A stroke happens when the blood supply to part of the brain is interrupted. Brain tissue deprived of blood begins to die within minutes, which is why stroke is treated as an emergency in the same way a heart attack is. The outcome depends more on how quickly treatment starts than on almost anything else — and that part is decided at home, by whoever recognises the signs.
In short: sudden weakness on one side, a drooping face, slurred speech, sudden loss of balance or sudden visual loss mean call emergency services immediately — 112 in Türkiye and across the EU, 999 in the UK, 911 in the US. Note the time the symptoms started, because it determines which treatments are possible. Symptoms that resolve within minutes are a transient ischaemic attack, and that is a warning that needs assessment the same day, not a reason to relax.
What is a stroke?
The brain has no reserve of oxygen or glucose of its own; it depends on continuous flow. When an artery supplying a region is blocked or bursts, the function controlled by that region is lost — movement, speech, vision, balance or sensation, depending on which territory is affected. Around the dead core there is a rim of tissue that is starved but still alive for a limited period. Treatment aims at that rim, and the rim is what shrinks with every minute that passes.
Types of stroke
| Type | What happens | Roughly how common | Typical emergency treatment |
|---|---|---|---|
| Ischaemic | An artery to the brain is blocked by a clot or by narrowing | The large majority of strokes | Clot-dissolving medicine and/or mechanical clot removal |
| Haemorrhagic | A vessel bursts and bleeds into or around the brain | A minority of strokes | Blood pressure control, reversal of blood thinners, sometimes surgery |
| Transient ischaemic attack (TIA) | Blood flow is briefly interrupted and restored | Common and often ignored | Urgent assessment to prevent the stroke that may follow |
That last point is the reason you should never give aspirin to someone you suspect is having a stroke. If the cause is bleeding, a blood thinner makes it worse, and only a scan can tell the difference.
Recognising it: FAST, and what FAST misses
The widely taught rule is FAST:
- F — Face. Ask the person to smile. Has one side drooped?
- A — Arms. Ask them to raise both arms. Does one drift downward?
- S — Speech. Is speech slurred, or are they unable to find words or understand you?
- T — Time. If any of these are present, call emergency services now and note the time symptoms began.
FAST is excellent for the common presentations, but it misses strokes in the back of the brain. Many emergency services now teach BE-FAST, adding two signs that are easy to dismiss:
- B — Balance. Sudden loss of balance or coordination, or an abrupt inability to walk steadily.
- E — Eyes. Sudden loss of vision in one or both eyes, or sudden double vision.
Other sudden symptoms worth treating the same way: numbness down one side, severe confusion, and the sudden, severe headache sometimes described as the worst of a person's life, which can indicate bleeding.
If you suspect a stroke, call emergency services immediately — 112 in Türkiye and the EU, 999 in the UK, 911 in the US. Note the time the symptoms started, or the last time the person was definitely normal. Do not drive them yourself and do not wait to see whether it passes. Do not give aspirin, food or drink. Keep them sitting or lying safely, and stay with them. If the symptoms disappear after a few minutes, they still need to be seen urgently.
Why the clock matters so much
Treatment for an ischaemic stroke is time-limited. Clot-dissolving medicine is generally given within a few hours of symptom onset, and mechanical clot retrieval can be offered in a wider window in selected patients with a large vessel blockage, decided on imaging. Both windows are counted from the moment symptoms began — which is why the first question in the emergency department is always what time it started, and why someone who wakes with symptoms is a different problem from someone who develops them while awake.
None of this can be judged at home. The practical message is narrower and simpler: recognise, call, note the time.
Causes and risk factors
Factors you can change
- High blood pressure — the single largest modifiable contributor to both stroke types.
- Atrial fibrillation — an irregular heart rhythm that lets clots form in the heart and travel to the brain; it is a factor in a substantial share of strokes and frequently causes no symptoms at all. Checking whether your pulse is regular is the simplest way to raise the question, and how to take your pulse properly explains it; the rhythm side is covered under arrhythmia treatment.
- Smoking, which accelerates narrowing in the carotid and cerebral arteries.
- Diabetes and high cholesterol.
- Carotid artery narrowing — plaque in the neck artery, from which fragments can break off and travel to the brain; see carotid artery disease.
- Excess weight, inactivity and heavy alcohol use.
Factors you cannot change
- Age — risk rises steadily with each decade, although strokes occur in young adults too.
- Family history of stroke or early cardiovascular disease.
- A previous stroke or TIA — the strongest predictor of another.
Risk factors compound rather than simply add. Someone with untreated hypertension, atrial fibrillation and a narrowed carotid artery is not carrying three separate small risks; they are carrying a risk that is considerably greater than the sum.
A TIA is an emergency too
A transient ischaemic attack produces the same symptoms as a stroke but they resolve, often within minutes, usually within an hour. Because everything returns to normal, it is the symptom people are most likely to dismiss — and it is the one that offers the clearest opportunity. The risk of a full stroke is highest in the days immediately afterwards, and it falls substantially when the cause is found and treated promptly. Someone who has had a TIA needs assessment urgently, not an appointment next month.
Diagnosis
- Brain imaging — CT or MRI, first to distinguish a blockage from a bleed, then to show how much tissue is affected.
- Carotid Doppler ultrasound — looks for narrowing in the neck arteries; see colour Doppler ultrasound.
