A stroke is an acute disruption of cerebral blood circulation that damages brain tissue and impairs its functions. It is the second leading cause of death worldwide and the main cause of long-term disability. Understanding what exactly happens in the brain in the first minutes helps to act quickly and correctly.
Historical Note: From Apoplexy to Thrombosis
As early as the 460s BCE, Hippocrates described a case of loss of consciousness due to a brain disease. Claudius Galen labeled such a condition with the term "apoplexy," meaning paralysis, and this term became firmly established in medicine for a long time. Only in 1628 did William Harvey describe blood circulation and the function of the heart as a pump, laying the foundation for understanding the vascular causes of stroke. Later, Rudolf Virchow proposed the terms "thrombosis" and "embolism" and linked arterial thrombosis with atherosclerosis.
Two Types of Stroke and What Happens in the Brain
Based on the nature of their course, strokes are divided into ischemic and hemorrhagic. Ischemic stroke, or cerebral infarction, develops when blood vessels of the neck or brain are blocked by a thrombus or embolus, as well as when there is insufficient blood flow due to a narrowed vessel. When the supply of oxygen and nutrients stops, brain tissue softens. According to international studies, ischemic and hemorrhagic strokes occur in a ratio of approximately 4:1–5:1, i.e., 80–85% and 15–20%, respectively. Hemorrhagic stroke is an intracerebral hemorrhage, as well as subarachnoid hemorrhage, which have their own clinical differences.
FAST Test: Face, Arms, Speech, Time
The simplest way to recognize a stroke is the B.E. F.A.S.T. test recommended by the CDC. It checks balance (B — Balance), eyes (E — Eyes), face (F — Face), arms (A — Arms), speech (S — Speech), and time (T — Time).
- Balance: ask if the person feels dizzy or has lost balance.
- Eyes: ask if vision has suddenly worsened.
- Face: ask them to smile — check if one side has drooped.
- Arms: ask them to raise both arms — check if one drifts downward.
- Speech: ask them to repeat a simple phrase — check if it is slurred or distorted.
If even one of these signs is present, immediately call emergency services at 103 or 112 and note the time when symptoms appeared — this will help medical professionals determine the best approach. Do not take the person to the hospital yourself: the ambulance team will start helping on the way.
Why Every Minute Counts
During a stroke, every minute matters. Prompt treatment reduces brain damage. The most effective treatment is available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Those who arrive late may no longer be eligible for this treatment.
Other Signs, Transient Ischemic Attack, and Risk Factors
The CDC lists among the symptoms sudden trouble walking, dizziness, loss of balance or coordination, sudden vision problems, numbness or weakness in the face, arm, or leg, especially on one side, confusion, and trouble speaking. A sudden severe headache with no known cause is also singled out. If symptoms resolve within a few minutes, it may be a transient ischemic attack, also called a "mini-stroke." It is brief but is a sign of a serious condition that will not go away without medical help, so it should be reported to a doctor immediately.
Risk factors for stroke include advanced age, arterial hypertension, heart disease, transient ischemic attacks, diabetes, smoking, and asymptomatic carotid artery stenosis. Ischemic stroke most often occurs in people over 60 years of age with heart rhythm disorders, a history of myocardial infarction, or diabetes. Cardioembolic stroke often develops as a result of an episode of atrial fibrillation. Often, a person has several factors combined, each of which may be moderately expressed. Special scales allow assessing individual risk for the next 10 years, the most well-known being the Framingham scale.
When to call an ambulance immediately (103 or 112): sudden weakness or numbness on one side, crooked face or drooping corner of the mouth, sudden speech or vision impairment, loss of balance, or severe headache without cause — call emergency services right away.
This article is for informational purposes and does not replace a doctor's consultation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer