Summary

Acute stroke is sudden loss of brain function due to interrupted blood supply to the brain, causing brain cell death and neurological deficits. Think of your brain as needing constant blood supply—when a blood vessel to the brain gets blocked (ischemic stroke) or bursts (hemorrhagic stroke), brain cells downstream don't get enough blood and die, causing symptoms like weakness, speech problems, or vision loss. Stroke is a medical emergency and a leading cause of death and disability worldwide. There are two main types: ischemic (80-85%—blocked artery, usually by a clot) and hemorrhagic (15-20%—bleeding into or around the brain). The key to management is recognizing stroke quickly (FAST—Face, Arm, Speech, Time), confirming the diagnosis (clinical assessment, CT scan to rule out hemorrhage), classifying the type (ischemic vs hemorrhagic), and providing urgent treatment (thrombolysis or thrombectomy for ischemic stroke if within time window, blood pressure control for hemorrhagic stroke). Early recognition and prompt treatment are essential—time is brain, and every minute of delay means more brain cells die.

Key Facts

• Definition: Sudden loss of brain function due to interrupted blood supply
• Incidence: Very common (hundreds of thousands of cases/year worldwide)
• Mortality: 10-20% overall, higher if delayed treatment
• Peak age: Older adults (60+ years), but can occur at any age
• Critical feature: Sudden neurological deficits, time-sensitive treatment
• Key investigation: Clinical assessment (FAST), CT scan, MRI
• First-line treatment: Thrombolysis/thrombectomy (ischemic), blood pressure control (hemorrhagic)

Clinical Pearls

"Time is brain" — Every minute of delay in treatment means more brain cells die. For ischemic stroke, aim for door-to-needle time <60 minutes or door-to-groin time <90 minutes.

"FAST saves lives" — FAST (Face drooping, Arm weakness, Speech problems, Time to call 999) helps recognize stroke quickly. Don't delay—call 999 immediately.

"CT first to rule out hemorrhage" — All patients with suspected stroke need a CT scan immediately to rule out hemorrhage before giving thrombolysis. Don't skip this.

"Ischemic vs hemorrhagic matters" — Ischemic stroke (blocked artery) may get thrombolysis/thrombectomy. Hemorrhagic stroke (bleeding) needs blood pressure control, may need surgery. Treatment is opposite—don't mix them up.

Why This Matters Clinically

Stroke is a leading cause of death and disability worldwide and requires urgent recognition and treatment. Early recognition (especially FAST), prompt diagnosis (CT scan), and urgent treatment (thrombolysis/thrombectomy for ischemic, blood pressure control for hemorrhagic) are essential. This is a condition that emergency clinicians and neurologists manage, and prompt treatment saves lives and prevents disability.

Structured Approach: ABCDE

A - Airway

• Assessment: May be compromised (if decreased consciousness, swallowing problems)
• Action: Secure if compromised

B - Breathing

• Look: Usually normal (may have problems if brainstem affected)
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal
• Feel: Pulse (usually normal), BP (may be high)
• Listen: Heart sounds (usually normal)
• Measure: BP (may be high), HR
• Action: Monitor, control BP if needed

D - Disability

• Assessment: Neurological status (GCS, deficits)
• Action: Assess severity

E - Exposure

• Look: Full neurological examination
• Feel: Assess strength, sensation
• Action: Complete examination

Specific Examination Findings

Neurological Examination:

• GCS: Assess consciousness
• Cranial nerves: Check all
• Motor: Check strength (face, arms, legs)
• Sensation: Check sensation
• Speech: Check speech
• Vision: Check vision
• Balance: Check balance, coordination

Stroke Scales:

• NIHSS: Assesses severity
• FAST: Quick recognition

Special Tests

Natural History (Without Treatment)

Untreated Stroke:

• High mortality: 20-30% mortality
• Disability: High risk
• Poor outcomes: If not treated

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes (especially thrombolysis/thrombectomy)
• Small stroke: Better outcomes
• Young, healthy: Better outcomes
• Good rehabilitation: Better outcomes

Poor Prognosis:

• Delayed treatment: Higher mortality, more disability
• Large stroke: Higher mortality, more disability
• Older, comorbidities: May have worse outcomes
• Poor rehabilitation: Worse outcomes

