Every Minute Counts: How to Spot a Stroke and What to Do Next

This article originally appeared in The Neurotransmitter, Dr. Grunch’s weekly newsletter.

Your dad suddenly can’t find the word for “fork” at dinner. Your friend stands up from the couch and wobbles like the floor tilted. Your own vision goes double for a few minutes and then clears up like nothing happened.

Most people’s first instinct is to wait it out, sleep it off, and see how things look in the morning. With a stroke, that instinct is exactly backward. The treatments we have today work best in the first few hours, and every minute you wait, more brain is lost for good.

If I could get every adult to carry around one piece of brain health knowledge, it would be this: how to recognize a stroke, and what to do in the next 60 seconds.

What a Stroke Actually Is

A stroke is a brain attack. Some part of your brain suddenly stops getting the blood it needs, and brain cells start to die within minutes.

I like to think of the brain as a city, with your arteries as the power lines feeding every neighborhood. The lights can go out in two ways:

• Ischemic stroke – a clot or plaque blocks a line and a neighborhood goes dark. This is the most common type, more than 8 out of 10 strokes.
• Hemorrhagic stroke – a line bursts and blood spills into the brain itself or the space around it. Bleeding strokes are less common but often more severe.

When a line gets blocked, there’s usually a core area that loses power right away, surrounded by a ring of neighborhoods running on backup generators. We call that ring the penumbra – brain tissue that’s struggling but can still be saved. Those generators run out of fuel fast, and everything we do in emergency stroke care is about getting power back to the penumbra before it’s gone.

One landmark estimate found that during a typical untreated stroke, the brain loses about 1.9 million nerve cells every minute [4]. That’s where the phrase “time is brain” comes from, and the number backs it up.

Who Has Strokes? More People Than You Think

Every 40 seconds, someone in the United States has a stroke. That adds up to more than 795,000 strokes a year, and about 1 in 4 of them happen in someone who has already had one [1]. Stroke is also one of the biggest causes of serious long-term disability, and it reduces mobility in more than half of survivors age 65 and older [1].

And stroke isn’t only a problem for older adults. A CDC report found that from 2011 to 2022, stroke prevalence rose about 15% among adults ages 18 to 44, and nearly 16% among adults ages 45 to 64 [2]. Southern states had some of the highest rates in the country [2], which is why those of us here in Georgia live in what’s known as the “Stroke Belt.”

The encouraging part is that a global study of nearly 27,000 people across 32 countries found that 10 risk factors you can change are linked to about 90% of strokes [3]. High blood pressure alone accounted for nearly half [3]. Most strokes are preventable, not random bad luck.

The Warning Signs: BE FAST

You may have learned FAST (Face, Arm, Speech, Time). It’s a good tool, but it misses some strokes, especially ones in the back of the brain that control balance and vision. One study found that FAST alone missed about 14% of strokes, and adding two letters cut the missed strokes dramatically [5]. That’s why I teach BE FAST:

• B – Balance: sudden dizziness, loss of balance, or trouble walking
• E – Eyes: sudden blurry, double, or lost vision in one or both eyes
• F – Face: one side of the face droops or goes numb. Ask them to smile.
• A – Arms: one arm or leg is weak or numb. Ask them to raise both arms and watch whether one drifts down.
• S – Speech: slurred words, the wrong words, or trouble understanding you
• T – Time: call 911 right away, and note the exact time symptoms started

The key word in all of these is sudden. Stroke symptoms come on all at once, not gradually over weeks.

See a doctor right away (call 911) if you or someone near you has:

• Any BE FAST sign, even if it goes away
• Sudden numbness or weakness on one side of the body
• Sudden confusion or trouble understanding simple things
• A sudden, severe headache unlike any you’ve had before
• Sudden trouble walking or a new, severe spinning feeling with other symptoms

The “Mini-Stroke” Myth

Someone’s arm goes numb for 15 minutes, then it’s fine. They feel silly calling anyone, so they go to bed. That’s the scenario that worries stroke doctors most.

That episode may have been a TIA – a transient ischemic attack, or “mini-stroke.” It’s a temporary blockage that clears on its own. People hear “mini” and think “minor,” and I’d ask you not to.

In a classic study of patients seen in California emergency rooms for a TIA, about 1 in 10 had a full stroke within 90 days, and half of those strokes happened within the first two days [9]. A TIA is a warning, and acting on it quickly works. In a well-known study from the UK, getting people evaluated and treated urgently after a TIA cut their early stroke risk by roughly 80% [10].

If the symptoms went away, you still need to be seen today, not next week.

Why You Should Call 911 Instead of Driving

I know it feels faster to throw someone in the car. It usually isn’t.

Paramedics start your care in the driveway. They check blood sugar (low sugar can mimic a stroke), call ahead so the stroke team is waiting at the door, and know which nearby hospitals can do the most advanced procedures. In a study of more than 200,000 stroke patients, those who arrived by ambulance got their brain scans faster, yet more than a third of patients still didn’t use EMS [6]. Younger patients and people in rural areas were the least likely to call [6].

