Ischaemic Stroke

What is this condition?

An ischaemic stroke occurs when a clot blocks an artery supplying the brain. Brain cells begin to fail within minutes, so stroke treatment is organised around speed. Symptoms that disappear can be a transient ischaemic attack and still require urgent assessment because a completed stroke may follow.

What symptoms can it cause?

• Sudden face droop, arm or leg weakness, especially on one side
• Sudden speech difficulty, confusion or inability to understand
• Sudden loss of vision, severe imbalance or unexplained collapse
• Write down the last time the person was known to be normal

How is it assessed and diagnosed?

Urgent non-contrast CT distinguishes bleeding from ischaemia. CT angiography can show a large-vessel blockage; perfusion imaging or MRI may identify salvageable brain in selected cases. ECG, heart monitoring, neck-vessel imaging, blood tests and echocardiography help find the source and guide prevention.

Treatment without surgery

Stroke-unit care protects the airway, oxygenation, temperature, glucose, hydration and swallowing. Antiplatelet or anticoagulant treatment is chosen only after the stroke type and cause are understood. Blood-pressure management is individualised. Rehabilitation and prevention of another stroke begin early.

When is surgery or a procedure considered?

Eligible patients may receive intravenous thrombolysis as soon as possible, commonly within 4.5 hours in selected patients. Mechanical thrombectomy can remove a large-vessel clot and may be offered to selected patients up to 24 hours after onset based on imaging and clinical criteria. A large stroke causing life-threatening swelling may require decompressive craniectomy. None of these time ranges is a reason to wait—arrival should be immediate.

Treatment and procedure options

• Intravenous thrombolysis for eligible patients
• Mechanical thrombectomy for selected large-vessel occlusion
• Decompressive craniectomy for malignant swelling
• Carotid treatment in selected symptomatic narrowing after specialist review
• Rehabilitation and cause-specific secondary prevention

Risks from the disease and from treatment

Delay can convert recoverable brain into permanent infarction. Disease complications include swelling, aspiration pneumonia, clots, seizures, depression and lasting disability. Reperfusion treatment can cause bleeding, so eligibility is assessed urgently but carefully. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Recovery varies widely. Improvement can continue for months with physiotherapy, speech/swallow therapy, occupational therapy and family training. The prevention plan may include blood-pressure, diabetes and cholesterol control, smoking cessation and treatment of atrial fibrillation or carotid disease. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• CDC — Stroke: https://www.cdc.gov/stroke/about/index.html
• American Stroke Association — Acute Ischaemic Stroke: https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots/ais-infographic