Causes

Causes of Stroke

A case-control study of 26,919 people in 32 countries found ten modifiable factors that together account for about 90% of the population attributable risk of stroke, with the same pattern in every region, in men and women and at every age⁷. Attributable risk describes how much stroke in a population is linked to these factors, not how much any one person can prevent.

Cause	How It Contributes to Stroke	What Helps
High blood pressure	A history of high blood pressure or a reading of 140/90 mmHg or higher carried an odds ratio of 2.98 and a population attributable risk of 47.9%, the largest of the ten, and it was more strongly associated with bleeding into the brain than with clots⁷	Blood pressure treatment from your prescriber, kept to the target you agreed on, plus the sodium, potassium and food pattern set out in the diet section here and on our high blood pressure guide
Physical inactivity	Regular physical activity carried an odds ratio of 0.60 against stroke, and its absence a population attributable risk of 35.8%, second only to blood pressure⁷	Aerobic activity most days with resistance training twice a week, as the treatment section describes, and supervised rehabilitation after a stroke rather than unstructured exercise
Atherogenic cholesterol particles and diet quality	The ratio of apolipoprotein B to apolipoprotein A1 carried a population attributable risk of 26.8%, and a poor diet score 23.2%, and both were more strongly linked to clot-type stroke⁷	The vegetables, fatty fish, olive oil, nuts and whole grains in the diet section, and the cholesterol treatment your clinician prescribes; the two work together rather than as alternatives
Cardiac causes, including atrial fibrillation	Cardiac sources of clot carried the highest odds ratio of the ten, 3.17, with a population attributable risk of 9.1%⁷; pooling 29 trials, adjusted-dose anticoagulation cut stroke in atrial fibrillation by 64%¹⁰	Having an irregular pulse checked and monitored (as the diagnosis section describes) and anticoagulation decided by your clinician; no supplement on this page substitutes for it, and several interact with blood thinners
Smoking	Current smoking carried an odds ratio of 1.67 and a population attributable risk of 12.4%, and was more strongly linked to clot-type stroke than to bleeding⁷	Stopping smoking, with help from your clinical team, as the treatment section sets out
Abdominal obesity, alcohol, psychosocial factors and diabetes	Waist-to-hip ratio carried a population attributable risk of 18.6%, psychosocial factors 17.4%, high or heavy episodic drinking 5.8% and diabetes 3.9%⁷	The food pattern and alcohol limits in the diet section, glucose treatment from your clinical team, and naming persistent stress or low mood to your clinician rather than treating it as a lifestyle detail

Treatment Comparison

Conventional and Holistic Treatment for Stroke

🌿 HOLISTIC

💊 CONVENTIONAL

🌿

Holistic / Functional Approach

Prevention (most stroke risk is linked to modifiable factors) + recovery support. Acute treatment is hospital-only.

Acute Stroke

EMERGENCY: call 911. No holistic acute treatment. Every minute matters.¹¹

Prevention

Ten modifiable risk factors, led by high blood pressure, together account for about 90% of population attributable risk of stroke⁷

Post-Stroke Recovery

Neuroplasticity supported by nutrition, exercise, intense rehab, sleep, social engagement

Recurrence

About 26% cumulative recurrence at 5 years after a first stroke in pooled studies, lower in more recent cohorts⁹

