Stroke symptoms NHS, causes, and treatment information

What to Do Immediately if You Suspect a Stroke

1. Call emergency services immediately.
2. Say that you suspect a stroke.
3. Record the time. Note when symptoms began or when the person was last known to be normal.
4. Keep the person safe. Help them sit or lie in a comfortable position without unnecessary walking.
5. Do not give anything by mouth. Stroke can impair swallowing.
6. Gather useful information. Prepare the medicine list, allergies, medical conditions, anticoagulant use, recent surgery, pregnancy status, and emergency contact information.
7. Follow dispatcher instructions.

Why the Last-Known-Well Time Matters?

Stroke teams use the time symptoms began or the last time the person was known to be normal when assessing treatment options.

For a person who wakes with symptoms, the last-known-well time may be when they were last seen without symptoms before sleep.

Do not delay the emergency call while trying to reconstruct every detail.

If Symptoms Occur During a Phone or Video Call

Call emergency services for the person’s location.

Stay connected when possible.

Ask someone nearby to unlock the door and remain with the person.

FAST Stroke Warning Signs

The NHS uses FAST to help the public recognize common stroke symptoms.

Face

Ask the person to smile.

Look for:

• One-sided facial drooping
• An uneven smile
• Numbness on one side
• Difficulty controlling saliva

Arms

Ask the person to raise both arms and keep them raised.

Look for:

• One arm drifting down
• Inability to lift one arm
• Sudden weakness
• Sudden numbness

Weakness can also affect one leg or one entire side of the body.

Speech

Ask the person to repeat a simple sentence.

Listen for:

• Slurred speech
• Incorrect words
• Speech that does not make sense
• Difficulty finding words
• Difficulty understanding what is said
• Sudden inability to speak

Time

Call emergency services immediately if any one FAST sign is present.

Do not wait to see whether it improves.

BE FAST and Other Stroke Symptoms

FAST identifies many strokes, but not every stroke causes obvious facial, arm, or speech changes.

BE FAST adds balance and eye symptoms.

Balance

Possible sudden symptoms include:

• Loss of balance
• Severe dizziness
• New unsteadiness
• Falling
• Difficulty coordinating movement

Dizziness alone has many causes.

It is more concerning when it begins suddenly or occurs with vision, speech, weakness, numbness, or severe headache.

Eyes

Possible signs include:

• Sudden blurred vision
• Sudden double vision
• Loss of vision in one eye
• Loss of part of the visual field
• Difficulty controlling eye movement

Other Sudden Symptoms

• Confusion
• Memory change
• Severe headache with no known cause
• Nausea or vomiting with neurologic symptoms
• Difficulty swallowing
• New clumsiness
• Sudden altered awareness

A severe sudden headache can also indicate bleeding around the brain.

Call emergency services.

When Stroke Symptoms Disappear: TIA

A transient ischemic attack is a temporary disruption of blood flow to the brain.

Symptoms can look exactly like a stroke.

They may last minutes or hours and then disappear.

There is no safe way to know at the beginning whether symptoms are a TIA or a major stroke.

NHS guidance says to call emergency services when stroke symptoms occurred within the previous 24 hours even when they have stopped.

A TIA is a warning that stroke risk may be high in the following days and weeks.

Evaluation may include:

• Brain imaging
• Blood-vessel imaging
• Heart-rhythm testing
• Blood-pressure evaluation
• Blood tests
• Medicine to prevent another clot when appropriate

Do not book a routine appointment and continue normal activity after possible TIA symptoms.

Seek emergency assessment.

What Not to Do During Possible Stroke Symptoms

Do Not Give Aspirin

Aspirin can help prevent or treat some clot-related events after a clinician confirms the situation.

It can worsen bleeding in the brain.

Do not give aspirin before brain imaging or emergency instructions.

Do Not Give Food or Drink

Stroke can impair swallowing.

Food, water, or tablets can enter the airway and lungs.

A swallowing screen is often needed before oral intake.

