How does one make a decision to go to the hospital emergency room when one has an acute change in mental status? This is actually a two-part question, or actually a question for two different classes of individuals; for the person with the change in mental status and for the friend or family who notices the change.
Signs of a major stroke usually involve half the body, manifesting in weakness, numbness, a droopy face, slurred words, inability to talk or understand speech. The National Institute of Health lists the symptoms of stroke as follows:
- “Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
- Sudden confusion, trouble speaking or understanding speech
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause ” 
Note the emphasis on ‘sudden’. Many people know these signs and, if the affected person is lucky, and stricken with the symptoms mentioned by NIH in the presence of a knowledgeable person, it is possible that he or she can get to the emergency room in enough time to minimize any damage.
What about less obvious signs?
Suppose that a loved one wakes up with a headache, feels dizzy and doesn’t exactly slur words, but doesn’t ‘sound right’? Suppose that this person doesn’t want to bother anyone or make a big fuss? After all, nothing happened all of a sudden, so it can’t be a stroke, right?
WebMD notes a number of subtle signs that may indicate stroke:
- “Weakness in the face (such as a droopy eyelid or lip)
- Loss of balance
- Slurred speech
- Headache ” 
Difference between men and women
According to Wayne Kuznar’s report, “The most common complaints among the patients without any of the warning signs were loss of consciousness or syncope, respiratory complaints, falls or accidents, pain, and seizure. Each of these complaints was more common among women than men.”  The study he refers to investigated the symptoms of 1724 emergency room patients later confirmed to have a stroke. It showed that 10% of men and 15% of women in a population of stroke victims did not report any of the five typical symptoms of stroke as noted above. 
The bottom line
It is important to know the physical and mental state of loved ones and to be sensitive to any changes and to make sure the emergency room staff knows that you suspect a stroke.
This post is not intended as medical advice.
 Gargano JW, Wehner S, Reeves MJ. Sex differences in clinical presentation among confirmed acute stroke admissions from a statewide stroke registry. Stroke. 2007;38:508. Abstract P102.