Full Holistic Approach Includes

Aggressive blood pressure control, target <130/80. The largest modifiable risk factor. Each 10 mmHg fall in systolic pressure lowered stroke risk by 27% in trials¹².
Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diet, with about 30% fewer major cardiovascular events, stroke among them, on a Mediterranean diet than on a reduced-fat diet in PREDIMED¹³. Vegetables, fruits, fatty fish, olive oil, nuts, whole grains, beans.
Quit smoking: the risk of disease and death from stroke falls, approaching that of people who never smoked¹⁴.
Aerobic exercise 150+ min/week, linked with lower stroke risk: 27% lower in the most active people than the least active, pooled across 23 studies¹⁵. Resistance training 2x/week.
Address sleep apnea, a major and underdiagnosed risk factor; a sleep study decides whether a CPAP breathing machine is needed.
Limit alcohol, 1 drink or less a day for women, 2 or less for men¹⁶ (or none; recent evidence suggests no safe amount)
Optimize diabetes control, HbA1c under 7%. Prediabetes (HbA1c 5.7 to 6.4%) also increases risk.
Treat AFib aggressively, anticoagulation per CHA2DS2-⁠VASc¹⁰ score
Address atherosclerosis, LDL under 70 mg/dL (1.8 mmol/L) in high-risk patients; statin therapy proven; address Lp(a)
Fatty fish as part of the diet; omega-⁠3 capsules have not been shown to prevent stroke
Stress reduction, meditation, yoga; chronic stress elevates BP and clotting
Post-stroke: intense rehab (physical, occupational, speech therapy). Neuroplasticity drives recovery, especially first 6 months.
Post-stroke nutrition: Mediterranean diet supports recovery; correct dysphagia-related malnutrition

✅ Key point: most stroke risk is linked to modifiable factors. The big four: control BP, don't smoke, eat Mediterranean, exercise. Add: treat AFib if present, optimize cholesterol, control diabetes. Lifestyle and prescribed treatment work together for stroke prevention.

💊

Conventional / Medical Approach

Acute: tPA + thrombectomy¹¹. Secondary prevention: antiplatelets, anticoagulants, statins, BP control.

Acute Ischemic (≤4.5h)

IV thrombolysis (alteplase or tenecteplase) restores flow; alteplase within 3 hours made minimal or no disability at 3 months at least 30% more likely⁸

Large Vessel Occlusion

Mechanical thrombectomy within 6 hours, extended to 24 hours in selected patients using perfusion imaging¹¹

Hemorrhagic

BP control, reverse anticoagulation, neurosurgical evaluation for evacuation

Secondary Prevention

Antiplatelet/anticoagulant + statin + BP control + lifestyle

Conventional Approach Includes

Acute ischemic stroke (within 4.5 hours): IV tPA (alteplase) or tenecteplase dissolves the clot. Strict eligibility criteria (no recent surgery, normal clotting tests, no hemorrhage on CT).
Mechanical thrombectomy (within 6 hours, up to 24 hours in selected patients): catheter-based clot retrieval for large vessel occlusion. Improves outcomes.
Hemorrhagic stroke: fast lowering of blood pressure (top number under 140 mmHg), reversal of any blood thinner with the right reversal treatment and neurosurgery evaluation
Antiplatelet therapy (non-cardioembolic): after a minor stroke or high-risk TIA, aspirin 81 mg + clopidogrel for 21 days, then either alone; otherwise a single antiplatelet from the start. Long-term aspirin or clopidogrel.
Anticoagulation (cardioembolic or AFib): DOACs (apixaban, rivaroxaban, edoxaban) preferred over warfarin
High-intensity statin: atorvastatin 80 mg or rosuvastatin 40 mg, target LDL under 70 mg/dL (1.8 mmol/L)
BP control: target <130/80; ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics
Carotid intervention: endarterectomy or stenting for symptomatic stenosis >70%
PFO closure: in selected younger patients with cryptogenic stroke
Rehabilitation: critical first 6 months; physical, occupational, speech therapy intensive

⚠️ Time Is Brain: The earliest treatment gives the greatest benefit. Even within the 4.5-⁠hour tPA window, every 15-⁠minute delay reduces benefit. Know stroke symptoms, call 911 immediately, do NOT drive yourself.

Nutritional Strategy

Diet for Stroke

In PREDIMED, a Mediterranean diet with extra-virgin olive oil or nuts had about 30% fewer major cardiovascular events, stroke among them, than a reduced-fat diet¹³. Post-stroke: same diet supports brain recovery via reduced inflammation and improved vascular health.