Do Not Lower Blood Pressure at Home

The safe blood-pressure approach depends on the stroke type, treatment plan, and other conditions.

Taking extra medicine can reduce brain blood flow or complicate treatment.

Do Not Let the Person Sleep It Off

Sleep does not treat a stroke.

Symptoms that seem mild can worsen.

Do Not Use Home Remedies

Do not use herbs, massage, exercise, caffeine, sugar, cold showers, or breathing techniques as stroke treatment.

Do Not Assume It Is Migraine, Low Sugar, Stress, or Intoxication

These conditions can resemble stroke.

Emergency teams can check glucose and other possible causes without delaying brain assessment.

Types of Stroke

Ischemic Stroke

An ischemic stroke happens when a clot blocks blood flow to part of the brain.

The clot may:

• Form in a narrowed brain or neck artery
• Travel from the heart
• Develop because of another blood-vessel condition

Ischemic stroke is the most common type.

Hemorrhagic Stroke

A hemorrhagic stroke occurs when a blood vessel ruptures.

Bleeding may occur:

• Inside the brain
• Around the brain in the space called the subarachnoid space

High blood pressure, aneurysm, blood-vessel abnormalities, trauma, and anticoagulant use can contribute.

Transient Ischemic Attack

A TIA causes temporary stroke-like symptoms without the same lasting pattern of brain injury.

It is still a medical emergency and a warning sign.

Stroke Mimics

Conditions that may resemble stroke include:

• Low blood glucose
• Seizure and post-seizure weakness
• Migraine with aura
• Inner-ear disease
• Brain tumor
• Infection
• Medication or drug effects
• Functional neurologic disorder

Only medical assessment can separate these safely.

What Causes a Stroke?

Stroke usually results from blood-vessel disease, a blood clot, or bleeding.

Important risk factors and causes include:

• High blood pressure
• Atrial fibrillation and other heart disease
• High LDL cholesterol
• Diabetes
• Smoking and tobacco exposure
• Previous TIA or stroke
• Carotid artery disease
• Sickle cell disease
• Obesity and physical inactivity
• Heavy alcohol use
• Sleep apnea
• Some autoimmune, blood, cancer, and infectious conditions
• Cocaine, amphetamines, and other stimulants
• Pregnancy-related high blood pressure

High Blood Pressure

High blood pressure is a major preventable stroke risk factor.

It can damage arteries and contributes to both ischemic and hemorrhagic stroke.

Atrial Fibrillation

Atrial fibrillation can allow a clot to form in the heart and travel to the brain.

Some people have no noticeable palpitations.

Pulse checks, ECG testing, or longer rhythm monitoring may be needed.

Carotid and Brain-Artery Disease

Plaque can narrow arteries that supply the brain.

Treatment depends on the degree of narrowing, symptoms, age, anatomy, and overall health.

Aneurysm and Blood-Vessel Abnormalities

An aneurysm is a weakened area in an artery.

If it ruptures, it can cause subarachnoid hemorrhage.

Arteriovenous malformations and other vessel abnormalities can also bleed.

Stroke in Women, Pregnancy, and the Postpartum Period

The core warning signs are the same in women and men.

Chest pain, hiccups, or generalized fatigue should not replace FAST or BE FAST screening.

Women may have additional risk factors, including:

• High blood pressure during pregnancy
• Preeclampsia
• Postpartum hypertension
• Some hormonal contraceptives
• Migraine with aura
• Pregnancy-related blood clots
• Atrial fibrillation later in life

Pregnancy-related stroke can occur during pregnancy or after birth.

Call emergency services for sudden:

• Facial drooping
• One-sided weakness or numbness
• Speech difficulty
• Vision loss
• Severe headache
• Seizure
• Confusion
• Balance loss

Do not assume a severe postpartum headache is caused by lack of sleep, an epidural, stress, or migraine without urgent assessment when neurologic symptoms are present.

Stroke Can Affect Younger Adults and Children

Stroke risk rises with age, but stroke can happen at any age.

