Stroke, also known as a cerebrovascular accident (CVA), is a sudden interruption of blood supply to the brain. It remains one of the leading causes of death and disability worldwide. Despite advances in medicine, stroke continues to impose a heavy burden on individuals, families, and healthcare systems.

Historical Perspectives

• The term “apoplexy” was first used by Hippocrates (460–370 BC) to describe sudden paralysis.
• Ancient Greek physicians believed strokes were caused by an imbalance of bodily “humors.”
• In the 17th century, physician Johann Jakob Wepfer (1620–1695) identified that stroke results from either bleeding in the brain or blockage of arteries.
• By the 19th century, physicians connected stroke risk with hypertension and atherosclerosis.
• Modern neurology and neuroimaging (CT & MRI) have since revolutionized early diagnosis and treatment.

Types of Strokes

• Ischemic Stroke (≈85%)
  • Caused by a blood clot blocking cerebral arteries.
  • Often linked to atherosclerosis, hypertension, or atrial fibrillation.
• Hemorrhagic Stroke (≈15%)
  • Caused by rupture of blood vessels leading to bleeding in or around the brain.
  • Commonly associated with uncontrolled hypertension or aneurysm.
• Transient Ischemic Attack (TIA)
  • A “mini-stroke” with temporary symptoms.
  • A warning sign of impending major stroke.

Risk Factors

• Non-modifiable: Age, male gender, family history, prior stroke.
• Modifiable: Hypertension, diabetes mellitus, smoking, high cholesterol, obesity, sedentary lifestyle, stress.

Symptoms (FAST Principle)

• F – Face drooping
• A – Arm weakness
• S – Speech difficulty
• T – Time to call emergency help immediately

Additional symptoms: sudden loss of vision, dizziness, severe headache, imbalance.

Diagnosis

• Clinical evaluation: Neurological examination.
• Imaging: CT scan (to differentiate ischemic vs. hemorrhagic stroke).
• Blood tests: To rule out metabolic causes.
• Cardiac evaluation: ECG, echocardiography for embolic sources.

Management

• Ischemic Stroke:
  • Intravenous thrombolysis with tPA (if within 4.5 hours of onset).
  • Mechanical thrombectomy for large vessel occlusion (up to 6–24 hours).
• Hemorrhagic Stroke:
  • Control blood pressure.
  • Neurosurgical interventions (clipping/coiling of aneurysms, hematoma evacuation).
• Supportive Care: Oxygen, fluids, blood sugar control, prevention of complications.

Rehabilitation

• Early physiotherapy and occupational therapy.
• Speech and swallowing therapy.
• Psychological support for depression and anxiety.
• Family counseling to aid reintegration.

Prevention

• Control hypertension, diabetes, and cholesterol.
• Quit smoking and reduce alcohol intake.
• Regular exercise and balanced diet.
• Antiplatelet therapy (aspirin, clopidogrel) in high-risk individuals.
• Anticoagulation in atrial fibrillation when indicated.

Global and Regional Burden

• Stroke is the 2nd leading cause of death globally and the leading cause of disability.
• WHO estimates nearly 15 million people suffer stroke annually, of which 5 million die and another 5 million are permanently disabled.
• In South Asia, stroke incidence is rising due to increasing rates of hypertension, diabetes, and lifestyle changes.

Take Away Message

• Stroke is a preventable and treatable condition if recognized early.
• Historical progress has shifted stroke from a mysterious “apoplexy” to a well-understood neurological emergency.
• Public awareness, timely medical intervention, and preventive strategies remain key to reducing stroke burden.
• As physicians, our duty is to educate, prevent, and treat stroke to improve survival and quality of life.

If you or a loved one is living with stroke or develops signs of FAST , don’t wait. Reach out, get evaluated, and take the first step toward better brain health.