, associate professor at Harvard Medical School and director of the Massachusetts General Hospital Stroke Service.
“That doesn’t mean it’s insignificant, though,” Dr. Furie says. Silent strokes can cause subtle signs, such as cognitive impairment.” Reseachers at Harvard confirmed a study published in the January 3 issue of the journal Neurology which looked at “more than 650 people without a history of dementia. Using MRI scans, the study authors tracked interruptions in blood supply to the participants’ brains. More than 170 of the participants were found to have small areas of dead tissue from a lack of blood supply (called infarcts) in the brain, even though only 66 of them reported having had symptoms of a stroke. People with these brain infarcts had difficulties with memory and mental processes (cognition). The memory issues occurred independent of any shrinkage of the hippocampus (the part of the brain responsible for memory)—which is typically seen with Alzheimer’s and other forms of age-related memory loss.”
Researchers affirm that over time, the damage from silent strokes can grow larger, leading to more memory problems. “The more brain damage or injury that you have due to these silent strokes, the more difficult it is for the brain to function normally,” Dr. Furie says.
“I don’t think it would be cost effective for everybody to have an MRI scan,” Dr. Furie says. However, she adds, silent strokes “should make people aware that it’s imperative to manage risk factors.” 

Those risk factors include:
  • High blood pressure
  • High cholesterol
  • Atherosclerosis
  • Smoking
  • High LDL (“bad”) cholesterol
  • Diabetes
  • Obesity
  • Sedentary lifestyle
  • Atrial fibrillation or Afib
News from a Swedish blog says, “While traditional
strokes can be obvious and sometimes devastating,
silent strokes are far more subtle and difficult to
recognize. The impact of a silent stroke is smaller and
typically affects less functional areas of the brain.
Because silent strokes do not affect speech or
movement, many people do not realize they’ve suffered
one. The cumulative effects of silent strokes may lead to
significant memory issues or dementia and increase the
likelihood of more serious strokes in the future.”


The blog goes onto say that you may go your whole lifetime and never you had a stroke. But silent strokes shouldn’t be regarded as insignificant. They may lead to impairment of a person’s balance, leading to more fall, temporary lack of coordinated muscle movement, loss of bladder control causing urine leakage, changes in mood and personality, or loss of cognitive abilities. 
Every doctor says the same thing, and you only have to check regularly, not every week:

Eat a healthy diet that includes plenty of fresh fruits, veggies, and whole grains.

Keep tabs on your blood pressure, and get it under control if it’s too high. 

Keep your blood sugar at the right levels. 


Check your cholesterol.

If you smoke, quit it instantly. 

Cut back on saturated fats, salt, and sugar. 

Get regular exercise. 


Keep to a healthy weight. 



OK. It’s easier said than done. But how about now?

Joyce Hoffman

Joyce Hoffman

Joyce Hoffman is one of the world's top 10 stroke bloggers according to the Medical News Today. You can find the original post and other blogs Joyce wrote in Tales of a Stroke Survivor. (https://talesofastrokesurvivor.blog)
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4 thoughts on “The Silent Stroke: Holy Crap! aka You Might Have a Stroke and Not Know It Until Something’s Not Right in Your Brain

  1. I wonder what was happening to my brain on the days before my stroke when I repeatedly dropped objects. This is a great post because ignoring early warning signs is not good.

  2. My doctor informed me that I had multiple small white matter infarcts, Of course he didn't show me the pictures or suggest any course of action. I didn't see any writeup on that in my medical notes either.

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