Foods that lower stroke risk, and what to strictly limit

What to eat or do	Details
✅ Prioritize:
Leafy Greens & Vegetables	5 to 7+ servings daily. Nitrate-rich vegetables (beets, spinach, arugula) lower BP. Folate-rich foods lower homocysteine. If you take warfarin, keep your intake of leafy greens consistent and agree on any increase with the clinician managing your anticoagulation, as vitamin K changes the INR; this does not apply the same way to DOACs¹⁷.
Fatty Fish (2 to 3x/week)	Wild salmon, sardines, Atlantic mackerel. Part of a Mediterranean pattern. Omega-⁠3 capsules have not been shown to prevent stroke, so eat the fatty fish rather than relying on supplements.
Extra-Virgin Olive Oil	2 to 4 tablespoons daily as primary fat. In PREDIMED, the Mediterranean diet with extra-virgin olive oil had 31% fewer major cardiovascular events, stroke among them, than a reduced-fat diet (hazard ratio 0.69)¹³.
Berries & Fruits	Especially berries, citrus, apples. Flavonoids improve endothelial function. Potassium-rich foods (bananas) help BP.
Nuts (5+/week)	Walnuts (omega-⁠3), almonds, pistachios. 1 oz (28 g) on 5 or more days a week improves cholesterol, BP, vascular function.
❌ Strictly Avoid/Limit:
High Sodium	Target <2,300 mg/day (<1,500 mg if hypertensive). Hidden in processed foods, restaurant meals, canned soups, deli meats. Read labels obsessively.
Processed/Ultra-Processed Foods	The highest intake was linked with 9% higher stroke risk in a 2024 meta-analysis of prospective studies (on low-certainty evidence) and more firmly with heart disease¹⁸. Trans fats, sodium, additives, refined carbs.
Red & Processed Meats	Limit red meat <3 servings/week; eliminate processed meats (bacon, sausage, deli). Saturated fat, sodium, nitrates increase stroke risk.
Heavy Alcohol	High or heavy episodic drinking roughly doubled the odds of stroke in a 32-⁠country study⁷. Recent evidence suggests no safe amount. Binge drinking particularly dangerous.
Refined Sugar & Sweet Drinks	Drive insulin resistance, hypertension. Sodas, juices, sweets. Each extra 8 oz (250 mL) a day was linked with about 9% higher stroke risk in pooled prospective studies¹⁹.

Supplement Protocol

Evidence-Based Supplements for Stroke

For prevention and post-stroke recovery. Critical: tell your doctor about all supplements; many interact with blood thinners.

