Stroke
Also called: brain attack, cerebrovascular accident (CVA), ischaemic stroke, haemorrhagic stroke, brain haemorrhage, falij (paralysis attack)
A stroke happens when blood supply to part of the brain is blocked or a blood vessel in the brain bursts. It is a medical emergency. Learn FAST: Face drooping, Arm weakness, Speech problems, Time to call an ambulance now. Quick hospital treatment saves brain and lives.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
A stroke is a sudden attack on the brain. Brain cells need a constant flow of blood to bring oxygen. If that flow stops, brain cells are damaged very quickly. Most strokes (nearly 9 in 10) are ischaemic strokes, where a clot blocks an artery that carries blood to the brain. The clot may form inside a narrowed artery or travel from the heart, for example in people with an irregular heartbeat called atrial fibrillation. The rest are haemorrhagic strokes, where a blood vessel bursts and bleeds into or around the brain. Bleeding strokes are the most dangerous type.
A transient ischaemic attack (TIA, or mini-stroke) has the same signs, but they go away, usually within minutes and always within 24 hours. A TIA needs urgent care too: it is a warning sign, and a specialist should see the person within 24 hours.
About 15 million people worldwide have a stroke each year. About a third die and another third are left with lasting disability, such as weakness on one side, speech loss or poor vision. Stroke is commonest in older people but can happen at any age. High blood pressure and tobacco are the biggest risks that people can change. Treatment works best in the first few hours, which is why every minute counts. After the emergency, medicines and lifestyle changes greatly lower the chance of another stroke.
In Pakistan
A community survey in a low-income area of Karachi found that about one in five adults aged 35 and over had had a stroke or TIA, most did not know it, and chewing tobacco (paan, gutka, supari) was linked with higher risk. The authors also noted that stroke patients in Pakistan tend to be about ten years younger than in Western studies.
Symptoms
- FACE: one side of the face droops; the person cannot smile evenly or the mouth or eye has dropped
- ARMS: weakness or numbness in one arm, so the person cannot lift both arms and keep them up
- SPEECH: slurred or garbled speech, or the person cannot speak or understand you
- TIME: if you see any one of these signs, it is time to call an ambulance at once
- Sudden weakness or numbness down one side of the body, including the leg
- Sudden blurred vision or loss of sight in one or both eyes
- Sudden confusion, trouble finding words or memory loss
- Sudden dizziness, loss of balance or falling over
- Sudden very severe headache, often with feeling sick (nausea) or vomiting
- Signs come on suddenly; they may also go away again (a TIA), but still need emergency care
Causes and risk factors
Causes
- A blood clot that forms in an artery of the brain or neck narrowed by fatty build-up (atherosclerosis)
- A clot that forms in the heart and travels to the brain (embolism), most often because of atrial fibrillation
- Blockage of the small deep arteries of the brain (small vessel or lacunar stroke)
- A burst blood vessel bleeding into the brain (intracerebral haemorrhage), for example in someone taking blood-thinning medicines such as warfarin
- Bleeding into the space around the surface of the brain (subarachnoid haemorrhage)
- Less common causes such as a tear in a neck artery (dissection), blood clotting disorders, or sickle cell disease in children
What makes it more likely
- High blood pressure (the most important risk you can change)
- Smoking and chewing tobacco such as paan, gutka or supari
- Atrial fibrillation (irregular heartbeat), heart failure or a past heart attack
- Diabetes or high blood sugar
- High cholesterol
- A previous stroke or TIA
- Older age and a family history of stroke or heart disease
- Lack of physical activity, long periods of sitting and an unhealthy, salty diet
Complications
A stroke can leave weakness or paralysis on one side of the body, problems with speech and understanding (aphasia), loss of part of the vision, and trouble with memory and thinking. Many people have difficulty swallowing (dysphagia), which can let food or drink go into the lungs and cause pneumonia (aspiration pneumonia). Lying still raises the risk of blood clots in the legs and lungs. Some people develop fits (seizures) or depression. Large strokes can cause the brain to swell, which can be life-threatening. Without good prevention, there is a high chance of another stroke.
