By Dr. Rajeev Agarwal, M.D. (Paediatrics), ADHA, PGDMLS · Medical Director, Shree Kkasturi Medicare Pvt. Ltd. Published: 02 September 2026 · Medically reviewed: 02 September 2026
A stroke does not usually hurt. That is the problem.
A heart attack announces itself with pain and frightens the family into action. A stroke often arrives quietly — an arm that will not lift, a mouth that has gone crooked, words that come out wrong — and because nothing hurts, the family sits down to discuss it. Someone suggests tea. Someone suggests waiting an hour to see if it settles.
Those are the most expensive hours in medicine.
The brain is not like other organs. It cannot wait, and it does not repair. From the moment blood supply is cut off, brain tissue starts dying — by one widely cited estimate, around 1.9 million nerve cells every minute. A stroke treated at ninety minutes and the same stroke treated at six hours are two entirely different lives afterwards.
This article is about recognising it fast, and about the small number of things that must and must not be done in the first hour.
What is a stroke?
A stroke is a sudden interruption of blood supply to part of the brain. There are two kinds, and the distinction is not academic — the treatments are opposite.
Blockage (ischaemic stroke) — a clot blocks an artery. About four in five strokes. Treatment aims to dissolve or remove the clot.
Bleeding (haemorrhagic stroke) — a vessel bursts inside the brain. Treatment aims to stop the bleeding and control pressure.
No doctor can tell these apart at the bedside. They look identical. Only a CT scan of the brain distinguishes them, and this is precisely why nothing should be given by mouth and no blood-thinning tablet should be given at home — a medicine that helps one type can be catastrophic in the other.
BE FAST — the six signs
Most people have heard of FAST. BE FAST adds two letters that matter, because strokes affecting the back of the brain often produce no facial droop and no arm weakness at all — and those are the ones most often sent home.
B — Balance
Sudden loss of balance or coordination. Sudden severe giddiness with unsteadiness. Difficulty walking, veering to one side, or a sudden fall with no explanation.
E — Eyes
Sudden loss of vision in one or both eyes, sudden blurring, or double vision. This is a brain sign, not an eye problem, when it comes on abruptly and is accompanied by anything else on this list.
F — Face
One side of the face droops. Ask the person to smile. If the smile is uneven, that is the sign.
A — Arms
Weakness or numbness in one arm or leg. Ask the person to raise both arms and hold them up. If one drifts downward, that is the sign.
S — Speech
Speech is slurred or garbled, words come out wrong, or the person cannot understand what you are saying. Ask them to repeat a simple sentence — "aaj mausam achha hai." If it comes out wrong, that is the sign.
T — Time
Note the time. Then call an ambulance.
Not the time you noticed the problem — the last time the person was seen completely normal. If they woke up like this, it is the time they went to sleep. Doctors will ask this within the first minute of arrival, and the answer determines which treatments are still possible. Write it down; under stress people misremember it.
Why the clock is everything
There is a window in which a blocked artery can be reopened, and it closes.
1. Clot-dissolving medication works within about four and a half hours from when symptoms began. After that the risk outweighs the benefit.
2. Mechanical removal of the clot, at specialised centres, extends the window further — up to twenty-four hours in carefully selected patients, but only where scanning shows salvageable brain tissue.
Within those windows, earlier is dramatically better. Treatment at ninety minutes is not slightly better than treatment at four hours. It is a different outcome.
And the arithmetic that decides it is usually made at home. Not by doctors — by families deciding whether to wait a little longer.
What to do in the first hour
1. Note the time last seen normal. Do this first, before anything else.
2. Call an ambulance. Treatment begins in the vehicle and the hospital prepares before you arrive. If an ambulance is not available, have someone else drive. Do not let the patient walk further than necessary.
3. Lie the person down with the head and shoulders slightly raised. If they are vomiting or drowsy, turn them onto their side.
4. Loosen tight clothing at the neck.
5. Take their medicine strips or a photograph of them — especially any blood thinner. This changes what can be given.
6. Stay calm and keep talking to them. Many stroke patients can hear and understand perfectly even when they cannot reply. Do not discuss their prognosis in front of them.
What never to do
This section matters as much as the signs.
1. Do not give anything by mouth — no water, no tea, no food, no tablets. Swallowing is very often impaired in a stroke, and liquid goes into the lungs instead of the stomach. Aspiration pneumonia is a major cause of death after stroke, and it frequently begins with a well-meant glass of water.
2. Do not give aspirin. This is the most dangerous crossover mistake. Aspirin is advised in some heart attacks — but if the stroke is a bleed, aspirin makes it worse. Until a CT scan has been done, nobody knows which type it is.
3. Do not prick the fingertips or earlobes with a needle. There is a widely forwarded message claiming this releases blood and reverses a stroke. It is false, it has no basis, and the minutes spent doing it are minutes of brain lost. Please delete that forward rather than passing it on.
4. Do not massage the weak limb, apply oil, or attempt any home remedy.
5. Do not wait to see if it improves. Improvement does not mean safety — see the section below.
6. Do not wait to assemble the family or for a decision-maker to arrive. Go, and phone them from the road.
7. Do not take the person to a clinic without a CT scanner in the hope of saving time. It costs time.
"It went away after ten minutes"
If weakness, slurred speech, facial droop or visual loss appeared and then resolved completely, that was very likely a transient ischaemic attack — a brief blockage that cleared on its own.