Possible causes in younger people include:

• Artery dissection
• Congenital heart disease
• Blood-clotting disorders
• Sickle cell disease
• Autoimmune disease
• Pregnancy
• Stimulant drug use
• Infection
• Trauma
• Inherited vascular conditions

Children may show:

• Sudden one-sided weakness
• Speech or language change
• Seizure
• Severe headache
• Balance or coordination change
• Altered alertness

Emergency assessment is required.

How Stroke Is Diagnosed

Stroke teams need to determine:

• Whether a stroke occurred
• Whether it is caused by blockage or bleeding
• Which blood vessel and brain area are involved
• When symptoms began
• Whether emergency treatment is safe
• What caused the event

Brain Imaging

A CT scan is commonly used quickly to look for bleeding.

MRI can show areas of brain injury in more detail.

CT angiography or MR angiography can show blocked or narrowed blood vessels.

Perfusion imaging may help select some patients for advanced treatment.

Blood Tests

Tests may assess:

• Blood glucose
• Blood count
• Clotting
• Kidney function
• Electrolytes
• Cholesterol
• Other possible causes

Heart and Blood-Vessel Tests

Testing may include:

• ECG
• Continuous heart-rhythm monitoring
• Echocardiogram
• Carotid ultrasound
• Longer rhythm monitoring after discharge

A normal early test does not always end the evaluation.

Emergency Treatment for Ischemic Stroke

The 2026 AHA and American Stroke Association guideline updates treatment for acute ischemic stroke.

Eligibility depends on symptoms, timing, brain imaging, bleeding risk, blood pressure, medicine history, vessel location, age, and other factors.

Intravenous Thrombolysis

A clot-dissolving medicine may be used for eligible patients.

Current options can include alteplase or tenecteplase according to the treatment system and patient criteria.

Treatment is time-sensitive.

Some eligible patients can receive intravenous thrombolysis within four and a half hours of symptom onset.

Never delay the emergency call while trying to decide whether the person is in the treatment window.

Mechanical Thrombectomy

Thrombectomy uses a catheter-based device to remove a clot from a large artery.

It can benefit selected patients with a large-vessel blockage.

The 2026 guideline broadens eligibility for some patients based on clinical and imaging findings.

Some people who present later or wake with symptoms may still qualify.

Only a stroke team can decide.

Antiplatelet Medicine

Aspirin or another antiplatelet may be started after imaging confirms that it is safe.

Timing depends on whether thrombolysis was given and other clinical factors.

Do not start it at home.

Anticoagulation

People with atrial fibrillation or another clot source may need anticoagulant medicine to prevent another stroke.

The timing after a stroke is individualized because starting too early can increase bleeding risk.

Emergency Treatment for Hemorrhagic Stroke

Treatment aims to control bleeding, pressure, and complications.

It may include:

• Care in a specialist stroke, neurologic, or intensive-care unit
• Careful blood-pressure management
• Reversal of anticoagulant effects
• Treatment of abnormal clotting
• Medicine or procedures to control brain pressure
• Neurosurgery in selected cases
• Aneurysm clipping or endovascular coiling
• Treatment of seizures when present

The correct treatment depends on the location, amount of bleeding, cause, neurologic condition, medicine use, and overall health.

Aspirin and anticoagulants can worsen some hemorrhagic strokes.

Early Hospital Care and Stroke Complications

Stroke care may also address:

• Airway and breathing
• Blood glucose
• Fever and infection
• Swallowing safety
• Nutrition and hydration
• Blood-clot prevention
• Pressure-area protection
• Bladder and bowel care
• Mobility
• Depression, anxiety, and delirium

Swallowing Assessment

Stroke can cause dysphagia.

A swallowing screen should occur before food, drink, or oral medicine when swallowing safety is uncertain.

Aspiration can cause pneumonia.

Brain Swelling

Large strokes can cause dangerous swelling.

Some patients require intensive monitoring or surgery.

Seizures

A seizure can occur during or after a stroke.

