How to spot a stroke and administer first aid? Doctor gives steps

World Stroke Day is observed annually on October 29 by the World Health Organisation (WHO). Marking its 20th anniversary, this year's theme, 'The Time is Now / #StrokeActionNow', underscores the urgency of recognising symptoms early, seeking prompt medical intervention, and preventing stroke. Stroke, or brain attack, remains the leading cause of physical disability and the third leading cause of death globally. Raising awareness about emergency protocols, recovery options, and long-term care is vital to reducing its severe burden.

What is a stroke?
A stroke is a time-critical medical emergency that occurs when blood flow to a region of the brain is interrupted, depriving brain cells of vital oxygen and nutrients. Globally, around 12 million people suffer a stroke each year, leaving approximately 5 million individuals with long-term disabilities. In India, an estimated 148 out of every 100,000 people suffer a stroke annually, while in Kerala, the incidence rate ranges between 128 and 140 per 100,000. Worldwide, a stroke occurs every three to four seconds, and one in four people over the age of 25 will experience a stroke in their lifetime. About 20 per cent of strokes occur immediately upon waking in the morning.

The three primary types of stroke
Understanding the specific type of stroke is crucial for administering appropriate emergency treatment.

Ischaemic stroke
Accounting for roughly 85 per cent of all cases, an ischaemic stroke occurs when a blood clot blocks an artery supplying blood to the brain. This blockage is often caused by fatty deposits, known as plaque, building up along the inner walls of blood vessels in the neck or brain.

Haemorrhagic stroke
This type occurs when a weakened blood vessel in the brain leaks or ruptures, causing bleeding directly into the surrounding brain tissue.

Transient ischaemic attack (TIA)
Often referred to as a mini-stroke, a TIA occurs when blood flow to part of the brain is temporarily blocked. While symptoms mirror those of an ischaemic stroke, they typically resolve within five minutes to an hour without causing permanent brain damage. However, a TIA is a serious neurological emergency and acts as a critical warning sign of a potential major stroke in the future. Symptoms may include sudden memory loss (transient global amnesia), temporary loss of vision in one eye, transient weakness or numbness in an arm or leg, or sudden loss of balance.

Spotting symptoms: The FAST protocol and immediate first aid
The FAST acronym is a simple, effective tool designed to help the public recognise stroke symptoms instantly and act without delay:
• F (Face): Sudden weakness or drooping on one side of the face.
• A (Arms): Sudden weakness, numbness, or inability to raise one arm.
• S (Speech): Slurred speech, difficulty speaking, or inability to understand words.
• T (Time): Time is critical. Call emergency medical services immediately if any of these signs appear.

While waiting for an emergency ambulance, keep the patient calm and reassured. Position them with their head slightly elevated and tilted to one side. Do not offer any food, water, or medication, as impaired swallowing can lead to choking. Loosen tight clothing and check their breathing and pulse. If the person stops breathing and you are trained, perform CPR. Upon reaching the emergency room, note the exact time symptoms first appeared. Emergency medical teams will initiate immediate evaluations, including blood tests and imaging studies like MRI scans or angiograms, to determine the stroke type and guide treatment.

Advanced emergency treatments for ischaemic stroke
Time lost is brain lost. For ischaemic strokes, time-sensitive therapies offer the best chance of full recovery.

Thrombolysis therapy
Administering clot-dissolving medication within the first hour of symptom onset—known as the golden hour—dramatically reduces brain damage and long-term disability. Thrombolysis can generally be performed within six hours of initial symptom onset.

Mechanical thrombectomy
When blood clots are too large to be dissolved by thrombolysis alone, mechanical thrombectomy is a highly effective advanced procedure. Using a catheter guided through an angiogram, specialists physically retrieve and remove the clot from the blocked artery.

Prevention and modifiable risk factors
While non-modifiable risk factors such as advancing age, ethnicity, genetic predisposition, and family history cannot be changed, nearly 80 per cent of strokes are preventable through lifestyle modifications and risk management. Key controllable risk factors include high blood pressure, smoking, diabetes, high cholesterol, irregular heart rhythms, obesity, excessive alcohol consumption, oral contraceptive use, and obstructive sleep apnoea (OSA).
Engaging in 30 minutes of moderate-intensity exercise—such as brisk walking, cycling, or swimming—five days a week can reduce overall stroke risk by up to 25 per cent.

Dietary adjustments for stroke prevention
Adopting a balanced diet can help manage weight, diabetes, cholesterol, blood pressure, and sleep apnoea, cutting stroke risk by up to 40 per cent.
• Recommended foods: A Mediterranean-style diet rich in fresh vegetables, fruits, unsaturated fats (found in avocados, nuts, and seeds), and omega-3-rich fish such as mackerel, sardines, tuna, and salmon.
• Foods to avoid: Highly processed foods and red meat (beef, mutton, pork).
• Foods to limit: High-fat dairy products, sausages, bacon, butter, and cheese. Reducing daily salt intake is also essential.

Key medical risk factors
• High blood pressure: Hypertension is the single largest risk factor for both ischaemic and haemorrhagic strokes, present in nearly 60 per cent of stroke patients. Regular medical check-ups, timely medication, and lifestyle adjustments significantly lower this risk.
• Diabetes: Increases stroke risk by 28 to 50 per cent.
• High cholesterol: Elevated cholesterol and triglyceride levels raise stroke risk by 8 to 10 per cent.
• Smoking: A major hazard; smoking 20 cigarettes a day increases stroke risk by 25 per cent. Carbon monoxide in cigarette smoke impairs oxygen flow, while nicotine accelerates heart rate.
• Heart disease: Atrial fibrillation (AF), an irregular and rapid heart rhythm, increases stroke risk by 5 to 25 per cent.
• Alcohol consumption: Heavy drinking elevates blood pressure, disrupts diabetes management, triggers irregular heart rhythms, and contributes to obesity.
• Obstructive sleep apnoea (OSA): Individuals who snore heavily, have a high body mass index (BMI), or experience frequent awakenings due to breathing pauses should undergo polysomnography testing to address this independent stroke risk factor.

Post-stroke recovery and rehabilitation
Recovery outcomes following a stroke vary widely:
• 10 per cent of patients achieve complete recovery.
• 25 per cent recover with minor impairment and remain independent.
• 40 per cent experience moderate to severe disability requiring specialised care.
• 10 per cent require round-the-clock long-term nursing care.
• 10 to 15 per cent succumb shortly after the event.

Post-stroke care and rehabilitation are extensive and demanding, yet essential for restoring mobility, communication skills, vision, and swallowing capability. Comprehensive recovery requires dedicated physiotherapy, speech therapy, occupational therapy, psychological support, and strong encouragement from family, friends, and healthcare professionals.

(The author, Dr Manorama Devi K Rajan, is a Senior Neuro Consultant at SP Medifort, Inchakkal, Thiruvananthapuram)