Families almost always treat this as good news. It is the opposite.
A TIA is a warning that a full stroke may follow, and the highest risk period is the next few days — often the next forty-eight hours. It is the one genuine chance to prevent the stroke before it happens. Investigation and treatment started now can substantially reduce that risk; nothing done at all leaves it in place.
If symptoms appeared and vanished, go to hospital today. Not next week. Today.
What happens at hospital
Assessment starts immediately. Blood sugar is checked first — a very low blood sugar can mimic a stroke exactly, and it is reversible in minutes, so it is always excluded early. Blood pressure, an ECG and blood tests follow.
Then the decisive step: an urgent CT scan of the brain, to determine whether this is a blockage or a bleed. Everything about treatment follows from that scan.
Where to go matters, and we want to be direct about it. For a suspected stroke, go to the nearest hospital that has a CT scanner and a stroke pathway. This is one of the very few situations where the nearest capable hospital beats the familiar hospital, and any doctor will tell you the same. If you are already at a facility without imaging, the priority is immediate onward transfer, not observation.
[TO BE CONFIRMED BY MEDICAL DIRECTORS — final wording depends on CT availability on site. This paragraph will state what Kasturi does and does not provide in a suspected acute stroke, and name the referral pathway.]
Recovery does not end at discharge
The acute phase is measured in hours. Recovery is measured in months, and it is where a great deal of function is regained or lost.
Rehabilitation should begin within days, not once the patient "feels ready". The brain's capacity to rewire around damaged areas is greatest in the first three to six months, and structured physiotherapy during that period changes long-term independence more than almost anything else. This includes physiotherapy for limb strength and walking, speech and swallowing therapy where those are affected, occupational therapy for daily activities, and careful attention to preventing bedsores, contractures and depression — the last of which is very common after stroke and very often untreated.
Equally important: a stroke, once it has happened, substantially raises the risk of another. Blood pressure control, diabetes control, cholesterol management and any prescribed blood thinner are not optional afterwards. The second stroke is often preventable and is usually worse than the first.
Shree Kkasturi Medicare provides in-patient care, physiotherapy and home care services supporting post-stroke recovery, alongside management of the blood pressure, diabetes and cardiac conditions that underlie it.
Who is at higher risk, and what actually reduces it
High blood pressure is by far the largest contributor to stroke, and in India it is very often undiagnosed or treated only when the reading is high. Blood pressure that is "normal because of the tablet" is the tablet working — not a reason to stop it.
Other major factors: diabetes, smoking and all forms of chewed tobacco, high cholesterol, obesity, physical inactivity, heavy alcohol use, a previous stroke or TIA, and an irregular heartbeat (atrial fibrillation), which causes a substantial share of strokes and is frequently silent.
One practical thing worth doing today: feel your own pulse. Place two fingers on the inside of your wrist below the thumb and count for thirty seconds. A pulse that is irregularly irregular — no pattern at all, skipping unpredictably — should be shown to a doctor. Atrial fibrillation found and treated prevents strokes; found after one, it explains it.
And note that stroke in India appears roughly a decade earlier than in Western populations. Being in your forties is not protection.
Frequently asked questions
Q. Is "stroke" the same as a paralysis attack, or lakwa? A. Yes — these are the same event described in different words. The word used does not change the urgency. What people often mean by "lakwa" is the weakness that persists afterwards; the stroke itself is the sudden interruption of blood supply, and that is the part with a treatment window.
Q. Should I give an aspirin, like for a heart attack? A. No. This is a critical difference. If the stroke is a bleed, aspirin worsens it. Aspirin has a role in some strokes, but only after a CT scan has shown there is no bleeding. Never give it at home.
Q. Is the finger-pricking method real? A. No. It is a widely circulated message with no scientific basis. It does not help, and it delays the only thing that does. If you receive that forward, please do not pass it on.
Q. The symptoms lasted a few minutes and then went completely. Do I still need to come? A. Yes, today. That pattern is a TIA, and it signals a high risk of a full stroke within the following days. It is the best warning you will ever get, and acting on it can prevent the stroke.
Q. Can a young person have a stroke? A. Yes. Stroke occurs about a decade earlier in Indians than in Western populations, and in younger patients causes include heart rhythm and structural problems, blood clotting disorders, and the combination of smoking with oral contraceptive pills. Age alone never rules it out.
Q. Will the person recover fully? A. That depends on the type of stroke, how much brain was affected, and — very significantly — how quickly treatment began and how early rehabilitation started. Outcomes vary widely and no honest doctor will predict one at the outset. What is certain is that early treatment and early, sustained rehabilitation improve the odds.
Q. How can I remember all six letters in an emergency? A. You do not have to. If someone looks suddenly and inexplicably wrong — the face, an arm, the speech, the balance, the vision — treat it as a stroke and go. BE FAST is a reminder, not a test to pass.
Shree Kkasturi Medicare Pvt. Ltd. is a 45-bed NABH Entry Level accredited multispecialty hospital in Bhayander West, serving Mira-Bhayander since 2001, with 24×7 casualty, ICU, ICCU, diagnostics, physiotherapy and home care services. Free ambulance pick-up is available.
Disclaimer: This article provides general health information and is not a substitute for consultation, examination or diagnosis by a qualified doctor. If you suspect a stroke, do not use this page to decide whether to wait — note the time the person was last seen normal and go to the nearest hospital with CT and stroke facilities immediately.