Prognostic Factors

Key Guidelines

1. AHA/ASA Guidelines (2023) — Guidelines for the early management of patients with acute ischemic stroke. American Heart Association

Key Recommendations:

• FAST recognition
• CT within 25 minutes
• Thrombolysis within 4.5 hours
• Thrombectomy if large vessel
• Evidence Level: 1A

2. NICE Guidelines (2023) — Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. National Institute for Health and Care Excellence

Key Recommendations:

• Similar to AHA/ASA
• Evidence Level: 1A

Landmark Trials

Multiple studies on thrombolysis, thrombectomy, outcomes.

Evidence Strength

What is a Stroke?

A stroke is when part of your brain stops working because it doesn't get enough blood. Think of your brain as needing constant blood supply—when a blood vessel to the brain gets blocked (ischemic stroke) or bursts (hemorrhagic stroke), brain cells don't get enough blood and die, causing symptoms like weakness, speech problems, or vision loss.

In simple terms: Part of your brain has stopped working because it's not getting enough blood. This is serious and needs urgent treatment, but with prompt treatment, many people recover well.

Why does it matter?

Stroke is a leading cause of death and disability worldwide and requires urgent treatment. Early recognition (especially FAST) and prompt treatment are essential. The good news? With prompt treatment, especially if treated quickly, many people recover well.

Think of it like this: It's like part of your brain not getting enough blood—it needs urgent treatment to restore blood flow, but once treated, many people recover well.

How is it treated?

1. Immediate Recognition (FAST):

• FAST: Face (drooping), Arm (weakness), Speech (problems), Time (call 999)
• Why: To recognize stroke quickly and get help immediately

2. Diagnosis:

• CT scan: You'll have a CT scan immediately to see what type of stroke you have
• Why: To see if it's a blocked artery (ischemic) or bleeding (hemorrhagic), as treatment is different

3. Treatment:

• If ischemic (blocked artery): You may get a medicine to dissolve the clot (thrombolysis) or a procedure to remove the clot (thrombectomy), if you're within the time window (usually within 4.5-24 hours)
• If hemorrhagic (bleeding): Your doctor will control your blood pressure and may need to do surgery
• Why: To restore blood flow (ischemic) or stop bleeding (hemorrhagic)

4. Supportive Care:

• Monitoring: You'll be monitored closely for complications
• Rehabilitation: You'll start rehabilitation early to help you recover
• Medicines: You'll get medicines to prevent another stroke

The goal: Restore blood flow (ischemic) or stop bleeding (hemorrhagic), prevent complications, and help you recover.

What to expect

Recovery:

• Treatment: Usually starts immediately
• Hospital stay: Usually days to weeks
• Recovery: Most people start improving within days to weeks, but full recovery may take months

After Treatment:

• Rehabilitation: You'll do rehabilitation (physical therapy, speech therapy, etc.) to help you recover
• Medicines: You'll need to take medicines long-term to prevent another stroke (aspirin, blood thinners, cholesterol medicine, blood pressure medicine, etc.)
• Lifestyle changes: You'll need to make lifestyle changes (stop smoking, healthy diet, exercise)
• Follow-up: Regular follow-up to monitor your recovery and prevent another stroke

Recovery Time:

• Acute phase: Usually days to weeks
• Full recovery: Usually weeks to months (varies, some people have permanent deficits)
• Long-term: Ongoing management, rehabilitation

When to seek help

Call 999 (or your emergency number) immediately if:

• You have sudden face drooping (one side)
• You have sudden arm or leg weakness (one side)
• You have sudden speech problems (slurred, can't speak)
• You have sudden vision loss (one eye or field)
• You have sudden balance problems or dizziness
• You have any sudden neurological symptoms
• You think you or someone else is having a stroke

See your doctor if:

• You have symptoms that concern you
• You have risk factors for stroke and develop symptoms
• You have a known stroke and develop new symptoms

Remember: If you have sudden face drooping, arm weakness, or speech problems, especially if it's on one side, call 999 immediately. Stroke is serious, but with prompt treatment, especially if treated quickly, many people recover well. Don't delay—time is brain, and every minute counts. Use FAST: Face, Arm, Speech, Time to call 999.