Stroke: Recognising FAST and Why Minutes Matter

A stroke is a sudden interruption of blood supply to part of the brain, either because a vessel is blocked (ischaemic, about 85% of cases) or because it bursts (haemorrhagic). Around two million brain cells die every minute that a large vessel stays blocked.

Treatments exist that can dissolve or physically remove the clot, but they work within a window measured in hours. Most patients in India arrive well outside it.

Recognising a stroke: FAST

• F — Face: ask the person to smile. Does one side droop?
• A — Arms: ask them to raise both arms. Does one drift down?
• S — Speech: ask them to repeat a simple sentence. Is it slurred or jumbled?
• T — Time: if any of these are present, call an ambulance immediately and note the time symptoms started.

Other sudden symptoms that can indicate stroke:

• Sudden numbness or weakness of face, arm or leg, especially on one side
• Sudden confusion or difficulty understanding speech
• Sudden loss or blurring of vision in one or both eyes
• Sudden severe dizziness, loss of balance or coordination
• Sudden severe headache with no known cause, often described as the worst ever

What to do, and what not to do

Do:

• Call an ambulance straight away; an ambulance can pre-alert the stroke unit
• Note the exact time symptoms began, or the last time the person was seen normal. This single piece of information determines which treatments are possible.
• Lay the person down with head and shoulders slightly raised
• If unconscious but breathing, place them on their side
• Bring a list of their medications

Do not:

• Give aspirin. Unlike a heart attack, a stroke may be a bleed, and aspirin would make it worse. Only give it after a scan has ruled out haemorrhage.
• Give food or water. Swallowing is often impaired and fluid can enter the lungs.
• Wait to see if it improves
• Drive the person yourself if an ambulance is available

Why the time window matters

• Thrombolysis with clot-dissolving medication is generally possible within 4.5 hours of symptom onset
• Mechanical thrombectomy, physically removing the clot, can be effective up to 6 hours and in selected patients up to 24 hours with advanced imaging

Outside these windows, treatment becomes supportive and rehabilitation focused. This is why a stroke is an emergency in exactly the same sense as a heart attack.

Transient ischaemic attack

A TIA produces the same symptoms but they resolve within minutes to an hour. It is often dismissed because everything returns to normal. It should not be. The risk of a full stroke is highest in the days immediately afterwards, and urgent assessment with treatment can prevent it. A TIA is a warning that has been acted on successfully only if you go to hospital the same day.

Reducing risk

• Blood pressure is the largest single modifiable risk factor for stroke
• Atrial fibrillation, an irregular heartbeat, causes a large share of severe strokes and is often silent. An irregular pulse should be investigated; anticoagulation dramatically reduces risk.
• Stop smoking
• Control diabetes
• Treat high cholesterol
• Limit alcohol
• Regular physical activity
• Reduce salt intake
• Treat obstructive sleep apnoea

After a stroke

Recovery continues for months and sometimes years. Early, intensive and sustained rehabilitation, including physiotherapy, occupational therapy and speech therapy, makes a substantial difference. Secondary prevention with medication is lifelong, and depression after stroke is common, treatable and frequently missed.

When to act

Any sudden, unexplained neurological symptom, even if it passes, is a reason to seek emergency assessment the same day. Waiting until morning is the most common and most costly decision in stroke care.

This article is general health information and is not a substitute for emergency care. If you suspect a stroke, call emergency services immediately and note the time symptoms began.