The Vascular Brain
For Patients & Families

Patient Guides.

Stroke explained in plain language — what to do during symptoms, what happens at the hospital, how recovery works, and how to lower the chance of another stroke.

If you or someone with you may be having a stroke right now — call 911 immediately. Do not drive yourself. Do not wait to see if symptoms pass. Note the time symptoms started.

Guide 01

What to do during stroke symptoms

Strokes are time-critical. The treatments that restore brain function only work in a limited window — the sooner you arrive at the hospital, the more brain can be saved.

  • Call 911. Do not drive yourself or have a family member drive you — paramedics start treatment in the ambulance and route to the closest stroke-ready hospital.
  • Note the time symptoms started, or the last time the person was known to be normal.
  • Do not give aspirin, food, or water — the team needs to know whether the stroke is from a clot or a bleed first.
  • Stay with the person. Keep them as calm and still as possible.
Guide 02

What happens in the emergency department

A "code stroke" is called — meaning a whole team converges to evaluate and treat as fast as possible. Expect:

  • A rapid neurological exam (the NIHSS) at the bedside.
  • A CT scan of the head within minutes — first to rule out bleeding.
  • If it is an ischemic (clot) stroke, IV clot-busting medication (tPA or TNK) may be given.
  • If a large vessel is blocked, an angiogram and possibly mechanical thrombectomy (clot removal) will be done.
  • Admission to a stroke unit or neuro-ICU for close monitoring.
Guide 03

The first 24 hours after stroke

The first day is about close monitoring and starting the workup to find what caused the stroke. Common pieces:

  • Frequent neuro checks — nurses will wake the patient repeatedly to test strength, speech, and vision.
  • Blood pressure monitoring — targets are tightly controlled and depend on whether thrombolysis or thrombectomy was done.
  • Swallow evaluation — nothing by mouth until safe swallowing is confirmed.
  • Telemetry for heart rhythm, basic labs, and a follow-up brain scan (often MRI) to see the stroke in detail.
  • The team will start talking about rehab and what kind of facility may be needed.
Guide 04

Common tests after a stroke

Finding the cause shapes the prevention plan. Expect a combination of:

  • Vessel imaging — CT or MR angiography to look at the arteries supplying the brain.
  • Heart rhythm monitoring — to look for atrial fibrillation, a common stroke cause.
  • Echocardiogram — an ultrasound of the heart to look for clots, holes, or weak pumping.
  • Labs — cholesterol panel, blood sugar (A1C), and others depending on the case.
  • In younger patients or unclear cases — extra tests for clotting disorders, blood-vessel inflammation, or dissection.
Guide 05

Rehab and recovery

Most stroke recovery happens in the first 3 to 6 months, but improvement can continue for years with consistent effort. The team usually includes physical therapy, occupational therapy, and speech-language pathology.

  • Inpatient rehab — intensive therapy 3+ hours/day, usually 2-3 weeks, for patients who can tolerate it.
  • Skilled nursing facility — lighter therapy load for those who need more medical support.
  • Outpatient therapy — continues progress after discharge, often for weeks to months.
  • Common challenges — fatigue, depression, post-stroke pain, aphasia, swallowing changes. Each has treatment.
  • Plateaus are normal. They are not the end of recovery.
Guide 06

Preventing another stroke

After a stroke, the most important medical goal is preventing the next one. The plan depends on what caused the first stroke, but usually includes:

  • Blood pressure control — the single highest-impact prevention step.
  • An antithrombotic medication — aspirin, clopidogrel, or anticoagulation if AFib is present.
  • A statin — even when cholesterol numbers look fine.
  • Treating contributing conditions — diabetes, sleep apnea, smoking, alcohol use.
  • Diet, activity, and weight — the harder but high-yield long-term work.
Guide 07

Questions to ask before discharge

Before you leave the hospital, you should have clear answers to each of these. Bring this list to your discharge conversation:

  • What kind of stroke did I have? Where in the brain?
  • What caused it? If you don't know yet, what's the plan to find out?
  • What medications am I going home on, and why each one?
  • What is my blood-pressure target?
  • What rehab or therapy is being arranged?
  • Which doctor will follow my stroke care — and when is the first appointment?
  • What warning signs should bring me back to the hospital?
  • Are there activities I should avoid — driving, work, exercise — and for how long?

These guides are for education. They do not replace advice from your stroke team, who knows your specific situation.