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The common symptoms of stroke are well known. You might picture someone with one side of their body slumping, slurring their words, unable to smile using their entire mouth. However, there are other symptoms you may not expect like nausea, vomiting, and even hiccups.

“These are rare stroke symptoms,” said Lee Chung, MD, a neurologist with University of Utah Health. “In most cases, these symptoms may signal food poisoning or some other problem, but in a few patients they are warning signs that something is going on in the brain.”

There are even rarer symptoms that only affect about one percent of stroke patients. These include hallucinations, delusions, or the loss of common skills. “In one case the stroke made it impossible for someone to do math. They could talk, write, read, but they could not do math,” Chung said. “Another patient had trouble recognizing people — even their own face.”

The way to discern if the symptoms being experienced could be related to a stroke are whether other symptoms are also present. Again, we aren’t talking necessarily about the expected symptoms that are easy to spot like paralysis in one hand or arm. “Think vertigo or dizziness,” Chung said. “The patient could also have a lack of coordination, confusion or a headache. All of these are signs that there is some involvement in the brain stem.”

Why are these stroke symptoms so different? It has to do with where in the brain the stroke is occurring. With classic stroke symptoms, the injury is occurring in the anterior section of the brain. However, in cases where symptoms are less common the posterior of the brain is the area being affected. “Specifically they tend to be in the lower back half of the brain,” Chung said.

Any time a stroke is suspected it is important to get help as soon as possible. After all, as they say, time is brain. Treatment for a stroke can vary depending on when the symptoms are discovered and help is sought. “In the emergency department we are focused on reversing the symptoms of stroke,” Chung said. “But this can only be done in the first few hours after it occurs — and the earlier these procedures are done the more likely they are to be successful.”

A stroke occurs when blood flow to the brain is cut off. In 85 percent of cases, this is because of a clot or blockage keeping blood from flowing freely. With this type of stroke — known as an ischemic stroke — steps are taken in the hours after it occurs to remove the blockage to reverse the symptoms.

“Medication can be given to dissolve the clot,” Chung said. “Or we can work to physically remove the clot.”

If help for a stroke is not sought until several hours after it occurs treatment no longer is about reversing the symptoms, but instead is focused on patient rehabilitation. This could include physical, speech, or occupational therapies. “It also includes making lifestyle changes to avoid another stroke,” Chung said. “Having a stroke increases the risk of having a second.”

One key way to avoid stroke is to control your blood pressure. New guidelines put high blood pressure or hypertension at 130 over 80. If yours is higher should see a doctor and make lifestyle changes to lower it. These should include eating a healthy diet, getting regular exercise, losing weight if you are overweight, and quitting smoking if you do.

“Your brain health is dependent on your overall health,” Chung said. “Improving your overall health decreases the chance you will see any symptoms of stroke – common or rare."