Stroke
Sudden loss of brain function from blocked or bleeding blood vessels — a medical emergency.
Overview
Stroke is caused by a blocked artery (ischaemic, ~85%) or a bleed (haemorrhagic). Time-critical treatment with clot-busting drugs or thrombectomy can save brain tissue. Use the FAST test: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.
Symptoms
- • Sudden facial droop
- • Arm or leg weakness on one side
- • Slurred or absent speech
- • Sudden vision loss
- • Severe sudden headache
- • Loss of balance
Risk factors
- • Hypertension
- • Atrial fibrillation
- • Diabetes
- • Smoking
- • High cholesterol
- • Previous TIA
Causes
- • Atherothrombotic occlusion
- • Cardioembolism (commonly from AF)
- • Small-vessel disease
- • Intracerebral haemorrhage
🚨 Red flags — seek urgent care
- • Any FAST symptom — call emergency services immediately
- • Sudden 'thunderclap' headache
- • Sudden loss of consciousness
When to seek care
- • Any sudden neurological deficit — emergency
- • Brief 'mini-stroke' symptoms (TIA) — urgent same-day review
Diagnosis
- • FAST screening: Face, Arms, Speech, Time — call emergency services immediately
- • Urgent non-contrast CT head to differentiate ischaemic (87%) from haemorrhagic (13%)
- • CT angiography for large-vessel occlusion eligible for thrombectomy
- • MRI with diffusion-weighted imaging for posterior circulation / minor stroke
- • ECG and bloods (FBC, U&E, glucose, coag) at admission
Treatment
- • Ischaemic stroke: IV thrombolysis (alteplase or tenecteplase) within 4.5 h; mechanical thrombectomy up to 24 h in selected large-vessel occlusion
- • Aspirin 300 mg for 2 weeks after thrombolysis or from admission if ineligible
- • Long-term secondary prevention: antiplatelet (or DOAC if AF), high-intensity statin, BP control, lifestyle
- • Haemorrhagic stroke: BP lowering (<140 mmHg systolic), reversal of anticoagulation, neurosurgical referral
- • Multidisciplinary stroke unit care, early rehabilitation
Prevention
- • Treat hypertension, AF and diabetes aggressively
- • Smoking cessation
- • Statin for high cardiovascular risk
- • Mediterranean diet, exercise, weight control
- • Carotid endarterectomy for symptomatic 70–99% stenosis
Complications
- • Persistent neurological deficit (motor, sensory, language, cognitive)
- • Aspiration pneumonia
- • Venous thromboembolism
- • Post-stroke depression, anxiety, fatigue
- • Recurrence (up to 25% over 5 years)
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
What is a TIA?
A transient ischaemic attack is a stroke that resolves within 24 hours. It is a warning — risk of full stroke is highest in the first 48 hours.
How fast does treatment need to start?
Within 4.5 hours of symptom onset for thrombolysis, and up to 24 hours for mechanical thrombectomy in selected patients. The earlier the treatment, the better the outcome — 'time is brain'.
What is a TIA?
A transient ischaemic attack — stroke-like symptoms that fully resolve within 24 hours (usually under an hour). It is a major warning and requires urgent assessment, as up to 1 in 10 people have a full stroke within a week.
Can I prevent another stroke?
Yes. Antiplatelet or anticoagulant therapy, statins, tight blood pressure control, smoking cessation and treating atrial fibrillation collectively reduce recurrence by more than half.