Health condition · Clinically reviewed
Stroke: the guide that answers what to do next.
A stroke is a medical emergency. If you spot any FAST sign — Face drooping, Arm weakness or Speech difficulty — call 999. Time changes outcomes more than any other decision.
Why this guide matters
- 01
Time is brain
Every minute of a stroke, about 1.9 million brain cells die. Treatment works best in the first hour.
- 02
FAST is not everything
Sudden vision loss, vertigo with clumsiness or a thunderclap headache are also stroke signs.
- 03
A TIA is a chance
Symptoms that resolve within a day still need same-day assessment. That is when a full stroke is most preventable.
Key facts
Stroke in six numbers and phrases.
The essentials to hold onto: what it is, how common, and the windows that matter.
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What it is
A sudden interruption of blood supply to part of the brain — either a clot (ischaemic) or a bleed (haemorrhagic).
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How common
Around 100,000 strokes a year in the UK; a leading cause of long-term disability.
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Time window
Clot-busting drugs work up to 4.5 hours from onset. Some clot-removal procedures up to 24 hours.
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Warning shot
A TIA (mini-stroke) resolves within 24 hours but signals a much higher stroke risk in the next days.
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Diagnosis
CT or MRI of the brain within an hour of arrival at hospital to identify clot vs bleed.
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Prevention
Treating high blood pressure, AF and cholesterol prevents most strokes.
Diagnosis
From first sign to treatment — what happens, in order.
The stroke pathway is time-critical. Here is what a hyperacute stroke unit does in the first hours.
Phase 1 · First hour
999 to imaging
Phase 2 · Treatment
Clot-busting or clot removal
Phase 3 · Next
Cause and rehab
- 01
First hour
Symptoms appear suddenly
Face drooping, arm weakness or speech difficulty — the FAST signs. Note the time they started.
- 02
First hour
999 activates the stroke pathway
Ambulance crews recognise stroke and pre-alert the nearest hyperacute stroke unit.
- 03
First hour
Imaging within the hour
CT (and sometimes MRI) confirms stroke and distinguishes clot from bleed — determining treatment.
- 04
Treatment
Clot-busting (thrombolysis)
If ischaemic and within 4.5 hours: an IV clot-busting drug (alteplase or tenecteplase).
- 05
Treatment
Clot removal (thrombectomy)
For large-vessel clots, catheter removal of the clot — up to 24 hours in selected cases.
- 06
Next
Cause identified
Blood tests, ECG, echocardiogram and carotid imaging look for the underlying cause.
- 07
Next
Rehabilitation begins early
Physio, speech and language, occupational therapy — starting within days.
Symptoms
The signs that mean call 999 now.
FAST catches most strokes. A handful of other signs — vision, balance, thunderclap headache — matter just as much.
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Face drooping
One side of the face weakens or sags — ask the person to smile.
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Arm weakness
Numbness or weakness in one arm — ask them to raise both arms.
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Speech difficulty
Slurred, jumbled or absent speech — ask them to repeat a simple sentence.
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Sudden loss of vision
A curtain across one eye, or double vision — a stroke sign that FAST misses.
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Sudden loss of balance
Vertigo with clumsiness, especially with other symptoms — a posterior stroke sign.
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Thunderclap headache
Worst-ever, sudden-onset headache — possible bleed on the brain.
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A TIA that resolves
Symptoms that come and go within a day still need same-day assessment — a large stroke often follows.
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What to do
Call 999. Do not drive. Note the time symptoms started — it decides which treatments are still on the table.
Treatment
What the stroke team can offer.
The treatments that reopen a blocked artery, prevent the next stroke, and rebuild what was lost.
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Thrombolysis
IV clot-busting drug within 4.5 hours of onset for ischaemic stroke.
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Thrombectomy
Catheter clot removal for large-vessel stroke — up to 24 hours in selected patients.
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Aspirin & antiplatelet
Started immediately after ischaemic stroke; long-term antiplatelet or anticoagulant chosen by cause.
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Blood-pressure control
Careful lowering during the acute phase and long-term thereafter.
