Stroke & Cerebrovascular Disease

BE FAST stands for: Balance — sudden loss of balance or coordination. Eyes — sudden blurred or double vision, or loss of vision in one eye. Face — ask the person to smile; one side drooping or numb. Arms — ask them to raise both arms; one drifts downward or is weak. Speech — slurred, garbled, or unable to speak or understand. Time — if any one of these signs is present, call an ambulance immediately and note the exact time symptoms started. Do not give water, food, or medication. Do not drive to a small nursing home — go directly to the nearest hospital with a CT scanner and neurologist. Every minute of delay is irreversible brain loss.

For ischemic stroke (clot): intravenous tPA (clot-buster) can be given up to 4.5 hours from symptom onset — earlier is always better. For large vessel occlusions, mechanical thrombectomy (catheter-based clot removal) can be performed up to 24 hours in carefully selected patients — this procedure is now available at major Indian stroke centres. For haemorrhagic stroke (bleed): no clot-buster — treatment focuses on controlling blood pressure, reversing any blood thinners, and sometimes surgical drainage. Both types need CT scan to distinguish them before any treatment — which is why going directly to a well-equipped hospital matters. A nursing home without a CT scanner cannot begin treatment.

It depends on which brain area was affected, how much tissue was lost, and how quickly treatment was given. Some patients recover completely, particularly those with small strokes treated rapidly. Rehabilitation — physiotherapy for movement, speech therapy for language and swallowing, occupational therapy for daily activities — is the cornerstone of recovery and should begin within 24-48 hours of stabilisation. The brain has significant plasticity, especially in the first 3-6 months — this is the window of fastest improvement. Recovery continues more slowly for 1-2 years. Family involvement in rehab, home-based exercises, and maintaining motivation through a long process significantly affect outcomes.

A transient ischaemic attack (TIA) is caused by a brief blockage of a brain artery that resolves within minutes to hours — leaving no permanent damage. The symptoms are identical to stroke (weakness, speech change, vision loss) but resolve completely. A TIA is a serious warning: roughly 10% of TIA patients have a full stroke within 90 days, with the highest risk in the first 48 hours. A TIA is not 'nothing happened' — it is a medical emergency requiring same-day evaluation (brain imaging, ECG, echocardiogram, blood tests) and starting appropriate prevention (antiplatelet or anticoagulant medication, blood pressure and cholesterol control). Never dismiss a temporary neurological episode.

Blood pressure control is the single biggest lever — keeping BP below 130/80 reduces stroke risk by about 40%. Beyond that: treat atrial fibrillation with anticoagulants (AF is a major stroke cause), manage diabetes and high cholesterol, stop tobacco entirely (including gutka and chewing forms), exercise 150 minutes per week, maintain a healthy weight, drink alcohol only moderately. Aspirin is used for secondary prevention (after a stroke or TIA) not routine primary prevention in most people. If you have had a TIA or stroke, statins and antiplatelets or anticoagulants are part of standard prevention — take them consistently. These measures together prevent approximately 80% of strokes.