Foundations
What is a stroke?
A stroke happens when blood flow to part of the brain is suddenly cut off — either by a blocked artery (ischemic stroke, ~85% of strokes) or by bleeding (hemorrhagic stroke, ~15%). Brain tissue starts dying within minutes, which is why the speed of treatment matters more than almost anything else in medicine.
Warning signs
BE-FAST
- Balance — sudden loss of balance or coordination
- Eyes — sudden vision change in one or both eyes
- Face — one side of the face droops
- Arm — one arm drifts down when raised
- Speech — slurred, garbled, or unable to speak
- Time — call 911 right away. Note the time.
Types
Ischemic vs hemorrhagic
Ischemic strokes are caused by a clot blocking a brain artery. Treatments include clot-busting medication (thrombolysis) and physical clot removal (thrombectomy). Hemorrhagic strokes are caused by bleeding inside or around the brain. Treatment focuses on stopping the bleed and controlling pressure.
Warning episode
TIA — mini-stroke
A transient ischemic attack (TIA) is stroke-like symptoms that resolve within minutes to hours. It is not harmless — it is a major warning that a full stroke may follow within days. Urgent evaluation and prevention treatment can dramatically reduce that risk.
Acute treatment
Thrombolysis: alteplase & tenecteplase
IV clot-busting drugs given within 4.5 hours of symptom onset (and in select cases, longer) can dissolve the clot and restore blood flow. Tenecteplase (TNK) is increasingly used as a single-bolus alternative to alteplase. Eligibility depends on time, imaging, and bleeding risk.
Acute treatment
Mechanical thrombectomy
For large-vessel strokes, an interventional neuroradiologist threads a catheter to the clot and physically removes it. The window can extend up to 24 hours when advanced imaging shows salvageable brain tissue. It is one of the most effective treatments in modern medicine.
After the event
Recovery
Stroke recovery happens over months to years, with the steepest gains in the first 3-6 months. Inpatient rehab, outpatient therapy, speech-language pathology, and home exercise programs each have a role. Recovery is not linear — plateaus are normal; progress continues with effort.
After the event
Secondary prevention
Once you have had a stroke, the highest priority is preventing the next one. Pillars: blood-pressure control, antithrombotic therapy (aspirin, clopidogrel, or anticoagulation if AFib), statin therapy, diabetes control, and treating any structural cause — carotid disease, PFO, AFib.
Conversation
Questions to ask the stroke team
What kind of stroke was it? What caused it? What is the plan to prevent another? What medications am I going home on, and why? What therapy is being arranged? What warning signs should bring me back to the hospital? See the patient guides for a full discharge checklist.