While you wait for help:

• Write down the time symptoms started, or the last time the person was seen normal. This one detail shapes every treatment decision.
• Don’t give aspirin, food, or drinks. Some strokes are bleeding strokes, where aspirin can make things worse, and swallowing may not be safe.
• Gather their medication list, especially any blood thinners.

What Happens at the Hospital: Treatment Has Changed

Stroke care has changed enormously in the last decade, and that gives me a lot of hope. In January 2026, the American Heart Association and American Stroke Association released updated guidelines reflecting that progress [7].

First comes a fast brain scan, usually a CT, to tell the difference between a blocked vessel and a bleed. That answer decides everything that comes next.

For a blocked vessel, there are two main tools:

• Clot-busting medicine (IV thrombolysis), given through a vein. It’s standard within 4.5 hours of symptom onset, and the new guidelines say it may be reasonable up to 9 hours in carefully selected patients based on special imaging [7]. They also now list tenecteplase, a medicine given as a single quick injection, as an equally preferred option alongside the older drug, alteplase [7].
• Thrombectomy, where a specialist threads a thin tube from the wrist or groin up into the brain and pulls the clot out. For big blockages, a pooled analysis of five major trials found that for about every 2 to 3 people treated, one ended up less disabled [8]. With the right imaging, some patients can benefit up to 24 hours after onset, and the 2026 guidelines expand who qualifies [7].

For a bleeding stroke, care focuses on controlling blood pressure, reversing blood thinners, and watching for brain swelling. As a neurosurgeon, I sometimes operate to remove a blood clot or relieve dangerous pressure on the brain. Not every patient needs surgery, but when they do, timing matters just as much.

After that comes rehabilitation, which is where a lot of the real recovery happens. The brain can rewire itself, especially in the first months, and good rehab helps that along.

What You Can Do Starting Today

About 90% of strokes are tied to risk factors you can change [3]. Here’s where to start:

• Know your blood pressure number. It’s the single biggest stroke risk factor you can change [3]. Home monitors are inexpensive, and many pharmacies check it for free.
• Don’t smoke or vape. If you do, quitting is one of the best things you can do for your brain.
• Move your body most days. Walking counts.
• Keep blood sugar and cholesterol in check, and take prescribed medicines consistently.
• Ask about an irregular heartbeat. A condition called atrial fibrillation (AFib) can cause clots that travel to the brain, and it’s very treatable.
• Limit alcohol and eat mostly whole foods with less salt.
• Teach BE FAST to your family, including your kids and your parents. The person having a stroke often can’t recognize it in themselves.

Questions to ask your doctor

• What’s my blood pressure goal, and am I meeting it?
• Do I have any risk factors for AFib, and should I be checked?
• Based on my history, what’s my personal stroke risk, and what would lower it most?
• If I’ve had a TIA or stroke, am I on the right medicines to prevent another one?

Key Takeaways

• Learn BE FAST: Balance, Eyes, Face, Arms, Speech, Time. Sudden is the key word.
• Call 911. Don’t drive, don’t wait, and write down when symptoms started.
• A “mini-stroke” that goes away is still an emergency. Get seen the same day.
• Today’s treatments can reverse many strokes, but only if you get there fast.
• About 90% of strokes are linked to risk factors you can change, starting with blood pressure.

References

1. Centers for Disease Control and Prevention. Stroke facts. Updated 2025. https://www.cdc.gov/stroke/data-research/facts-stats/index.html

2. Imoisili OE, Chung A, Tong X, Hayes DK, Loustalot F. Prevalence of stroke — Behavioral Risk Factor Surveillance System, United States, 2011–2022. MMWR Morb Mortal Wkly Rep. 2024;73(20). doi:10.15585/mmwr.mm7320a1

3. O’Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761-775. doi:10.1016/S0140-6736(16)30506-2

4. Saver JL. Time is brain — quantified. Stroke. 2006;37(1):263-266.

5. Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke. 2017;48(2):479-481.

6. Ekundayo OJ, Saver JL, Fonarow GC, et al. Patterns of emergency medical services use and its association with timely stroke treatment: findings from Get With the Guidelines-Stroke. Circ Cardiovasc Qual Outcomes. 2013;6(3):262-269. https://pubmed.ncbi.nlm.nih.gov/23633218

7. Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: a guideline from the American Heart Association/American Stroke Association. Stroke. Published online January 26, 2026. doi:10.1161/STR.0000000000000513

8. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials (HERMES). Lancet. 2016;387(10029):1723-1731.

9. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284(22):2901-2906.

10. Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370(9596):1432-1442.

Disclaimer: This article is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. If you have symptoms or questions about your own health, please consult your healthcare provider. If you think you are having a medical emergency, call 911.

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