A stroke is a medical emergency that occurs when the blood supply to a part of the brain is interrupted or when a blood vessel in the brain ruptures. Without adequate oxygen and nutrients, brain cells begin to die within minutes. Early recognition and immediate treatment can save lives, reduce permanent disability, and improve the chances of recovery.

A stroke can affect people of any age, although the risk increases with advancing age, high blood pressure, diabetes, smoking, and certain cardiovascular conditions. Recognising the warning signs and reaching an appropriate hospital without delay are crucial.

If you suspect a stroke, do not wait for symptoms to improve. Call emergency medical services immediately. Every minute matters.

What Is a Stroke?

A stroke occurs when normal blood flow to the brain is disrupted. There are two main types of stroke.

1. Ischaemic Stroke

An ischaemic stroke occurs when a blood clot blocks an artery supplying the brain. It is the most common type of stroke.

The clot may form within a blood vessel in the brain or travel from another part of the body, such as the heart. Conditions such as atherosclerosis and atrial fibrillation can increase the risk.

2. Haemorrhagic Stroke

A haemorrhagic stroke occurs when a blood vessel in the brain ruptures, causing bleeding within or around the brain.

High blood pressure is an important risk factor. Other causes include certain vascular abnormalities, aneurysms, and bleeding disorders.

Both types of stroke require urgent medical assessment, but their treatments differ. A treatment that helps one type of stroke may be dangerous for the other, which is why brain imaging is essential before specific treatment decisions are made.

What Are the Warning Signs of a Stroke?

Stroke symptoms usually develop suddenly. The person may appear well one moment and develop difficulty speaking, weakness, or loss of balance the next.

The most important warning signs include:

• Sudden facial drooping: One side of the face may appear uneven, particularly when smiling.

• Weakness or numbness in an arm or leg: This commonly affects one side of the body.

• Difficulty speaking: Speech may become slurred, unclear, or difficult to understand.

• Difficulty understanding speech: The person may struggle to understand simple instructions.

• Sudden loss of vision: Blurred vision, double vision, or loss of sight in one or both eyes may occur.

• Sudden dizziness or loss of balance: The person may be unable to walk normally or coordinate movements.

• Sudden severe headache: A particularly severe headache without an obvious cause may indicate bleeding in the brain.

Not every stroke causes all these symptoms. Some strokes present mainly with balance problems, visual disturbances, or difficulty coordinating movements.

Remember FAST: A Simple Way to Recognise Stroke

The FAST method helps identify common stroke symptoms quickly.

F — Face: Ask the person to smile. Does one side of the face droop?

A — Arms: Ask the person to raise both arms. Does one arm drift downward or fail to rise?

S — Speech: Ask the person to repeat a simple sentence. Is the speech slurred or unusual?

T — Time: If any of these signs are present, call emergency medical services immediately.

Do not delay while checking additional symptoms. Even one sudden warning sign may indicate a stroke.

A useful extension is BE-FAST, which also includes sudden loss of balance and changes in eyesight.

What Should You Do If Someone Has a Stroke?

Taking the right steps before reaching the hospital can reduce avoidable delays and complications.

1. Call Emergency Medical Services Immediately

Arrange urgent transport to a hospital equipped to assess and treat acute stroke. An ambulance may allow earlier assessment and help the receiving hospital prepare for the patient's arrival.

Do not wait for a family member to arrive or for symptoms to settle.

2. Note the Time Symptoms Started

Record the exact time the symptoms began. If the person was last seen normal before symptoms were noticed, record that time as well.

This information is important because some stroke treatments are available only within specific time windows, although selected patients may qualify for treatment beyond the usual window based on imaging findings.

3. Do Not Give Food, Water, or Oral Medicines

Stroke can interfere with swallowing, creating a risk of choking or aspiration.

Do not give food, drinks, or tablets until the person has been medically assessed and swallowing safety has been established.

4. Do Not Give Aspirin on Your Own

Aspirin may be appropriate in selected cases of ischaemic stroke, but it can worsen bleeding in a haemorrhagic stroke.

Brain imaging is generally required before deciding whether antiplatelet treatment is appropriate. Do not start aspirin or other blood-thinning medicines without medical direction.

5. Keep the Person Safe

Keep the person in a safe, comfortable position and monitor their breathing and responsiveness. If they become unconscious but are breathing normally, follow the emergency dispatcher's instructions regarding positioning. If they are not breathing normally, begin CPR if indicated and follow the dispatcher's guidance.

Do not try to make the person walk or drive them yourself if emergency transport is available.

How Is a Stroke Diagnosed in the Emergency Department?

Stroke evaluation begins immediately on arrival at the hospital. The medical team assesses the patient's neurological condition, vital signs, blood glucose, medical history, and the time symptoms began.

Brain Imaging

A non-contrast CT scan of the brain is commonly performed urgently to identify bleeding and assess for other abnormalities. Early ischaemic strokes may not always be visible on an initial CT scan.

CT angiography or other vascular imaging may be required to identify a blocked major artery. MRI may be useful in selected patients.