Supplement	What it is for	Typical range	Timing	Notes & cautions
Omega-⁠3 (EPA/DHA)	Reduces inflammation and improves endothelial function. On stroke specifically the trial evidence is unsupportive: VITAL and ASCEND, both large randomized trials of omega-⁠3 supplements, found no cardiovascular benefit. Eating fatty fish remains sensible; the capsules have not been shown to prevent stroke.²⁰	Not recommended for preventing stroke (the large trials used about 1 g a day)	Not applicable	Caution at high doses with anticoagulants; discuss with your cardiologist. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day²¹, so check any fish oil supplement with your clinician first.
Vitamin D3	Correcting a deficiency. In a large randomized trial, vitamin D supplements did not lower stroke or other major cardiovascular events against placebo²².	Set the dose with your clinician; most adults need no blood test first	With fat meal	If you also take vitamin K2 (see its row below), it can interfere with warfarin, so check first if you take a blood thinner.
Magnesium	Reduces blood pressure and supports endothelial function. Meta-analyses associate each 100 mg/day of dietary magnesium with roughly 8 to 9% lower ischemic stroke risk, an observational finding about food intake rather than a demonstrated effect of supplements²³.	400 to 600 mg/day	Evening	Glycinate, malate or threonate. Avoid oxide. This whole range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
B-Complex (Folate, B6, B12)	Lowers homocysteine²⁴; high homocysteine increases stroke risk. Folic acid works for people with MTHFR variants; methylfolate is an alternative, not a requirement.	Folate 800 mcg + B6 25 mg + B12 1,000 mcg	Morning	Test homocysteine; target under 9 µmol/L.
Coenzyme Q10	Mitochondrial support. The overall evidence does not support it for statin-related muscle pain, and it may interact with some blood thinners, so check first if you take one²⁵.	100 to 200 mg/day	With fat meal	Ubiquinol form preferred over age 50.
Berberine	Studied for blood sugar, cholesterol and blood pressure; not established for stroke prevention, and comparative data against prescription therapy is limited.	500 mg 2 to 3x/day	With meals	It slows the breakdown of many medicines, including some blood thinners such as apixaban and rivaroxaban, which can raise bleeding risk; do not take it with a blood thinner unless your prescriber agrees. Do not take it in pregnancy or breastfeeding.
Citicoline (Post-Stroke)	Widely used in some countries and supported by early studies, but the largest randomized trial was negative. ICTUS randomized 2,298 patients and was stopped for futility, with recovery essentially identical to placebo (odds ratio 1.03). Not established as effective after stroke.²⁶	Not recommended after stroke (the trial used 2,000 mg a day)	Not applicable	The largest trial was negative for recovery. Discuss with your neurologist.
Vitamin K2 (MK-⁠7)	Involved in how the body uses calcium; whether supplements protect bone or reduce artery calcification is not established.	100 to 200 mcg/day	With fat meal	CAUTION on warfarin¹⁷, interferes with anticoagulation. Does not interact the same way with DOACs.

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.²⁹ Stroke is the most time-critical condition on this site. Every minute of a blocked artery costs roughly 1.9 million neurons, clot-busting treatment works within about 4.5 hours of symptom onset, and thrombectomy within a longer but still limited window. If someone has sudden face drooping, arm weakness or speech difficulty, call emergency services immediately. Do not wait to see if it passes, do not drive them yourself, and do not look anything up first. Nothing on this page treats a stroke, and nothing on it should delay that call by a single minute. The nutrition here is for reducing risk beforehand and supporting recovery afterward. If you take an anticoagulant or antiplatelet, clear every supplement with your prescriber, because several affect bleeding.

