Vital Insights

Stroke Warning Signs: Early Symptoms to Know

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Dr. Rohit, MBBS MD (Sports Medicine)

Learn stroke warning signs, sudden symptoms in men and women, mini-stroke signs, and simple steps to help protect your brain health.

Think someone is having a stroke? Call 108 for an ambulance, or 112 for emergency services, now.

Note the time the signs started. Do not wait to see if they pass.

Think someone is having a stroke? Call 108 for an ambulance, or 112 for emergency services, now.

Note the time the signs started. Do not wait to see if they pass.

What is a stroke?

A stroke happens when blood cannot reach part of the brain, or when a blood vessel in the brain bursts. The first type, caused by a blocked artery, is called an ischaemic stroke. The second, caused by bleeding, is called a haemorrhagic stroke.

The brain needs a constant supply of blood and oxygen, so a stroke can damage it within minutes. It is also common. India recorded over 1.25 million new strokes in 2021 (Down To Earth, on Lancet Neurology data). Worldwide, about 1 in 4 adults over 25 will have a stroke in their lifetime (University of Washington).

Knowing the stroke warning signs helps you get medical help quickly, and that can save a life.

Can a stroke give warning signs one month before?

Many people search for stroke warning signs one month, one week or one day before. The honest answer is that there is no reliable way to know when a stroke will happen. Many strokes come without warning.

Sometimes, though, a stroke is preceded by a mini-stroke, called a transient ischaemic attack or TIA. Its signs are the same as a stroke's but last only minutes, then go away.

A mini-stroke is the closest thing to a warning sign a stroke gives, and the risk is highest straight after it. In a study of 1,707 people treated for a TIA in emergency departments, 1 in 10 had a full stroke within 90 days, and half of those strokes came within the first 2 days (JAMA, 2000).

So even if the person feels completely better, they need emergency medical help the same day. Fast treatment after a mini-stroke lowers the risk of the stroke that may follow.

Sometimes, though, a stroke is preceded by a mini-stroke, called a transient ischaemic attack or TIA. Its signs are the same as a stroke's but last only minutes, then go away.

So even if the person feels completely better, they need emergency medical help the same day. Fast treatment after a mini-stroke lowers the risk of the stroke that may follow.

10 stroke warning signs you should never ignore

The key word is sudden. These signs come on within seconds or minutes. If you notice any of them, call 108 or 112.

One side of the face droops. One side may look weak or fall. Ask the person to smile and see if the smile is uneven.
One arm is weak. One arm may feel weak or numb. Ask them to raise both arms; one may drift down.
Trouble talking. Speech may be slurred or strange, or the person may not be able to get words out.
Sudden vision problems. Loss of sight in one eye, loss of one side of the visual field in both eyes, blurred vision or double vision.
Trouble walking. Sudden difficulty walking straight or keeping balance.
Sudden dizziness. A sudden feeling that the room is spinning, especially with any other sign on this list.
Sudden numbness. The face, arm or leg suddenly feels numb, especially on one side of the body.
Sudden confusion. The person may suddenly be confused or unable to answer simple questions.
A sudden, very severe headache. Often described as the worst headache of the person's life, coming on in seconds. This can be a sign of bleeding in the brain.
Trouble understanding others. The person can hear you but cannot make sense of your words.

Unusual stroke symptoms: sudden vision problems and loss of balance (signs 4 and 5) are the ones people most often miss, because they expect a stroke to look like a drooping face or weak arm.

These signs can have other causes too. But if they start suddenly, do not wait to find out. Get medical help right away.

The key word is sudden. These signs come on within seconds or minutes. If you notice any of them, call 108 or 112.