Blood Tests and Additional Assessment

Blood tests may include blood glucose, complete blood count, kidney function, electrolytes, and coagulation studies, depending on the clinical situation. An ECG and cardiac assessment may help identify conditions such as atrial fibrillation that can cause embolic strokes.

The purpose of the emergency assessment is to determine the stroke type, identify eligible treatments, and prevent further brain injury.

What Is the Emergency Treatment for Stroke?

Stroke treatment depends on whether the stroke is ischaemic or haemorrhagic, the time since symptom onset, imaging findings, and the patient's overall condition.

Treatment for Ischaemic Stroke

1. Intravenous Thrombolysis

Eligible patients with an acute ischaemic stroke may receive intravenous thrombolytic medication to dissolve the clot. Treatment is commonly considered within 4.5 hours of symptom onset, subject to clinical eligibility and contraindications. Selected patients with unclear onset times may qualify based on advanced imaging.

2. Mechanical Thrombectomy

For selected patients with a blockage in a major brain artery, doctors may perform mechanical thrombectomy. A catheter is guided through the blood vessels to remove the clot and restore blood flow.

The procedure is time-sensitive and may be appropriate for selected patients up to 24 hours after they were last known to be well, depending on imaging and eligibility criteria.

3. Supportive and Stroke Unit Care

Management may include monitoring oxygenation and blood pressure, treating fever or abnormal glucose levels, assessing swallowing, and preventing complications. Antiplatelet medicines and other preventive treatments are introduced at the appropriate time based on the stroke type and treatment received.

Treatment for Haemorrhagic Stroke

Treatment aims to control bleeding, manage pressure within the skull, and prevent further injury.

Depending on the cause and severity, treatment may include:

• Carefully controlled blood pressure reduction.

• Reversal of anticoagulant medication effects when indicated.

• Management of raised intracranial pressure.

• Neurosurgical or endovascular procedures in selected cases.

• Intensive monitoring in an appropriate critical care setting.

The choice of treatment depends on the location and size of the bleed, the underlying cause, and the patient's clinical condition.

Why Is Early Stroke Treatment So Important?

Brain tissue depends on a continuous supply of oxygen-rich blood. When blood flow is interrupted, irreversible injury can develop rapidly.

Early treatment may restore blood flow, limit the extent of brain damage, and improve the likelihood of functional recovery. Delays can reduce the number of treatment options available.

However, reaching the hospital quickly does not guarantee that every patient will be eligible for clot-dissolving medication or thrombectomy. Eligibility depends on clinical findings, imaging, timing, and individual risk factors.

The correct action is always the same: seek emergency assessment immediately rather than trying to determine at home whether the stroke is mild or severe.

Can a Stroke Be Prevented?

Many strokes are preventable through effective management of risk factors.

• Control high blood pressure: Hypertension is one of the most important modifiable stroke risk factors.

• Manage diabetes: Regular monitoring and appropriate treatment reduce vascular complications.

• Monitor cholesterol: Follow medical advice regarding diet, exercise, and lipid-lowering medication when indicated.

• Stop smoking: Tobacco use increases the risk of blood vessel disease and stroke.

• Exercise regularly: Aim for an appropriate level of physical activity based on age and medical condition.

• Maintain a healthy weight: A balanced diet and healthy lifestyle help reduce cardiovascular risk.

• Identify atrial fibrillation: Appropriate anticoagulation can prevent some strokes in eligible patients.

• Take prescribed medicines consistently: Do not stop blood pressure, diabetes, cholesterol, or anticoagulant medicines without medical advice.

People who have already experienced a stroke or transient ischaemic attack (TIA) may require a personalised secondary prevention plan to reduce the risk of recurrence.

What Is the Difference Between a Stroke and a Mini-Stroke?

A transient ischaemic attack, or TIA, occurs when stroke-like neurological symptoms resolve without evidence of acute infarction under the relevant diagnostic criteria. Symptoms may last only a few minutes.

A TIA is not harmless. It can be a warning of a future stroke, particularly in the hours and days following the episode.

If facial weakness, speech difficulty, visual loss, or limb weakness occurs and then disappears, seek emergency medical assessment. Do not assume that recovery means the danger has passed.

Frequently Asked Questions About Stroke

1. Can a stroke occur in a young person?

Yes. Although stroke is more common in older adults, it can occur in younger people due to vascular abnormalities, heart conditions, blood clotting disorders, certain medications, and other risk factors.

2. Can stroke symptoms disappear on their own?

Yes. Some symptoms improve or resolve, but this does not rule out a stroke or TIA. Urgent medical evaluation is necessary even when the person appears to have recovered.

3. How quickly should a stroke patient reach the hospital?

Immediately. Call emergency medical services as soon as stroke symptoms are suspected. Do not wait to see whether symptoms improve.

4. Can a stroke patient recover completely?

Some patients recover substantially or completely, while others have persistent difficulties with movement, speech, memory, or daily activities. Recovery depends on the stroke's severity, location, treatment, and rehabilitation.

5. Is a CT scan necessary for every suspected stroke?

Urgent brain imaging is generally essential to distinguish bleeding from ischaemic stroke and guide treatment. CT is commonly the first investigation, with additional imaging selected according to the clinical situation.