On how fast brain is lost: a 2006 analysis estimated that in a typical large-vessel ischemic stroke about 1.9 million neurons, 14 billion synapses and 12 km of nerve fibers are destroyed for each minute the stroke goes untreated, PubMed 16339467. ↩
On stroke types: the CDC reports that about 87% of all strokes are ischemic, meaning blood flow to the brain is blocked, and that more than 795,000 people in the United States have a stroke each year, CDC, Stroke Facts. ↩
On stroke after a TIA: in a 1997 to 1998 cohort of 1,707 people diagnosed with a TIA in 16 US emergency departments, 10.5% had a stroke within 90 days, half of those within the first two days, PubMed 11147987. In a 2009 to 2011 registry of 4,789 people with a TIA or minor stroke, most of them seen by stroke specialists within 24 hours, the stroke rate was 1.5% at two days, 3.7% at 90 days and 5.1% at one year, lower than earlier studies had reported, PubMed 27096581. ↩
American Heart Association / American Stroke Association, Heart Disease and Stroke Statistics and acute ischemic stroke guidelines. stroke.org. Source for the FAST recognition acronym and the principle that outcome depends on how quickly reperfusion is achieved. ↩
On blood pressure: hypertension is the single largest modifiable risk factor for both ischemic and hemorrhagic stroke, and blood pressure control does more to reduce stroke risk than anything else on this page. See our high blood pressure guide for the dietary detail. ↩
On deaths from stroke: CDC national figures for 2024 rank stroke as the 4th leading cause of death in the United States, with 166,852 deaths, after heart disease, cancer and accidents, CDC, FastStats, leading causes of death. ↩
On modifiable risk factors: a case-control study of 26,919 people in 32 countries found that ten potentially modifiable risk factors, led by high blood pressure, were collectively associated with about 90% of the population attributable risk of stroke, and the pattern held across regions, sexes and age groups, PubMed 27431356. Attributable risk describes how much stroke in a population is linked to these factors, not how many strokes any one person can prevent. ↩
On thrombolysis: in the original randomized trial of intravenous alteplase given within three hours of ischemic stroke onset, treated patients were at least 30% more likely to have minimal or no disability at three months, at the cost of more symptomatic brain hemorrhage (6.4% against 0.6%), PubMed 7477192. That trial did not test tenecteplase or treatment beyond three hours. ↩
On recurrence: a 2011 meta-analysis of studies following 9,115 survivors of a first stroke found a pooled cumulative recurrence risk of 11.1% at 1 year and 26.4% at 5 years, with the 5-⁠year risk falling from 32% to 16.2% across studies over time, PubMed 21454819. The review suggests part of that fall may reflect changes in secondary prevention, and it found substantial differences between studies. ↩
On atrial fibrillation and stroke prevention: CHA2DS2-⁠VASc scoring guides anticoagulation decisions, though a 2026 review notes it does not capture the whole of an individual's thromboembolic risk, PubMed 42337163. Anticoagulation substantially reduces stroke risk in atrial fibrillation: pooling 29 trials, adjusted-dose warfarin cut stroke by 64%, PubMed 17577005. This is a prescribing decision. No supplement on this page substitutes for it. ↩
On treatment windows: intravenous thrombolysis is generally given within 4.5 hours of symptom onset, and mechanical thrombectomy for large vessel occlusion within 6 hours, extended to 24 hours in selected patients using perfusion imaging. These windows are the entire reason the emergency instruction above is written in the strongest terms available. ↩
On blood pressure lowering: a 2016 meta-analysis of 123 trials in 613,815 people found that every 10 mmHg reduction in systolic pressure lowered the risk of stroke by 27% (relative risk 0.73) and of major cardiovascular events by 20%, PubMed 26724178. ↩
On the Mediterranean diet: in a trial of 7,447 adults aged 55 to 80 at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or with mixed nuts had fewer major cardiovascular events, a combined measure of heart attack, stroke and cardiovascular death, than a reduced-fat control diet (hazard ratios 0.69 and 0.72) over a median 4.8 years. This is the 2018 republication after protocol deviations were found and the analysis was revised, PubMed 29897866. ↩
On stopping smoking: the CDC states that quitting reduces the risk of disease and death from stroke, with the risk approaching that of people who never smoked, and reduces the risk of coronary heart disease, which falls sharply one to two years after quitting, CDC, Benefits of Quitting Smoking. ↩
On physical activity: a 2003 meta-analysis of 23 studies found that highly active people had a 27% lower risk of stroke or stroke death than people with low activity, and moderately active people about 20% lower, with lower risk of both ischemic and hemorrhagic stroke, PubMed 14500932. ↩
On alcohol limits: the CDC defines moderate drinking as two drinks or less in a day for men and one drink or less in a day for women, CDC, moderate alcohol use. ↩
On vitamin K and warfarin: vitamin K directly antagonizes warfarin, so starting, stopping or changing the dose of a K2 supplement destabilizes the INR, and varied vitamin K intake is a recognized cause of INR fluctuation, PubMed 35685257. It does not interact the same way with direct oral anticoagulants. Anyone on warfarin should agree on vitamin K intake with the clinician managing their anticoagulation, and keep it consistent rather than avoiding it entirely. ↩
On ultra-processed food: a 2024 analysis of three large US cohorts, with a meta-analysis of prospective studies, found the highest intake of ultra-processed food associated with 17% higher cardiovascular disease risk, 23% higher coronary heart disease risk and 9% higher stroke risk than the lowest intake; the certainty of the evidence was rated high for coronary heart disease and low for stroke, PubMed 39286398. ↩
On sugary drinks: a 2022 dose-response meta-analysis of prospective studies found each additional 250 mL a day of sugar-sweetened beverages associated with about 9% higher stroke risk (relative risk 1.09), an observational finding, PubMed 35215425. ↩
On omega-⁠3 supplements: VITAL, N Engl J Med. 2019;380:23-⁠32, and ASCEND, N Engl J Med. 2018;379:1540-⁠1550, both large randomized trials of marine omega-⁠3 supplementation at about 1 g/day, found no significant reduction in cardiovascular events including stroke. REDUCE-IT, which was positive, tested prescription icosapent ethyl at 4 g/day in a selected population and is not evidence for fish oil capsules. High-dose omega-⁠3 also has a mild antiplatelet effect, which matters on this page. ↩
Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩
On vitamin D: in a randomized trial of 25,871 US adults followed for a median 5.3 years, 2,000 IU of vitamin D3 a day did not lower major cardiovascular events (hazard ratio 0.97) or stroke (0.95) compared with placebo, PubMed 30415629. ↩
On magnesium: dose-response meta-analyses of prospective cohorts associate each 100 mg/day increment of dietary magnesium with roughly 8 to 9% lower risk of ischemic stroke; one such meta-analysis pooled seven prospective studies (6,477 stroke cases among 241,378 participants): Larsson SC, Orsini N, Wolk A. Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies. Am J Clin Nutr. 2012;95(2):362-⁠366. PubMed 22205313. This concerns magnesium from food in observational cohorts and does not establish that supplements reduce stroke. The upper intake level for supplemental magnesium is 350 mg/day. ↩
On homocysteine and B vitamins: unlike coronary disease, where homocysteine-lowering trials were null for cardiac events, meta-analyses of folic acid supplementation have suggested a modest reduction in stroke, most evident in populations without folate fortification. The effect is small and the evidence is not uniform. Treat it as a reason to correct a deficiency, not as stroke prevention in someone already replete. ↩
On CoQ10: the NIH National Center for Complementary and Integrative Health states that the overall evidence does not support CoQ10 for muscle pain caused by statins, and that CoQ10 may interact with a commonly used blood thinner and with insulin, NCCIH, Coenzyme Q10. ↩
ICTUS trial: Davalos A, et al. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study. Lancet. 2012;380(9839):349-⁠357. thelancet.com. 2,298 patients randomized within 24 hours of onset to citicoline, 1,000 mg every 12 hours (2,000 mg a day) for 6 weeks, or placebo; stopped for futility, with global recovery odds ratio 1.03 (95% CI 0.86 to 1.25, p = 0.364). The authors concluded citicoline is not efficacious in moderate-to-severe acute ischemic stroke. Earlier smaller studies were more encouraging, which is exactly why the large trial matters more. ↩
On recognizing a stroke and on recovery: NHS guidance gives the main signs as face weakness, arm weakness and speech problems, remembered as FAST (face, arms, speech and time to call), and lists sudden weakness or numbness down one side, blurred vision or loss of sight, difficulty finding words, confusion, dizziness or falling over, severe headache and vomiting as other signs. It advises calling emergency services even if the signs have already stopped, and not driving yourself. On recovery it says the pace varies from days or weeks to months or years, describes a home recovery plan covering movement, cognition, speech, swallowing, vision and mood, and says progress should be reviewed after about 6 months, NHS, stroke symptoms and NHS, recovering from a stroke. ↩
On the pace of recovery: a prospective community series of 1,197 patients with acute stroke, all treated and rehabilitated in one unit, found that 80% reached their best activities-of-daily-living function within 6 weeks of onset and 95% had completed functional recovery within 12.5 weeks, ranging from 8.5 weeks after an initially mild stroke to 20 weeks after a very severe one, with neurological recovery running about two weeks ahead of functional recovery. The series predates current clot-dissolving and clot-retrieval treatment, so it describes the shape of recovery rather than the outcomes available now, PubMed 7741609. ↩
National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩

Symptom	What happens
BE FAST Acute Signs
B, Balance & Coordination Loss	Sudden loss of balance, severe dizziness, difficulty walking, unable to stand. May indicate cerebellar or brainstem stroke. Easily missed.
E, Eyes / Vision Changes	Sudden vision loss in one or both eyes, double vision, blurred vision, visual field cut. Patient may bump into things on one side.
F, Face Drooping	One side of face droops or feels numb. Ask the person to smile: is the smile uneven? Crooked mouth, drooping eyelid.
A, Arm Weakness	One arm weak or numb. Ask the person to raise both arms: does one drift downward? May affect leg as well (hemiparesis).
S, Speech Difficulty	Slurred speech, garbled words, inability to speak, can't understand what's being said. Ask the person to repeat a simple sentence: is it slurred or strange?
T, Time to Call 911	If ANY symptoms present, call 911 immediately. Note time of symptom onset, critical for treatment eligibility (tPA window: 4.5 hours; thrombectomy: 6 hours, up to 24 hours in selected patients).
Sudden Severe Headache ("Thunderclap")	"Worst headache of my life," sudden onset, severe, peaks within seconds. Suggests subarachnoid hemorrhage (often aneurysm). Medical emergency.
Confusion or Loss of Consciousness	Sudden confusion, trouble understanding, decreased consciousness. May be the only symptom in some strokes. Do not dismiss in older patients.