When to see a doctor
- Any FAST sign (face drooping, arm weakness, speech problems): call an ambulance immediately, do not wait to see if it gets better
- Signs of stroke that came and went in the last 24 hours (possible TIA): get emergency help the same day
- Sudden, very severe headache, the worst ever, especially with vomiting or confusion
- Sudden loss of vision, or sudden loss of balance and walking
- Becoming drowsy, hard to wake or unconscious
- Someone with a known stroke who suddenly gets worse, has a fit, or chokes and coughs when eating or drinking
Diagnosis
Stroke is diagnosed in hospital as quickly as possible. Ambulance and emergency teams use quick checks such as FAST and ask exactly when the person was last seen well, because this decides which treatments are possible. A finger-prick blood sugar test is done straight away, because very low blood sugar can look like a stroke.
The key test is an urgent brain scan, usually a CT scan without contrast, which shows whether the stroke is caused by a clot or by bleeding. A CT angiogram (a scan of the blood vessels) may show a blocked large artery that can be opened. An MRI scan can show small or early strokes and is often used after a TIA. Other tests include blood counts, kidney function, clotting tests, an ECG and heart rhythm monitoring to look for atrial fibrillation, and a scan of the neck arteries to look for narrowing (carotid stenosis), which may need an operation or a stent.
Treatment
- Call an ambulance at once and get to a hospital with a stroke team and a CT scanner; note the time the symptoms started
- In hospital, a brain scan is done urgently to find out whether the stroke is a clot or a bleed
- For a clot (ischaemic stroke), a clot-busting medicine (thrombolysis) may be given through a drip, usually within 4.5 hours of the start; some people with a large blocked artery also have the clot pulled out through a thin tube (thrombectomy), up to 24 hours in selected cases
- Once bleeding has been ruled out, an antiplatelet medicine such as aspirin is started within 24 hours; after a TIA, aspirin is usually given straight away and a specialist sees the person within 24 hours
- For a bleeding stroke, the team lowers very high blood pressure carefully, reverses any blood-thinning medicine, and sometimes arranges surgery
- Care on a stroke unit: swallowing is checked before any food, drink or tablets, fluids and blood sugar are controlled, and the person is helped to move early
- Rehabilitation and long-term prevention: physiotherapy and other rehabilitation, plus medicines for blood pressure, cholesterol, clot prevention and diabetes, chosen by your doctor, who also decides the dose
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Clot-busting medicines (thrombolytics) | given in hospital through a drip for ischaemic stroke, usually within 4.5 hours of onset, only after a scan rules out bleeding and only in an organised stroke service | Alteplase (2 brands) |
| Antiplatelet medicines | started within 24 hours of an ischaemic stroke once bleeding is ruled out, and straight away for a TIA; long-term use prevents another stroke; a short course of two antiplatelets together is used only for selected people with a minor stroke or high-risk TIA | Acetylsalicylic acid (Aspirin) (59 brands), Clopidogrel (124 brands), Clopidogrel + Aspirin (44 brands) |
| Anticoagulants (blood thinners) | for people whose stroke was caused by atrial fibrillation; not used routinely in the first days, and the stroke team decides when to start; not combined with antiplatelets except in rare cases | Apixaban (31 brands), Rivaroxaban (214 brands), Dabigatran etexilate (5 brands), Warfarin (24 brands) |
| Statins (cholesterol-lowering medicines) | long-term intensive treatment for most people after an ischaemic stroke or TIA; people already taking a statin should keep taking it; ezetimibe may be added if cholesterol stays high | Atorvastatin (86 brands), Rosuvastatin (6 brands), Simvastatin (121 brands), Ezetimibe + Simvastatin (4 brands) |
| Blood pressure medicines | long-term control of blood pressure to prevent another stroke, with the target set by your doctor; in the first hours they are used only in specific situations, such as before thrombolysis or in a bleeding stroke | Ramipril (7 brands), Lisinopril (21 brands), Losartan (129 brands), Telmisartan (25 brands), Amlodipine (175 brands), Indapamide (3 brands) |