One side of the face droops. One side may look weak or fall. Ask the person to smile and see if the smile is uneven.
One arm is weak. One arm may feel weak or numb. Ask them to raise both arms; one may drift down.
Trouble talking. Speech may be slurred or strange, or the person may not be able to get words out.
Sudden vision problems. Loss of sight in one eye, loss of one side of the visual field in both eyes, blurred vision or double vision.
Trouble walking. Sudden difficulty walking straight or keeping balance.
Sudden dizziness. A sudden feeling that the room is spinning, especially with any other sign on this list.
Sudden numbness. The face, arm or leg suddenly feels numb, especially on one side of the body.
Sudden confusion. The person may suddenly be confused or unable to answer simple questions.
A sudden, very severe headache. Often described as the worst headache of the person's life, coming on in seconds. This can be a sign of bleeding in the brain.
Trouble understanding others. The person can hear you but cannot make sense of your words.

Unusual stroke symptoms: sudden vision problems and loss of balance (signs 4 and 5) are the ones people most often miss, because they expect a stroke to look like a drooping face or weak arm.

These signs can have other causes too. But if they start suddenly, do not wait to find out. Get medical help right away.

How to remember stroke signs: FAST, or better, BE FAST

The word FAST helps you remember the main signs of a stroke:

F – Face: does one side of the face droop?
A – Arms: is one arm weak?
S – Speech: is the person having trouble talking?
T – Time: call 108 or 112 straight away.

FAST misses some strokes, especially those that affect balance or vision. A newer version, BE FAST, adds two letters in front:

B – Balance: sudden loss of balance or trouble walking?
E – Eyes: sudden loss of vision or double vision?

In a study of 736 stroke patients, 14% had none of the FAST signs. Adding Balance and Eyes cut the share of missed strokes to 4.4% (University of Kentucky).

The word FAST helps you remember the main signs of a stroke:

F – Face: does one side of the face droop?
A – Arms: is one arm weak?
S – Speech: is the person having trouble talking?
T – Time: call 108 or 112 straight away.

FAST misses some strokes, especially those that affect balance or vision. A newer version, BE FAST, adds two letters in front:

B – Balance: sudden loss of balance or trouble walking?
E – Eyes: sudden loss of vision or double vision?

In a study of 736 stroke patients, 14% had none of the FAST signs. Adding Balance and Eyes cut the share of missed strokes to 4.4% (University of Kentucky).

What to do while you wait for help

Why speed matters: the main treatments work only within a few hours.

A clot-busting drug can dissolve the blockage in an ischaemic stroke, but it must usually be given within 4.5 hours of the first sign.
Clot removal (a thin tube passed up to the brain to pull the clot out) can work up to 24 hours in selected patients.

The clock starts from the moment the person was last seen well. So, while you wait:

Note the time the signs started, or when the person was last seen normal.
Call an ambulance; do not drive the person yourself unless there is no other way.
Go to a hospital that can treat stroke, with a CT scan available around the clock. Ask the ambulance team.
Do not give food, water or medicine, including aspirin. Swallowing may be affected, and aspirin can make a bleeding stroke worse. Doctors need a scan first to know which type it is.
Keep the person comfortable, lying on their side if they are drowsy or vomiting.

Why speed matters: the main treatments work only within a few hours.

A clot-busting drug can dissolve the blockage in an ischaemic stroke, but it must usually be given within 4.5 hours of the first sign.
Clot removal (a thin tube passed up to the brain to pull the clot out) can work up to 24 hours in selected patients.

The clock starts from the moment the person was last seen well. So, while you wait:

Note the time the signs started, or when the person was last seen normal.
Call an ambulance; do not drive the person yourself unless there is no other way.
Go to a hospital that can treat stroke, with a CT scan available around the clock. Ask the ambulance team.
Do not give food, water or medicine, including aspirin. Swallowing may be affected, and aspirin can make a bleeding stroke worse. Doctors need a scan first to know which type it is.
Keep the person comfortable, lying on their side if they are drowsy or vomiting.

Are stroke signs different in women and men?

Most stroke signs are the same in women and men: a drooping face, a weak arm, trouble talking, and sudden problems seeing or walking. Some people also have a severe headache, feel sick or become confused.

