Stroke symptoms can sometimes resemble vertigo, migraine or low blood sugar, making them easy to miss. Learn the warning signs to watch for and why sudden neurological changes require immediate medical attention.
Stroke is commonly recognised by sudden facial deviation, weakness in one arm or leg, or difficulty speaking. However, it can also cause symptoms such as vertigo, headache and visual disturbances. Recognising these less familiar warning signs is important because timely diagnosis and treatment can prevent serious brain damage.
Sudden Vertigo and Loss of Balance
The symptoms of a stroke depend on which part of the brain is affected. The brainstem contains several important structures packed into a small area, while the cerebellum, located in the hindbrain, helps control balance and coordination.
A stroke affecting the vestibulocerebellum, the region involved in balance, can cause sudden vertigo, slurred speech that may sound like drunken speech, and difficulty walking steadily. If the lateral part of the medulla oblongata is affected, vertigo may occur along with difficulty swallowing and altered sensation on the opposite side of the body.
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These symptoms indicate central vertigo, which originates in the brain. It should not be confused with peripheral vertigo, caused by problems in the inner ear's balance-controlling labyrinth. Peripheral vertigo may vary with changes in head position and can be associated with hearing loss without other neurological signs.
In contrast, vertigo caused by a stroke may occur with double vision, slurred speech, difficulty swallowing or numbness affecting the face or one side of the body. Sudden vertigo accompanied by neurological symptoms requires emergency assessment and appropriate brain imaging, often including an MRI.
Headache and Visual Disturbances
Headache can precede or accompany a stroke, particularly a brain haemorrhage or a large infarct associated with swelling. Strokes affecting the posterior circulation, also called the vertebrobasilar system, may also present with headache.
When a stroke affects the occipital or visual cortex, it can cause loss of the same half of the visual field in both eyes, a condition called homonymous hemianopia. This may be mistaken for migraine with visual aura.
Migraine-related visual symptoms are usually temporary, often lasting less than an hour, and may occur with one-sided headache, sensitivity to light or sound, and recurrent episodes. Visual disturbances caused by stroke may persist and require immediate medical attention.
Low Blood Sugar Can Mimic a Stroke
Hypoglycaemia, or low blood sugar, usually causes sweating, generalised weakness, confusion and, in severe cases, loss of consciousness. These are known as neuroglycopenic symptoms. A significant fall in glucose can also disrupt brain function, causing one-sided weakness that resembles a stroke. Sweating, trembling and palpitations may provide additional clues.
Symptoms often improve after blood glucose is corrected. However, prolonged hypoglycaemia can cause irreversible brain damage, known as hypoglycaemic encephalopathy.
Any sudden neurological symptom should be treated as a medical emergency. Do not assume it is caused by migraine, vertigo or low blood sugar. Prompt evaluation is essential to identify the cause and begin appropriate treatment.
-This article is authored by Dr Rohit Pai, Consultant Neurologist, KMC Hospital Mangalore