| Medicines to reverse warfarin | used in hospital for a bleeding stroke in someone taking warfarin, together with prothrombin complex concentrate | Phytomenadione (16 brands) |
Also used (not yet in our price list): tenecteplase (clot-busting medicine given in hospital), prothrombin complex concentrate (to reverse warfarin in a bleeding stroke), ezetimibe on its own and PCSK9-blocking medicines (added when cholesterol stays high despite a statin)
Self-care and prevention
Self-care
- While waiting for the ambulance, stay with the person and follow what the emergency call handler tells you
- Do not give food, drink or tablets by mouth until the hospital has checked that the person can swallow safely
- Do not give aspirin at home before a scan, because some strokes are caused by bleeding
- If you have stroke signs, do not drive yourself to hospital; tell the team when the symptoms started
- After a stroke, take prevention medicines every day as prescribed and do not stop them without talking to your doctor
- Keep active in a safe way, with a supervised exercise programme if your movement is affected, and ask for help with low mood
- Check your blood pressure, blood sugar and cholesterol regularly and keep follow-up appointments
Prevention
- Get your blood pressure checked and keep it under control; this alone prevents many stroke deaths
- Stop smoking and stop chewing tobacco, paan, gutka and supari
- Eat a low-salt diet; a Mediterranean-style diet is also recommended
- Be physically active most days and avoid sitting for long periods
- Control diabetes and high cholesterol, and take a blood thinner if you have atrial fibrillation and your doctor advises it
- Treat a TIA as an emergency so that a full stroke can be prevented
Common questions
What does FAST mean?
FAST is a simple way to spot a stroke. Face: has one side drooped? Arms: can the person lift both arms and keep them up? Speech: is it slurred or confused? Time: if you see any of these, call an ambulance immediately.
What should I do if the stroke signs go away?
Still get emergency help. Signs that come and go may be a TIA (mini-stroke), which is a warning sign. Guidelines advise aspirin straight away and a specialist check within 24 hours, then prevention treatment to lower the chance of a full stroke.
Why is time so important in stroke?
Brain cells are damaged quickly when blood flow stops. Clot-busting medicine works only if given within a few hours, and clot removal also has a time limit. Getting to a hospital with a stroke team fast gives the best chance of recovery.
Can a young person have a stroke?
Yes. Stroke is more common in older people, but it can happen at any age. In younger adults high blood pressure is the main cause, and heart problems, neck artery tears and clotting disorders can also play a part.
Can people recover after a stroke?
Many people recover well, especially if they are treated quickly. Others are left with some weakness, speech or memory problems. Rehabilitation, such as physiotherapy, helps people regain as much function as possible.
Sources
- NICE. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NICE guideline NG128) (2022).
- American Heart Association / American Stroke Association. 2021 Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack Guideline - Professional Heart Daily | American Heart Association (2021).
- American College of Cardiology. AHA/ASA Stroke Secondary Prevention Guideline: Key Points - American College of Cardiology (2021).
- WHO Regional Office for the Eastern Mediterranean (EMRO). Stroke, Cerebrovascular accident (2026 (accessed)).
- NHS. Symptoms of a stroke (Content Widget - NHS) (2026 (accessed)).
- StatPearls (NCBI Bookshelf). Ischemic Stroke - StatPearls - NCBI Bookshelf (2026).
- BMC Neurology (Kamal AK et al.). The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study (2009).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
High blood pressure (hypertension)Atrial fibrillationHigh cholesterol (dyslipidaemia)Type 2 diabetes mellitusCoronary artery disease (angina)