Stroke warning signs: think FAST

Four signs to check right away

If you see any of these signs in yourself or someone else, do not wait to see if they pass. Note the time they started and call our 24/7 emergency line immediately — some stroke treatments only work within a narrow window from when symptoms began.

Go to the nearest emergency department immediately — do not drive yourself. Call Cardiocare's 24/7 emergency line on +234 806 142 4614 (staffed around the clock) and say you suspect a stroke — this helps the team prepare before you arrive.

Understanding a stroke

A stroke happens when blood supply to part of the brain is suddenly interrupted, either because a clot blocks a blood vessel (an ischaemic stroke, the more common type) or because a blood vessel bursts and bleeds into or around the brain (a haemorrhagic stroke). Brain cells need a constant supply of oxygen and glucose carried in blood; deprived of it, they begin to die within minutes.

Different parts of the brain control different functions — movement, sensation, speech, vision, balance — so the symptoms of a stroke depend on which part is affected and how much blood flow is lost. This is also why "time lost is brain lost": brain tissue dies at a steady rate for as long as blood flow stays cut off, and some treatments that can limit that damage only work if given within hours of symptoms starting. Every extra minute before treatment is minutes of brain tissue that cannot be recovered afterwards.

What a stroke may feel like

FAST catches the majority of strokes, but not all of them. These are useful clues to discuss with a clinician, or to act on immediately if they appear suddenly — not a checklist for diagnosing yourself.

• ●Face drooping or an uneven smile
• ●Weakness or numbness in an arm, a leg, or one side of the body
• ●Slurred, confused, garbled or absent speech, or trouble understanding others
• ●Sudden confusion or difficulty concentrating

Less-known signs worth knowing

These signs are just as urgent as FAST symptoms but are more often missed or explained away, which is exactly why they matter:

• ●A sudden, severe headache unlike any before, sometimes described as "the worst headache of my life" — a possible sign of bleeding around the brain
• ●Sudden vision loss or double vision, in one eye or both, or a sudden dark patch or blank area in the field of view
• ●Sudden loss of balance or coordination, unsteadiness, or difficulty walking that appears out of nowhere

Any of these appearing suddenly, on their own or alongside a FAST symptom, deserves the same urgency: note the time and call immediately.

What causes a stroke

The two main types of stroke have different, sometimes opposite, causes and treatments — which is exactly why urgent brain imaging is the first step, before any treatment decision is made.

Ischaemic stroke (blocked blood vessel)

The more common type. A blood clot forms in a narrowed artery in the brain or neck, or travels there from elsewhere in the body — often the heart, particularly in atrial fibrillation — and blocks blood flow to part of the brain.

Haemorrhagic stroke (bleeding)

Less common but often more severe. A weakened blood vessel, frequently one damaged by long-standing high blood pressure, bursts and bleeds into or around the brain, both cutting off blood flow beyond it and causing direct pressure damage from the bleeding itself.

Transient ischaemic attack (TIA) — a warning stroke

A TIA produces stroke-like symptoms that resolve on their own, usually within an hour, because the blockage clears before lasting damage occurs. It is not a "mild" event to be relieved about — it is a strong warning that a full stroke may follow, often soon, and needs the same urgent assessment as any other stroke symptom.

Who is more likely to have a stroke

Many stroke risk factors are the same ones that damage the heart, and several are especially relevant in Nigeria:

• ●High blood pressure — very common in Nigeria and often undiagnosed, it is the single most important treatable risk factor for stroke
• ●Atrial fibrillation and other irregular heart rhythms, which allow clots to form and travel to the brain
• ●Diabetes
• ●High cholesterol
• ●Smoking or tobacco use of any kind
• ●Sickle cell disease, particularly in younger patients
• ●A previous stroke or TIA
• ●A family history of stroke
• ●Obesity, low physical activity and heavy alcohol use

What happens if a stroke goes untreated

The severity and pattern of complications depend on which part of the brain is affected and how much tissue is lost before blood flow is restored.

Lasting disability. Weakness, numbness, speech or vision problems and difficulty swallowing can persist, sometimes permanently, depending on how quickly treatment began.

Swallowing difficulty and aspiration. A weakened swallow can let food or drink enter the airway rather than the stomach, risking chest infection — part of why food and drink are withheld until swallowing is formally assessed.

Recurrent stroke. Without treating the underlying cause, the risk of a further, sometimes larger, stroke remains raised.

Raised pressure within the skull. A large stroke, particularly a haemorrhagic one, can cause dangerous swelling or pressure inside the skull, occasionally needing emergency surgery.

How Cardiocare investigates suspected stroke

Suspected stroke is assessed as an emergency, because imaging determines which treatments are safe and possible:

• 01
  Immediate neurological examination. A structured check of strength, sensation, speech, vision and coordination establishes which symptoms are present and how severe they are.
• 02
  Urgent brain imaging. A CT or MRI scan of the brain shows whether the stroke is caused by a blockage or bleeding — the single most important test, since the two need very different treatment.
• 03
  Blood pressure, glucose, ECG and laboratory tests. These check for a contributing or complicating cause, including an irregular heart rhythm, low blood sugar mimicking stroke symptoms, and clotting status.
• 04
  Heart and blood-vessel assessment. Once stabilised, an echocardiogram and imaging of the neck and brain arteries look for the underlying source, such as a heart or artery clot risk.

How a stroke is treated

Treatment depends entirely on the type of stroke confirmed on imaging, then shifts toward preventing another one.

Restoring blood flow (ischaemic stroke)

Where imaging confirms a blockage and the patient is seen within the treatment window:

• ●Clot-dissolving medicine (thrombolysis) — given by infusion to break down the clot, most effective the earlier it is given
• ●Mechanical clot retrieval (thrombectomy) — a catheter-based procedure to physically remove a clot from a larger brain artery, for selected patients

Managing bleeding (haemorrhagic stroke)

Care focuses on controlling blood pressure, reversing any blood-thinning medicine, and monitoring closely for pressure build-up inside the skull; selected patients need surgery.

Medicines for prevention, by class

Once the acute stroke is managed, medicines reduce the risk of another one; your clinician will discuss the right choice for your stroke type:

• ●Antiplatelet medicines — reduce clumping of platelets, used mainly after ischaemic stroke
• ●Anticoagulants (blood thinners) — used where atrial fibrillation or another clot source is found
• ●Blood-pressure and cholesterol medicines — control the two most important modifiable risk factors

Rehabilitation

Physiotherapy, speech and language therapy and occupational therapy help the brain relearn and adapt, often making the biggest difference to a person's eventual independence.

Living well after a stroke

Recovery continues for months after the event, and daily habits meaningfully affect the risk of another stroke:

• ✓Take every prescribed medicine exactly as directed, including blood thinners and blood-pressure medicines
• ✓Attend rehabilitation sessions consistently — small, steady gains add up
• ✓Control blood pressure, diabetes and cholesterol with regular follow-up
• ✓Stop smoking completely, and limit alcohol
• ✓Ask about swallowing and diet guidance if speech or swallowing were affected
• ✓Teach family members FAST — a second stroke, or a first one in someone else at home, needs the same immediate response

Preparing for your follow-up appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Discharge summaries, brain scans or reports from any emergency treatment
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

Exactly when symptoms started, what they were, what treatment was given, and how strength, speech, swallowing and daily function have changed since.

Questions worth asking us

• ●What type of stroke did I have, and what caused it?
• ●What is my risk of another stroke, and how do we lower it?
• ●What rehabilitation do I need, and for how long?
• ●What symptoms should bring me back immediately?