What differs is risk. Women have some risk factors that men do not (womenshealth.gov):

Problems in pregnancy, such as pre-eclampsia or gestational diabetes.
Using hormonal birth control while smoking.
Migraine with aura, which is more common in women.
Using menopausal hormone therapy.

Whatever your sex, do not ignore any sudden change in the body. Get medical help quickly.

What differs is risk. Women have some risk factors that men do not (womenshealth.gov):

Problems in pregnancy, such as pre-eclampsia or gestational diabetes.
Using hormonal birth control while smoking.
Migraine with aura, which is more common in women.
Using menopausal hormone therapy.

Whatever your sex, do not ignore any sudden change in the body. Get medical help quickly.

What can increase the risk of a stroke?

Most strokes are linked to risks you can change. The INTERSTROKE study compared 13,477 stroke patients with 13,472 people without stroke across 32 countries, including India. Ten changeable risk factors accounted for about 90% of stroke risk, and high blood pressure alone for about 48% (Healio).

The risks that matter most:

High blood pressure, by far the biggest.
Diabetes (high blood sugar).
Heart problems, especially an irregular heartbeat called atrial fibrillation, which can send clots to the brain.
Smoking.
High cholesterol (too much fat in the blood).
Not getting enough exercise.
An unhealthy diet.
Carrying extra weight around the waist.
Drinking too much alcohol.
Long-term stress or depression.
Having had a stroke or mini-stroke before.

Getting older and having close family members who had a stroke also raise the risk, though you cannot change these. Having a risk does not mean you will have a stroke, but it does mean prevention matters more

The risks that matter most:

High blood pressure, by far the biggest.
Diabetes (high blood sugar).
Heart problems, especially an irregular heartbeat called atrial fibrillation, which can send clots to the brain.
Smoking.
High cholesterol (too much fat in the blood).
Not getting enough exercise.
An unhealthy diet.
Carrying extra weight around the waist.
Drinking too much alcohol.
Long-term stress or depression.
Having had a stroke or mini-stroke before.

How can you lower your risk of a stroke?

You cannot prevent every stroke, but most of the risk is in your hands.

Check your blood pressure. High blood pressure often has no symptoms, so the only way to know is to measure it. Ask your doctor what your target should be and how often to check.
Control blood sugar and cholesterol. If you have diabetes or high cholesterol, follow your doctor's advice and take your medicines as prescribed.
Stay active. Aim for at least 150 minutes of moderate activity a week, such as brisk walking, as the WHO recommends. Choose activities that are safe for you.
Eat well. Eat more fruits, vegetables, pulses and whole grains, and cut down on salt and fried food. Salt matters most because it raises blood pressure.
Stop smoking. Smoking damages blood vessels and raises stroke risk. Ask your doctor for help to quit.
Take your medicines. Take them as your doctor tells you, and do not stop without asking. This includes blood thinners if you have atrial fibrillation.
Learn the warning signs. Teach your family BE FAST and the numbers 108 and 112. Knowing the signs helps everyone act quickly in an emergency.

You cannot prevent every stroke, but most of the risk is in your hands.

Check your blood pressure. High blood pressure often has no symptoms, so the only way to know is to measure it. Ask your doctor what your target should be and how often to check.
Control blood sugar and cholesterol. If you have diabetes or high cholesterol, follow your doctor's advice and take your medicines as prescribed.
Stay active. Aim for at least 150 minutes of moderate activity a week, such as brisk walking, as the WHO recommends. Choose activities that are safe for you.
Eat well. Eat more fruits, vegetables, pulses and whole grains, and cut down on salt and fried food. Salt matters most because it raises blood pressure.
Stop smoking. Smoking damages blood vessels and raises stroke risk. Ask your doctor for help to quit.
Take your medicines. Take them as your doctor tells you, and do not stop without asking. This includes blood thinners if you have atrial fibrillation.
Learn the warning signs. Teach your family BE FAST and the numbers 108 and 112. Knowing the signs helps everyone act quickly in an emergency.