Test	What it shows
Acute Imaging
CT Head (Non-Contrast)	First imaging, done within minutes of ER arrival. Distinguishes ischemic from hemorrhagic stroke. A normal early scan cannot exclude ischemic stroke. Rules out bleed.
CT Angiogram (CTA)	Visualizes blood vessels, identifies large vessel occlusion (LVO) for thrombectomy candidates. CT perfusion identifies salvageable tissue ("penumbra").
MRI with Diffusion-Weighted Imaging	Most sensitive for early ischemia, detects strokes invisible on CT. Used after acute decisions, for staging and small lacunar strokes.
Etiology Workup
ECG & Holter Monitor	Identifies atrial fibrillation, major cause of cardioembolic stroke. Extended monitoring (30 days+) often needed to detect paroxysmal AFib.
Echocardiogram	Looks for cardiac source of embolism, patent foramen ovale (PFO), thrombus, valvular disease. TEE (transesophageal) more sensitive.
Carotid Doppler/Duplex	Identifies carotid stenosis; >70% stenosis often warrants endarterectomy or stenting to prevent recurrence.
Vascular Risk Workup	Lipid panel, HbA1c, homocysteine, Lp(a), CRP, hypercoagulability panel in younger strokes. Identifies modifiable risk factors.

Stroke

What Is Stroke?

Types of Stroke

Ischemic Stroke (Most Strokes)

Hemorrhagic Stroke

TIA ("Mini-Stroke")

Stroke by the Numbers

Symptoms of Stroke

Causes of Stroke

How Stroke Is Diagnosed

Conventional and Holistic Treatment for Stroke

Holistic / Functional Approach

Full Holistic Approach Includes

Conventional / Medical Approach

Conventional Approach Includes

Diet for Stroke

Evidence-Based Supplements for Stroke

What to Expect Over Time

What Lowers Stroke Risk

References & Evidence Notes

Stroke

What Is Stroke?

Types of Stroke

Ischemic Stroke (Most Strokes)

Hemorrhagic Stroke

TIA ("Mini-Stroke")

Stroke by the Numbers

Symptoms of Stroke

Causes of Stroke

How Stroke Is Diagnosed

Conventional and Holistic Treatment for Stroke

Holistic / Functional Approach

Full Holistic Approach Includes

Conventional / Medical Approach

Conventional Approach Includes

Diet for Stroke

Evidence-Based Supplements for Stroke

What to Expect Over Time

Related Conditions

What Lowers Stroke Risk

References & Evidence Notes