A stroke can begin in seconds, and every minute that follows matters.
It happens when part of the brain suddenly loses its normal blood supply, either because a blood vessel becomes blocked or because a vessel breaks and bleeds. Without enough oxygen, brain cells can quickly become damaged or die.
Stroke is especially common in older adults, although it can happen at any age. The risk rises as people get older because conditions that damage blood vessels, such as high blood pressure, diabetes and heart disease, become more common. Knowing the warning signs can help someone receive treatment before more brain tissue is lost.
Most strokes are ischemic strokes, which happen when a clot blocks blood flow to part of the brain. A smaller number are hemorrhagic strokes, caused by bleeding in or around the brain. Both are medical emergencies, and it is impossible to reliably tell the type at home.
Many people know the FAST warning signs. A person’s face may suddenly droop on one side, one arm may become weak or numb, and speech may become slurred or difficult to understand. The final part of FAST is time, a reminder to call emergency services immediately.
These symptoms often appear suddenly rather than developing slowly over days. Someone may smile and notice that one side of the face does not move normally. They may also be unable to keep both arms raised or may suddenly struggle to speak a simple sentence.
However, not every stroke produces the classic FAST pattern. Some strokes affect areas toward the back of the brain that control balance, coordination and vision. These strokes can produce symptoms that are easier to mistake for less serious problems.
Sudden dizziness or severe loss of balance can be a warning sign, particularly when it appears with other new neurological symptoms. A person may suddenly struggle to walk straight, feel unusually unsteady or lose coordination. Dizziness alone has many common causes, but a sudden combination of symptoms deserves urgent attention.
Vision can also change during a stroke. Someone may suddenly develop double vision, blurred vision or loss of vision in one or both eyes. Because people may assume an eye problem will pass on its own, this warning sign can sometimes be overlooked.
Sudden confusion is another possible symptom. A person who was speaking normally moments earlier may have trouble understanding what someone is saying, finding familiar words or following simple instructions. These changes can occur even when speech does not sound obviously slurred.
A sudden and extremely severe headache can sometimes signal bleeding in or around the brain. It may reach maximum intensity very quickly and can occur with vomiting, neck stiffness, confusion or loss of consciousness. An unusual explosive headache needs emergency medical assessment.
Stroke can also cause numbness or weakness in a leg as well as the face or arm. If one side of the body suddenly feels heavy or difficult to control, walking may become unsafe. Some people may fall because the leg stops working normally.
Swallowing problems can also develop because a stroke may affect the muscles and nerves used to swallow. A person might suddenly cough, choke or struggle when trying to drink. Food or liquid can enter the airway, creating an additional risk of lung complications.
Sometimes stroke symptoms disappear after several minutes. This can happen during a transient ischemic attack, often called a TIA or mini-stroke, when blood flow to the brain is temporarily interrupted. Even if the person feels normal again, urgent medical assessment is needed because a TIA can warn of a larger stroke.
Several health problems increase stroke risk. High blood pressure is one of the most important because it gradually damages blood vessels. Smoking, diabetes, high cholesterol, obesity and low physical activity can also increase risk.
Atrial fibrillation, an irregular heart rhythm, is another major risk factor. It can allow blood clots to form inside the heart and travel to the brain. Treating high blood pressure, controlling diabetes and cholesterol, avoiding smoking and managing atrial fibrillation can substantially reduce stroke risk.
Once a stroke begins, speed is critical because some treatments work only within limited periods. Doctors may be able to use medicines to dissolve certain clots or procedures to physically remove large clots from blocked arteries.
Brain imaging at the hospital helps the medical team determine what type of stroke has occurred and which treatment is appropriate.
People should not drive themselves to hospital when stroke is suspected. Calling emergency services allows medical care to begin sooner and alerts the hospital that a possible stroke patient is arriving. In Australia, the emergency number is 000.
The key message is that stroke does not always look dramatic. Face drooping, arm weakness and speech problems are important warnings, but sudden vision loss, severe imbalance, confusion, one-sided numbness or an explosive headache can also signal a brain emergency. Recognizing these symptoms and acting immediately can protect brain function and improve the chance of recovery.
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