Is It a Stroke or a Seizure? Here’s How to Tell Them Apart

Strokes and seizures can be hard to tell apart. And it can be a frightening experience when someone nearby is having either one. They both start suddenly, and they can completely change the way the brain and body behave. To make things even more complicated, a stroke can sometimes lead to a seizure. 

If someone in your life is at risk for either or both conditions, it can help to understand the differences between the two. And more importantly, it’s good to know what to do when you see one.

What happens in the brain during a stroke vs. a seizure? 

Strokes and seizures both affect the brain, but in different ways.

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Stroke

During a stroke, there’s a sudden change in blood flow to the brain. This can come from a blockage in a blood vessel or even bleeding in the brain. Either way, this leads to lack of blood flow (oxygen) to specific areas of the brain. And without blood flow, brain cells malfunction and die. 

Seizure

During a seizure, there’s a surge of electrical activity in the brain. So, it’s a problem with electrical signals rather than blood flow. Seizures start in a specific part of the brain. But the disorganized activity usually spreads to the whole brain (known as a “grand mal” seizure). This is why seizures often lead to a full loss of consciousness. 

Since strokes tend to only affect a specific part of the brain, they tend to only affect a few brain functions — like speech or movement of an arm.

What are the symptoms of a stroke vs. a seizure? 

The symptoms of a stroke and seizure can be very similar. Overlapping symptoms include:

• Headache

• Confusion

• Numbness or tingling sensations

• Difficulty seeing or vision changes

• Inability to speak

But there are still some key signs that can tell them apart.

EXPERT PICKS: WHAT TO READ NEXT

• What to do if someone’s having a seizure: Familiarize yourself with the things you can do to keep someone safe during a seizure.

• What is a mini stroke? Some strokes are small enough that the symptoms start and stop within minutes. But when this happens, you should still call 911.

• What does it feel like to have a stroke? People explain their symptoms and firsthand experience with having a stroke.

How do you know someone is having a seizure?

To understand what a seizure looks like, it’s first important to know that seizures can be either:

• “Partial”: also called focal seizures

• “Full”: also called generalized or grand mal seizures 

A partial seizure is less common than a generalized or grand mal seizure. Partial seizures affect only one part of the brain. These can lead to symptoms like: 

• A strange taste in the mouth

• Trouble concentrating

• Feelings of intense fear

• Nausea

• Staring episode

They can also look like a stroke, causing weakness or numbness in one part of the body. Partial seizures can also progress to a full seizure. 

Full seizures affect the whole brain, so they cause someone to lose consciousness. During the seizure, the person will typically experience:

• Stiffening of the body

• Jerking movements of arms and/or legs (this is a hallmark sign of a grand mal seizure)

• Drooling or frothing at the mouth

• Teeth clenching, which typically causes them to bite their tongue

• Sudden, rapid eye movements

• Loss of bowel or bladder control

• A temporary pause in breathing 

How do you know someone is having a stroke?

Unlike a seizure, a stroke usually starts without any warning or preceding symptoms. And it usually doesn’t result in loss of consciousness (passing out).

Symptoms that are more likely from a stroke than a seizure include:

• Weakness in the face, arm, or leg on one side of the body

• Numbness in one specific body part, which usually feels like a reduced sensation to touch

• Slurred speech, or garbled speech that seems like “word salad”

• Trouble walking, vertigo (room spinning sensation), or lack of coordination

• Trouble swallowing

It’s important to note that these aren’t hard and fast rules. Someone who’s having a stroke can lose consciousness. And someone who’s having a seizure may just have weakness or numbness in one part of the body. 

Can a stroke cause seizures? 

It depends. Some people who’ve had a stroke may go on to develop seizures. This can happen in two different ways:

1. The lack of blood flow can interfere with the electrical signals in the brain. When this is the case, the seizures happen at the start of the stroke. Or they can happen in the first 1 to 2 days after the stroke occurred. However, the latter is more common.

2. As someone’s brain is healing from a stroke, it can develop scar tissue where the brain cells died. Since the scar tissue can interfere with electrical activity, this can lead to seizures up to 2 or more years after the stroke.

Some people will have multiple episodes of seizures after a stroke and be diagnosed with epilepsy. Epilepsy is a brain disorder that leads to multiple episodes of seizures. But having one seizure after a stroke doesn’t mean that someone will develop epilepsy.

Can a seizure cause a stroke? 

In short, no. While a stroke can lead to seizures, seizures don’t lead to strokes. But right after someone has a seizure, they can have symptoms that look like a stroke. The medical term for this is Todd’s paralysis. This is when a seizure is followed by an episode of dysfunction as the brain recovers from the stroke. 

The paralysis is most often on one side of the body, which is what makes it look like a stroke. But it's only temporary and resolves quickly as the person returns to normal. They might have weakness in an arm or leg. Or they may not feel weakness or paralysis at all. They might just instead experience: 

• Confusion

• Loss of memory

• Trouble speaking

• Numbness

• Difficulty seeing

What should I do if someone is experiencing a stroke or a seizure?

Since there’s a lot of overlap between stroke and seizure symptoms, it can be hard to tell which one a person is experiencing. But the bottom line is the same: In either case, it’s best to call 911. 

A stroke is a medical emergency that always requires prompt care. The acronym FAST can help you recognize a stroke:

• F = face drooping: Look for drooping or numbness of one side of the face. An uneven smile can also be a clue.

• A = arm weakness: Weakness or numbness of one arm is concerning. If the person raises both arms, see if one sags downward.

• S = speech difficulty: Speech may be slurred.

• T = time to call 911: Acting quickly during a stroke is important.

A seizure isn’t always an emergency — especially for people who have them often and know what to do. But you should never hesitate to call 911. And there are certain scenarios when emergency treatment for a seizure is important. Call 911 if the person:

• Has never had a seizure before

• Seizes for longer than 5 minutes

• Has a second seizure after the first one

• Has difficulty breathing

• Has difficulty walking after the seizure

• Is injured during the seizure, like they fall and hit their head

• Is in water during the seizure

• Has another health condition, like diabetes or heart disease

• Is pregnant

At the end of the day, you aren’t expected to figure out if someone is having a stroke versus a seizure. The most important thing to do is call 911 as quickly as possible. But while you’re waiting for emergency personnel, there are a few more things you can do to help keep someone safe. 

When someone is having a seizure, you should: 

• Prevent them from hurting themselves by lowering them to the floor or clearing the area around them.

• Loosen any constriction around the neck, like a shirt or tie.

• Turn them on their side to help keep their airway clear. You may also help them breathe more comfortably by removing things like a mask, glass, or other objects around their face.

These guidelines also apply to someone having a stroke, especially if they have altered consciousness. And be sure to stay with the person until the ambulance arrives. This will help keep them safe and calm. 

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Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in New York City. She has held local and national roles at the American Medical Women’s Association including board member of the physician division and physician chair of social media.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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