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Can you have a stroke and not know it?

Though this may surprise you, silent strokes — or strokes that people don’t know they’ve had — are common, especially in older people.

Silent strokes can cause long-term problems with memory, focus, or balance.

Seeking care is important if you think that you or your loved one may have had a silent stroke. People who have had one silent stroke are at a higher risk of having another stroke.

If doctors find signs of a silent stroke, they can connect you to rehab services to help you recover. They can also help you prevent another stroke.

What Is a Silent Stroke?

A silent stroke happens when a blood vessel in the brain becomes blocked, stopping blood flow to part of the brain. This causes brain cells to die, the same as a regular stroke.

A silent stroke is often a lacunar stroke. This stroke occurs in a small blood vessel deep in the brain. Because lacunar strokes don’t disrupt blood flow as much as other strokes, they don’t always cause obvious symptoms.

Silent strokes may happen because a person is alone, so no one recognizes signs like facial drooping or slurred speech. A stroke can make someone unaware that something is wrong.

In other cases, the signs of a silent stroke are so subtle that even loved ones don’t recognize that it has occurred.

What Are the Signs and Symptoms of a Silent Stroke?

Silent stroke symptoms are subtler than typical stroke symptoms. A person with a silent stroke may only have one or two stroke symptoms.

Stroke symptoms include:

• Confusion.
• Clumsiness.
• Difficulty walking.
• Dizziness.
• Drooping of the eyelid or mouth on one side.
• Loss of balance.
• Numbness of the face, an arm, or a leg.
• Severe headache.
• Slurred speech.
• Suddenly unable to find words when speaking.
• Trouble seeing.
• Weakness of an arm or leg, or both, on one side of the body.

Does a silent stroke cause long-term effects?

In some cases, a silent stroke doesn’t cause any noticeable long-term effects. However, silent strokes damage the brain, which can lead to changes in behavior, mood, movement, and thinking.

Multiple silent strokes are much more likely than single silent strokes to cause long-term effects.

Signs and symptoms that can occur after a silent stroke include:

• Balance problems or frequent falls.
• Confusion.
• Difficulty making decisions.
• Difficulty walking, or walking more stiffly or slowly.
• Loss of bladder control.
• Memory problems.
• Sudden mood changes, such as anger or sadness.
• Trouble focusing.

Because these effects are often mild or confused with normal aging, they’re easy to overlook.

How Common Are Silent Strokes?

Silent strokes are prevalent, especially as people age. Studies involving brain imaging suggest that around 10% of people in their early 60s have had a silent stroke. Up to 30% of people in their 80s and above have had a silent stroke.

Silent strokes can also happen in children and young adults, but they’re far less common than in older people.

Who Is Most at Risk of a Silent Stroke?

People with the following risk factors are more likely to have a silent stroke or other types of stroke:

• A previous stroke.
• An irregular heartbeat.
• Chronic, or long-term, stress.
• Diabetes.
• High blood pressure.
• High cholesterol.
• Smoking.

Silent strokes and strokes in general are more common in women and in African Americans.

How Are Silent Strokes Diagnosed?

Your doctor will ask about your symptoms, including when they started and how they affect you. If the doctor thinks it’s possible that your symptoms are from a previous stroke, they’ll order additional evaluation, which may include:

• A blood pressure check — High blood pressure increases your risk of stroke.
• Brain scans — A CT scan or an MRI can show signs of damage from a previous stroke.
• Blood tests — High blood sugar or cholesterol levels increase your risk of stroke.
• Cognitive tests — Your doctor may refer you to a neurologist for more in-depth testing. Neurologists can assess your balance, coordination, speech, memory, and thinking.

Many health problems, including low blood sugar, multiple sclerosis, and brain tumors, can cause symptoms that are similar to poststroke symptoms. Your doctor may order other tests to rule out other possible health problems.

What’s the Difference Between a Silent Stroke and a Mini-Stroke?

Can you have a mini-stroke and not know it? Technically, a mini-stroke refers to a transient ischemic attack (TIA), which isn’t the same as a silent stroke.

A TIA happens when a clot blocks blood flow to part of the brain for a short time, usually fewer than five minutes. Then, the clot dissolves or gets dislodged.

Even though a blood clot often moves or dissolves after a few minutes, TIA symptoms can last up to 24 hours. Usually, however, symptoms get better in an hour.

In other words, unlike a silent stroke, a mini-stroke does cause symptoms, but they go away quickly.

If you think you had a mini-stroke or TIA, you should go the emergency department, since people who have mini-strokes are at a high risk of having a more serious stroke in the next week. The same is true if you believe you are having a stroke, because there are many more options for treating stroke if it is diagnosed in the first few hours of symptoms.

How Do Doctors Treat and Prevent Silent Strokes?

Your doctor can’t completely reverse the damage a stroke can cause. But they can connect you to support and rehab services. Depending on your needs, stroke treatment can include:

• Speech therapy — To help with ongoing speech or language problems.
• Physical therapy — To help if you have weakness or balance issues.
• Occupational therapy — To help you perform everyday tasks that you find challenging.
• Psychotherapy (talk therapy) — To help with depression or anxiety, which can follow a stroke.
• Community services — Such as meal delivery, home care, or other services, can help your recovery.

If you’ve had a stroke, your doctor may recommend one or more of the following to prevent another stroke.

• Diet changes — Lowering your sodium, sugar, and fat intake can reduce your stroke risk.
• Exercise — Moderate to vigorous exercise 30 minutes a day, five times a week can reduce your stroke risk by 25%, according to the World Stroke Organization.
• Medications — You may need medication to lower your blood pressure and cholesterol or prevent blood clots. You may also need more than one medication to prevent another stroke. Your doctor will choose the right medication for you based on your test results.
• Other lifestyle changes — Avoiding alcohol, smoking, and other substances can help you avoid a stroke.

Editor's Note: This article was originally published on August 11, 2025, and was last reviewed on September 3, 2025.