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Statin
Started for all ischaemic strokes to reduce recurrence risk.
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Anticoagulation for AF
If atrial fibrillation is found, a DOAC replaces antiplatelet therapy.
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Carotid endarterectomy
Surgery on a significantly narrowed neck artery, when relevant.
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Rehabilitation
Physiotherapy, speech therapy and occupational therapy — starting early and continuing in community.
Red flags
When it is a 999 call, not a GP appointment.
Any of these mean the phone comes out and 999 is dialled. Do not wait, do not drive.
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FAST signs — any one
Face, Arm, Speech — Time. Call 999 immediately. Do not wait to see if it passes.
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Thunderclap headache
Sudden worst-ever headache — possible subarachnoid haemorrhage. Call 999.
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Sudden loss of vision
In one eye or one half of the visual field — urgent assessment.
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Sudden vertigo with weakness
Especially with clumsiness or double vision — a posterior stroke sign.
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Symptoms that resolved within 24 hours
A TIA. Even if you feel fine now, same-day assessment reduces the risk of the stroke that often follows.
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Confusion or altered awareness
New confusion in an older adult — stroke is one of several urgent causes.
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A seizure with weakness
Can accompany a stroke — urgent assessment.
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Pregnancy
Any stroke-like symptoms in pregnancy or the first weeks after birth — call 999.
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Anticoagulation and head injury
Even minor — a bleed can develop inside the skull. Go to A&E.
Living with it
After the acute phase — the long arc.
Recovery is measured in months. Preventing the next one starts in hospital and continues at home.
- 01 Recovery
Progress in months, not days
The steepest recovery is in the first three months, but improvement continues for a year or more.
- 02 Prevention
The second stroke is preventable
Controlling blood pressure, cholesterol, AF and lifestyle cuts recurrence sharply.
- 03 Driving
A break, then a reassessment
DVLA rules require at least a month off driving after most strokes.
- 04 Mood & memory
Not just physical
Low mood and fatigue are common after stroke. Both are treatable — ask.
Sources
What this guide is based on.
Current UK guidance, plus the patient organisations that support people after stroke.
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NICE. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128).
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Stroke Association. Patient information and support.
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National Clinical Guideline for Stroke (Royal College of Physicians).
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NHS. Stroke: symptoms and treatment.
Frequently asked
Everything we get asked about stroke.
Quick answers on FAST, TIA, thrombolysis, thrombectomy, causes and recovery.
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What are the FAST signs of a stroke?
Face drooping, Arm weakness, Speech difficulty — Time to call 999. If any one is present, call an ambulance immediately.
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What is a TIA?
A transient ischaemic attack: stroke-like symptoms that fully resolve within 24 hours. It is a serious warning — assess urgently, because a full stroke often follows within days.
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Ischaemic vs haemorrhagic stroke?
Ischaemic strokes (about 85%) are caused by a clot; haemorrhagic strokes by a bleed. Imaging tells them apart because the treatments are opposite.
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What is thrombolysis?
A clot-busting drug given intravenously up to 4.5 hours after ischaemic stroke onset. It can significantly reduce disability if given in time.
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What is thrombectomy?
A procedure to physically remove a large clot from a brain artery, delivered through a catheter. Available for selected patients up to 24 hours after onset.
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Do I need imaging first?
Yes — because clot-busting drugs are dangerous in a haemorrhagic stroke. A CT or MRI is done within the first hour of arriving at hospital.
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What causes strokes?
Most are caused by clots from atrial fibrillation, narrowed neck arteries, high blood pressure, high cholesterol, diabetes or smoking. Some are due to a bleed from a weakened vessel.
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How can I lower my stroke risk?
Treat high blood pressure and AF, stop smoking, exercise, keep cholesterol low, moderate alcohol and manage diabetes.
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When can I drive again after a stroke?
DVLA rules require at least one month off driving after most strokes, longer for others. Your GP or stroke team advises.
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Why am I so tired afterwards?
Post-stroke fatigue is common and often underestimated. It usually improves over months and should be actively discussed with your team.
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