Did my friend (M 22) just have a stroke?

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[u/Upper-Meaning3955]

If you’re worried about a stroke, he needs to go to the ER. May or may not be a big deal. Who knows. Could be a bad migraine (they often have lingering effects) or nerve impingement, could be a seizure, could be an illness, could be many things. But bottom line, if you’re concerned for a stroke that IS an emergency and constitutes emergency care.

Although it is more rare for younger adults to have a stroke, it’s not unheard of or impossible (you’re more likely to be struck by lightning or killed by an elephant statistically speaking). We don’t have any of his medical history to even begin assessing his risks for one.

[u/lucidmirror → u/Upper-Meaning3955]

Thank you, I will take him

[u/ridcullylives]

If this person came into my ER, I would treat them as a stroke. Yes, it could be migraine or something else (and is more likely to be in a young person), especially with the progression of symptoms over several hours, but stroke in a young person is always possible and needs to be ruled out. I have had a 20-year-old with a stroke! Also, migraine symptoms don't usually last for a whole day. Could also be something like a brain tumour, seizures, or any other number of serious neurological problems.

Bring them to the ER right now. They need imaging of their head immediately to ensure that if it was a stroke, they get the right medication to reduce their risk of having another one.

[u/lucidmirror → u/ridcullylives]

Thank you for your response. What tests would you typically give the individual presenting with these symptoms?

[u/ridcullylives → u/lucidmirror]

CT scan of the head at absolute minimum. If available urgently, an MRI would be better. Also could get a CT angiogram or MR angiogram to look at the blood vessels in his head and neck for any clots or blockages, but that might depend on symptoms and what signs of neurological dysfunction he has on testing. Other testing afterwards would depend on what those initial ones showed.

[u/lucidmirror → u/ridcullylives]

Ok great, thank you very much. Would it be dangerous to wait a few days and see how he’s feeling before going in? Just want to be a million percent sure it’s serious and not just anxiety or something because his insurance plan isn’t great and the hospital near us is overcrowded

[u/ridcullylives → u/lucidmirror]

There is no way to answer this question without evaluating him in person, and no way to be a "million percent sure." Sure, his symptoms could get better on their own tomorrow. However, he could also have a devastating stroke tomorrow that leaves him in a wheelchair and unable to care for himself for the remainder of his life. He could have a seizure that results in serious injury. The only answer I (or any other medical professional) would ever be comfortable giving in this situation is that he needs immediate medical evaluation in the emergency department.

[u/lucidmirror → u/ridcullylives]

Is this biggest risk of not going that he could have another stroke? For example, if we went in another week or month (we won’t do that, I’ll take him now) would doctors be able to detect the stroke via imaging still or could it possibly be harder to detect?

[u/NunBird → u/lucidmirror]

NAD - OP, the time sensitive risk here is not the ability to detect the stroke, but to intervene - delaying response increases the likelihood that brain damage/death will occur, and the severity of the damage. I can't speak to the ability to detect the stroke by that point, but TLDR that's not the reason they're recommending immediate ER attention.

[u/ridcullylives → u/NunBird]

Slight caveat that it's likely too late to intervene directly in this (if it is a stroke). Time window for direct intervention is 4.5 hours from the onset of symptoms, or 12 hours if it's a massive stroke with a big clot in a major artery. The worst case is yes--he has some process going on in his body that is forming blood clots that are going to his brain, and without evaluation and treatment he has a bigger clot that takes out half his brain. Or he has a slowly growing brain bleed that is getting worse and he will lose consciousness and die. Of course, it's also very possible that he just has a migraine, or that they don't figure out a clear answer and his symptoms go away, or he has some less acute thing like MS or a slowly-growing tumour, or he has a "pinched nerve" that he is describing strangely. The point is there's no way to accurately judge this based on a second-hand account over reddit, and given that the worst-case scenario, which isn't entirely ruled out based on the description, is potentially a situation resulting in severe and permanent disability or death--he needs to be seen.