- ECG and rhythm monitoring — to detect atrial fibrillation, which may only appear intermittently and can be missed on a single tracing.
- Echocardiography — to look for a cardiac source of clot.
- Blood tests — glucose, cholesterol, clotting and, in younger patients, tests for less common causes.
Prevention, and where vascular surgery fits
Most of stroke prevention is medical: controlling blood pressure, treating atrial fibrillation with appropriate anticoagulation, managing cholesterol and diabetes, and stopping smoking. Vascular surgery enters in one specific place — the carotid artery.
Where a carotid artery is significantly narrowed, especially if it has already caused a TIA or stroke on that side, opening it reduces the risk of a further stroke. The procedure can be carried out as awake carotid surgery under local anaesthesia, which allows the patient's brain function to be monitored directly by talking to them during the operation, or by stenting in selected cases. The decision rests on the degree of narrowing, whether it has caused symptoms, and the person's general condition — it is not based on the narrowing alone. The subject is covered in more depth in carotid artery disease and stroke prevention.
| Risk factor | What reduces the risk |
|---|---|
| High blood pressure | Regular measurement, medication where indicated, reduced salt, weight management |
| Atrial fibrillation | Detection — including checking the pulse for irregularity — then anticoagulation where indicated |
| Carotid narrowing | Doppler assessment; medical treatment, and surgery or stenting in selected cases |
| Smoking | Stopping; risk begins falling within the first year |
| Diabetes and cholesterol | Treatment to target, reviewed regularly |
| Previous TIA or stroke | Urgent assessment and secondary prevention started without delay |
If you have several risk factors but no symptoms, a structured vascular check-up is the organised way to find out where you stand. Narrowing elsewhere often travels together — peripheral artery disease in the legs and aortic aneurysm share the same risk profile.
If you have several of these risk factors but no symptoms, putting a number on them helps decide what to do next: the 10-year cardiovascular risk calculator uses the Framingham model and is explicit about what it does and does not take into account.
After a stroke
Recovery depends on which part of the brain was affected and how quickly flow was restored. Rehabilitation — physiotherapy, speech and language therapy, occupational therapy — does the work of recovery, and it starts early. Running alongside it is secondary prevention: finding the cause and removing it, so that the second stroke does not happen. In practice that means blood pressure control, rhythm monitoring for atrial fibrillation, carotid assessment and strict management of cholesterol and diabetes.
In Istanbul
Prof. Dr. Yusuf Kalko evaluates stroke risk — including carotid artery assessment — at his clinic in Istanbul (Beylikdüzü) and plans prevention tailored to you. Contact us for an appointment. If there are active stroke signs, call emergency services first.
Related Pages
Why Choose Turkey (Istanbul) for Your Treatment?
- Over 30 years of experience in cardiovascular and vascular surgery.
- Advanced minimally invasive and hybrid techniques.
- English- and Arabic-speaking support for international and Gulf patients.
- Easy access to Istanbul from the Gulf, Europe and beyond.
- Pre-travel remote assessment, then treatment and appointment planning.
How to Start from Abroad (Remote Consultation)
You can send your medical reports and scan images via WhatsApp for an initial assessment before traveling. We then plan your treatment and appointment in Istanbul, Turkey, and support international patients at every step.
📋 This page is part of our Vascular Diseases guide. See the overview for other vascular conditions, symptoms and treatments in Turkey (Istanbul).
Frequently Asked Questions
What should I do if I see stroke signs?
Call emergency services immediately — 112 in Türkiye and the EU, 999 in the UK, 911 in the US — and note the time the symptoms started or when the person was last definitely normal. Do not drive them yourself, do not give aspirin, food or drink, and do not wait to see whether it passes.
Is a TIA (mini-stroke) dangerous?
Yes, precisely because it looks harmless. The symptoms resolve, but the risk of a full stroke is highest in the days immediately afterwards. A TIA needs urgent assessment to find and treat the cause, and that assessment substantially reduces the chance of a stroke following it.
What is the difference between FAST and BE-FAST?
FAST covers face, arms, speech and time. BE-FAST adds balance and eyes, because strokes affecting the back of the brain can present with sudden loss of balance or sudden visual loss without any facial droop or arm weakness, and those are the ones most often missed at home.
Why should I not give aspirin to someone having a stroke?
Because a stroke can be caused by bleeding as well as by a clot, and the two look identical from outside. Only a brain scan can tell them apart. Giving a blood thinner when the cause is bleeding makes the situation worse.
Can strokes be prevented?
A large proportion can. Blood pressure control, detecting and treating atrial fibrillation, stopping smoking, managing diabetes and cholesterol, and assessing the carotid arteries where indicated all lower the risk — and the effect of addressing several factors together is greater than any one alone.
How is carotid narrowing detected?
With a colour Doppler ultrasound of the neck, which is painless, involves no radiation and takes a few minutes. Where it shows significant narrowing, further imaging may be used before deciding on treatment.
How does an irregular pulse relate to stroke?
An irregular pulse can indicate atrial fibrillation, in which the upper chambers of the heart quiver instead of contracting properly. Blood can pool and form a clot, and if that clot travels to the brain it causes a stroke. Because it often causes no symptoms, feeling the pulse for irregularity is a simple way to raise the question with your doctor.
Do you treat international patients?
Yes. International and Gulf patients are seen in Istanbul with English- and Arabic-speaking support, and an initial remote assessment can be made from your reports and scan images before you travel.