Can an MRI scan find a stroke?

Yes. In an emergency, though, doctors usually do a CT scan first. It is fast, and it shows whether the stroke is caused by bleeding, which decides whether a clot-busting drug is safe.

An MRI takes more detailed pictures. A type of MRI image called diffusion-weighted imaging can show a stroke caused by a blocked artery within minutes of it starting, including small strokes a CT scan can miss. MRI can also show old silent strokes: small strokes that caused no obvious symptoms but still damaged the brain.

If you think someone is having a stroke, do not book a scan. Call 108 or 112, and the hospital will decide which test is needed.

Yes. In an emergency, though, doctors usually do a CT scan first. It is fast, and it shows whether the stroke is caused by bleeding, which decides whether a clot-busting drug is safe.

If you think someone is having a stroke, do not book a scan. Call 108 or 112, and the hospital will decide which test is needed.

About Vital Insights

Vital Insights is a performance and longevity lab in Chennai. Many of the biggest stroke risks have no symptoms until it is too late. High blood pressure, diabetes and high cholesterol can be found early with simple tests, and treated.

No test can tell exactly when a stroke will happen. But knowing your numbers shows where your risk is, so you and your doctor can lower it.

Frequently Asked Questions

Can we know about a stroke one month before?

What are the first signs of a stroke?

Can stroke signs go away?

Are stroke signs different in women?

Does a headache mean a stroke is coming?

Can an MRI scan find a stroke?

What should I do if the signs go away?

Frequently Asked Questions

Can we know about a stroke one month before?

What are the first signs of a stroke?

Can stroke signs go away?

Are stroke signs different in women?

Does a headache mean a stroke is coming?

Can an MRI scan find a stroke?

What should I do if the signs go away?

Conclusion

A stroke usually happens suddenly, so do not wait for warning signs a month before. The nearest thing to a warning is a mini-stroke, and it needs emergency care the same day.

Remember BE FAST: Balance, Eyes, Face, Arms, Speech, and Time to call 108 or 112. Sudden confusion or a very severe headache can also be signs of a stroke.

If you think someone is having a stroke, get emergency help right away, even if the signs go away. Every minute counts.

A stroke usually happens suddenly, so do not wait for warning signs a month before. The nearest thing to a warning is a mini-stroke, and it needs emergency care the same day.

Remember BE FAST: Balance, Eyes, Face, Arms, Speech, and Time to call 108 or 112. Sudden confusion or a very severe headache can also be signs of a stroke.

If you think someone is having a stroke, get emergency help right away, even if the signs go away. Every minute counts.

Words worth knowing

Vital Insights, Chennai. This article is for education and does not replace individual medical advice. In an emergency, call 108 or 112.

References

GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2021. Lancet Neurol. 2024. Summarised by Down To Earth, 20 September 2024.
GBD 2016 Lifetime Risk of Stroke Collaborators. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med. 2018;379:2429–2437. Summarised by the University of Washington.
Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284(22):2901–2906.
Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke. 2017;48(2):479–481. Summarised by the University of Kentucky.
O'Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE). Lancet. 2016;388(10046):761–775. Summarised by Healio.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update. Stroke. 2019;50(12):e344–e418. Source for the 4.5-hour and 24-hour treatment windows.
US Office on Women's Health. Stroke fact sheet.
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2020.

GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2021. Lancet Neurol. 2024. Summarised by Down To Earth, 20 September 2024.
GBD 2016 Lifetime Risk of Stroke Collaborators. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med. 2018;379:2429–2437. Summarised by the University of Washington.
Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284(22):2901–2906.
Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke. 2017;48(2):479–481. Summarised by the University of Kentucky.
O'Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE). Lancet. 2016;388(10046):761–775. Summarised by Healio.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update. Stroke. 2019;50(12):e344–e418. Source for the 4.5-hour and 24-hour treatment windows.
US Office on Women's Health. Stroke fact sheet.
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2020.