Stroke: Symptoms, Warning Signs and What to Do Immediately

Stroke is one of the most serious medical emergencies there is, yet many people don't recognise its signs — or wait to see whether it passes on its own. It doesn't. Brain cells begin to die quickly when their blood supply is cut off, and acting fast can substantially reduce the damage.

This article has one purpose: to help you recognise a stroke in seconds, and know exactly what to do.

What is a stroke?

A stroke happens when blood flow to part of the brain suddenly stops or drops sharply. Cells in that area stop receiving oxygen and nutrients and begin to be damaged. The more common type is caused by a clot blocking an artery in the brain. A less common type is caused by bleeding when a blood vessel ruptures.

Both are medical emergencies, and there is no way to tell them apart from symptoms alone — that requires brain imaging, which is one of the main reasons speed to hospital matters so much.

Recognising a stroke — the FAST test

There is a simple, internationally used check you can perform in seconds on anyone who suddenly seems not themselves:

• Face: ask them to smile. Is one side of the face drooping or not moving?
• Arms: ask them to raise both arms. Does one drift down, or can they not lift it?
• Speech: ask them to repeat a simple sentence. Is their speech slurred, jumbled, or absent?
• Time: if any of these is present — call an ambulance immediately and note the time the symptoms began.

Other important signs:

• Sudden weakness or numbness on one side of the body — face, arm or leg.
• Sudden loss of vision in one or both eyes, or double vision.
• Sudden severe dizziness, loss of balance, or inability to walk.
• A sudden, extremely severe headache with no obvious cause — particularly with vomiting or loss of consciousness.
• Sudden confusion or inability to understand speech.

Why does time matter so much?

Brain cells are highly sensitive to a loss of blood supply, and every period of delay increases the size of the damaged area. For strokes caused by a clot, treatments exist that aim to restore blood flow — either medication to dissolve the clot or a procedure to remove it — but these have a limited time window from when symptoms began, and only a doctor can determine whether a case is suitable for either.

In practice this means arriving late can close off treatments that would have been available had you come sooner. That is why the time symptoms started is one of the most important pieces of information the medical team needs.

What to do — and what not to do

Do:

• Call an ambulance or go to the nearest emergency department immediately.
• Note the exact time symptoms began, or the last time the person was known to be normal.
• Keep the person comfortable and stable; if unconscious but breathing, lay them on their side.
• Bring a list of their current medications and any available medical reports.

Do not:

• Give food, drink or any medication by mouth — swallowing may be affected and it could enter the lungs.
• Wait to see whether it improves — waiting spends the treatment window.
• Rely on home remedies or traditional treatments.
• Drive yourself if you are the one with symptoms — get help.

Risk factors

Several factors raise the likelihood of a stroke, and many of them can be controlled:

• High blood pressure — the single most important risk factor, and usually without symptoms.
• Poorly controlled diabetes.
• Heart rhythm disorders such as atrial fibrillation.
• Smoking, lipid disorders, obesity and physical inactivity.
• Family history and increasing age.
• A previous stroke or transient ischaemic attack.

Having a risk factor does not mean a stroke will happen — but it is reason enough for regular medical follow-up.

Transient attacks — a warning not to ignore

Sometimes symptoms appear and then disappear within minutes or hours. This is called a transient ischaemic attack. Many people feel reassured when symptoms pass and don't see a doctor — an important mistake, because a transient attack is considered a warning that a larger stroke may follow. It needs urgent assessment, not a postponed appointment.

Diagnosis at the hospital

Assessment begins with a rapid neurological examination and a review of symptom timing, followed by:

• A CT scan of the brain — the essential first step in distinguishing a clot from a bleed, because treatment differs completely.
• MRI or vascular imaging, depending on the case.
• ECG and blood tests to assess the cause and risk factors.

At Town Hospital, imaging, laboratory and emergency services are available 24 hours a day, which shortens the time between arrival and diagnosis — the interval that matters most in this condition.

Treatment and rehabilitation

Treatment depends on the type of stroke, its timing and the patient's condition. Where a clot is responsible, the aim is to restore blood flow if timing and circumstances allow. Where there is bleeding, the aim is different and includes controlling the bleed and pressure inside the brain. After the acute phase, rehabilitation begins — physiotherapy, speech and swallowing therapy where needed, and occupational therapy — and it is more effective when started promptly.

The medical team determines the plan, and outcomes vary between cases depending on the size and location of the injury and how quickly treatment began.

Prevention

• Check blood pressure regularly and follow the treatment plan if it is raised.
• Manage diabetes and cholesterol with your doctor.
• Stop smoking.
• Regular physical activity and a balanced, lower-salt diet.
• Follow up any heart rhythm disorder.
• Never stop or change a medication on your own — adjustments are made on your doctor's instruction.

Frequently Asked Questions

Does stroke only affect older people?

No. Likelihood increases with age, but stroke can occur in younger people — particularly where risk factors such as high blood pressure, smoking or clotting disorders are present. Sudden symptoms should be treated as an emergency at any age.

The symptoms went away on their own — should I still go to hospital?

Yes, and quickly. Symptoms that resolve may have been a transient ischaemic attack, which is a warning that a larger stroke could follow. Urgent assessment allows the cause to be identified and prevention started.

What is the difference between a clot and a bleed?

A clot means an artery is blocked; a bleed means blood is leaking from a vessel. They cannot be distinguished by symptoms alone — brain imaging determines which it is, and that is a key reason to reach hospital quickly.

Can a stroke happen again?

It can, particularly if risk factors remain uncontrolled. Following the monitoring and treatment plan your doctor sets markedly reduces the likelihood of recurrence.

How long does recovery take?

It varies considerably by case, depending on the size and location of the injury and how quickly treatment and rehabilitation began. Some people improve substantially; others need longer rehabilitation. Your medical team will explain what can realistically be expected in your case.

Can I tell it's a stroke without a scan?

No. The FAST test is a rapid recognition tool for suspecting a stroke and acting on it, but the final diagnosis and the type of stroke require medical assessment and imaging.

Neurosurgery consultation

If you need a specialist opinion after a stroke, or an assessment of your risk factors or a transient attack, you can book with Dr Ahmed El Ghannam, Neurosurgery Consultant at Town Hospital, or with the neurosurgery team. For emergencies, Town Hospital's emergency department is open 24 hours — Fifth Settlement, New Cairo. Hotline 15276.

This article is for general awareness and does not replace medical advice. If you suspect a stroke, go to the emergency department immediately.