Stroke Symptoms and Why Time Is Brain
Ischemic Stroke From First Symptom to Clot Removal
The Woman Who Could Not Even Say Her Own Name
Linda is sixty two. She walks into the emergency department with her daughter. She looks alert. She is awake. She is trying to speak.
The words do not come out right.
She knows what she wants to say. You can see it in her eyes. But the sounds are garbled. Fragments. Broken syllables. Her right hand is slightly weak. Her daughter says this started twenty minutes ago. That time matters more than anything else in the room.
What Is a Stroke, Really?
A stroke is sudden loss of blood flow to part of the brain. The medical term for a clot related stroke is ischemic stroke. Ischemia means lack of blood supply. Without blood, brain cells are deprived of oxygen and glucose. They begin to die quickly.
The brain controls speech, movement, vision, sensation, and coordination. Different regions have different jobs. That is why stroke symptoms vary. Weakness on one side. Facial droop. Slurred speech. Loss of vision. Confusion. The pattern of symptoms often tells us which part of the brain is affected. Time is brain. Every minute without blood flow means more neurons lost.
What Causes the Clot?
Most ischemic strokes are caused by a blood clot blocking an artery in the brain. Sometimes the clot forms directly inside a brain artery. Sometimes it travels from somewhere else. Atrial fibrillation, a heart rhythm disorder, allows clots to form in the heart. Those clots can break free and travel to the brain.
Other risk factors include high blood pressure, diabetes, smoking, high cholesterol, obesity, and age. High blood pressure damages arteries over time. Damaged arteries are more likely to narrow or clot. Lifestyle and genetics both play a role.
How Do We Know It Is a Stroke?
The first step is immediate imaging. A non contrast CT scan of the head is performed to rule out bleeding. Strokes come in two main types. Ischemic stroke is caused by a clot. Hemorrhagic stroke is caused by bleeding into the brain. The treatments are completely different. Giving clot busting medication to someone with a hemorrhagic stroke would be dangerous.
If there is no bleeding and the timing fits, we consider thrombolytic medication. Tissue plasminogen activator, often called TPA, or tenecteplase, called TNK, are medications that dissolve clots. In the United States, these must be given within 4.5 hours of symptom onset for most patients. There are strict eligibility criteria because these medications increase bleeding risk.
What If the Clot Is Large?
In recent years, mechanical thrombectomy has changed stroke care. In this procedure, a neurointerventional specialist threads a catheter through an artery in the groin or wrist up into the brain. Under imaging guidance, the clot is physically retrieved using specialized devices.
This approach is particularly effective for large vessel occlusions, meaning major arteries in the brain are blocked. In some patients, thrombectomy can be performed beyond the 4.5 hour window depending on advanced imaging. Modern stroke care is not just about medication. It is about rapid identification and targeted removal.
What Happens After?
If thrombolytics are given, patients are monitored in an intensive care unit because of bleeding risk. Blood pressure is carefully controlled. Aspirin is often started in patients who do not qualify for clot busting therapy. Additional medications such as clopidogrel may be used depending on the situation.
Recovery depends on how quickly blood flow was restored and how much brain tissue was injured. Some patients improve dramatically within hours. Others require rehabilitation for speech, mobility, or coordination. The earlier the treatment, the better the chance of preserving function.
THE BOTTOM LINE
• A stroke is sudden loss of blood flow to part of the brain, most commonly caused by a clot
• Symptoms such as facial droop, arm weakness, and speech difficulty require immediate evaluation
• Rapid treatment with clot busting medication or mechanical thrombectomy can save brain tissue and preserve function
Written by a Board-Certified Emergency Medicine Physician