Treatment is based on the individual situation.

Routine seizure medicine is not required for every stroke survivor.

Stroke Recovery and Rehabilitation

Recovery differs between people.

It depends on:

• Stroke location and size
• Treatment speed
• Age and previous health
• Complications
• Access to rehabilitation
• Family and community support

NINDS states that rehabilitation often begins in the hospital after the person is medically stable.

Physical Therapy

Physical therapy may help with:

• Strength
• Balance
• Walking
• Transfers
• Preventing falls

Occupational Therapy

Occupational therapy may support:

• Dressing
• Eating
• Bathing
• Home adaptations
• Returning to work or hobbies

Speech and Language Therapy

Therapy may address:

• Speaking
• Understanding language
• Reading and writing
• Communication aids
• Swallowing

Cognitive and Emotional Recovery

Stroke can affect:

• Memory
• Attention
• Planning
• Emotion control
• Mood
• Sleep

Depression, anxiety, grief, and personality changes need support and treatment.

Recovery Is Not a Fixed Timeline

Some recovery occurs quickly.

Other progress continues for months or years.

Avoid promises about full recovery.

The rehabilitation plan should be individualized.

How to Reduce Stroke Risk

The 2024 AHA and American Stroke Association primary-prevention guideline emphasizes screening and treating major risk factors.

Control Blood Pressure

High blood pressure is one of the most important modifiable stroke risks.

Use accurate monitoring and take prescribed medicine consistently.

Detect and Treat Atrial Fibrillation

Atrial fibrillation may require anticoagulation based on stroke and bleeding risk.

Do not take aspirin instead of prescribed anticoagulation unless the clinician advises it.

Manage Cholesterol

Statin or other lipid-lowering treatment may be recommended according to cardiovascular risk and stroke cause.

Manage Diabetes

Work with the care team on glucose, blood pressure, kidney health, cholesterol, eating, activity, and medicine.

Do Not Smoke

Smoking damages blood vessels and increases clot and bleeding risks.

Ask for cessation support.

Use a Heart-Healthy Eating Pattern

A Mediterranean or DASH-style eating pattern may support blood pressure, cholesterol, glucose, and weight management.

Be Physically Active

Activity recommendations depend on age, disability, pregnancy, cardiovascular health, and previous stroke.

Stroke survivors should follow a rehabilitation or clinician-approved plan.

Limit or Avoid Alcohol

Heavy alcohol use increases stroke risk.

Do not begin drinking for cardiovascular health.

Treat Sleep Apnea

Sleep apnea is linked with high blood pressure, atrial fibrillation, and stroke risk.

Seek testing for loud snoring, witnessed breathing pauses, gasping, daytime sleepiness, or resistant hypertension.

Take Prescribed Medicine

Do not stop:

• Blood-pressure medicine
• Antiplatelet medicine
• Anticoagulant medicine
• Cholesterol medicine

without medical advice.

Do Not Start Preventive Aspirin on Your Own

Aspirin can cause serious bleeding and is not appropriate for every person.

Prevention medicine must match individual risk and stroke cause.

Common Stroke Myths

Myth: Stroke Always Causes Pain

No. Many strokes are painless.

Myth: You Need All FAST Symptoms

No. One sign is enough to call emergency services.

Myth: Symptoms That Disappear Are Safe

No. They may represent a TIA and require emergency assessment.

Myth: Aspirin Should Be Given Immediately

No. Aspirin may worsen bleeding and should not be given before professional assessment.

Myth: Stroke Only Affects Older Adults

No. Stroke can occur at any age.

Myth: Women Have a Completely Different Symptom List

No. FAST and other sudden neurologic symptoms apply to all sexes.

Myth: A Person Should Drive to the Hospital

No. Call an ambulance so emergency assessment can begin and the hospital can prepare.

Myth: A Stroke Can Be Diagnosed at Home

No. Brain imaging and medical evaluation are needed.

Myth: Recovery Stops After a Few Months

No. Improvement can continue with rehabilitation and adaptation.