# Stroke: Symptoms, Diagnosis and Treatment > Stroke (cerebrovascular accident) in Barcelona: recognise symptoms with the FAST rule, types (ischaemic and haemorrhagic), urgent diagnosis, treatment (thrombolysis, mechanical thrombectomy, surgery) and neurological rehabilitation. Reviewed by Dr Arturo Renú. URL: https://brainandspine-bcn.com/en/neurology/stroke/ Fuente: Brain & Spine Barcelona — https://brainandspine-bcn.com --- # Stroke: symptoms, diagnosis and treatment Stroke is a medical emergency where every minute counts. Recognising symptoms in time and activating the Stroke Code saves neurones and improves prognosis. We explain how to identify it, how it is treated and what recovery involves. ## What is a stroke A **stroke** (also called a cerebrovascular accident or CVA) occurs when blood flow to an area of the brain is suddenly interrupted. The affected neurones stop receiving oxygen and glucose and begin to die within minutes, which is why it is a **time-critical medical emergency**: *time is brain*. ### Recognise it in time: FAST rule F Face Facial asymmetry: mouth drooping or one side of the face falling. A Arms Weakness or dropping of one arm when both are raised. S Speech Slurred speech, difficulty speaking or understanding. T Time If any sign appears, call 112 immediately. Call 112 without delay. Do not wait to see if it improves and do not make your own way there: the ambulance activates the Stroke Code and takes you to a hospital with a stroke unit, where treatment can be applied within the useful time window. ## Types of stroke ### Ischaemic stroke The most common (approximately 85% of cases). A cerebral artery is blocked by a **clot**, often coming from the heart (for example in atrial fibrillation) or from atheromatous plaques. The brain territory supplied by that artery is deprived of blood. ### Haemorrhagic stroke Caused by **rupture of a blood vessel**, with bleeding inside the brain (intracerebral haemorrhage) or in the space surrounding it (subarachnoid haemorrhage). An important cause is the rupture of a [cerebral aneurysm](https://brainandspine-bcn.com/en/brain-aneurysm-treatment-barcelona/), as well as poorly controlled high blood pressure. ### Transient ischaemic attack (TIA) These are stroke symptoms that resolve quickly because the obstruction is transient. Even if it seems that "nothing happened", a TIA is a **warning sign** that requires investigation and treatment to prevent a major stroke. ## How it is diagnosed and treated In hospital, an **urgent brain CT scan** (often with CT angiography and perfusion imaging) can distinguish within minutes whether the stroke is ischaemic or haemorrhagic: a critical distinction because treatment is opposite in each case. ### Treatment of ischaemic stroke - **Intravenous thrombolysis:** drug that dissolves the clot, usually within the first 4.5 hours. - **Mechanical thrombectomy:** clot removal via an arterial catheter in large-vessel occlusion, up to 6-24 hours depending on imaging. ### Treatment of haemorrhagic stroke - **Blood pressure and coagulation control** to stop the bleeding. - **Surgery or endovascular treatment** when a haematoma needs to be evacuated or the cause treated, such as [cerebrovascular surgery](https://brainandspine-bcn.com/en/brain-surgery/vascular-neurosurgery/) for a ruptured aneurysm. The sooner, the better the prognosis. Recognising symptoms and activating the Stroke Code has the greatest influence on long-term functional outcome. ## Rehabilitation after stroke After the acute phase, recovery relies on **neuroplasticity**: the brain's ability to reorganise and relearn lost functions. Early and intensive [neurophysiotherapy](https://brainandspine-bcn.com/en/neurophysiotherapy-barcelona/), together with speech therapy and occupational therapy, is key during the first months, when the greatest scope for improvement exists. The approach is multidisciplinary and is complemented by **secondary prevention** (control of hypertension, atrial fibrillation, diabetes, cholesterol and smoking) to reduce the risk of a further stroke. ## Frequently asked questions about stroke What should I do if I suspect a stroke? Call 112 immediately. Stroke is a time-critical medical emergency: every minute without treatment, millions of neurons die. Do not wait to see if symptoms improve and do not make your own way to hospital; the ambulance activates the "Stroke Code" and takes you to a hospital with a stroke unit in the shortest possible time. What is the FAST rule? It is a simple way to recognise a stroke: F (Face: facial asymmetry or drooping on one side), A (Arms: weakness or dropping of one arm when raising both), S (Speech: slurred speech, difficulty speaking or understanding) and T (Time: if any of these signs appear, call 112 immediately). What is the difference between ischaemic and haemorrhagic stroke? Ischaemic stroke (the most common, approximately 85%) occurs when a cerebral artery is blocked by a clot. Haemorrhagic stroke is caused by the rupture of a blood vessel, with bleeding inside or around the brain (often due to hypertension or a ruptured aneurysm). Treatment differs in each case, which is why an urgent brain CT is essential. What is mechanical thrombectomy? It is the removal of the clot using a catheter inserted via an artery to reach the blocked cerebral artery. It has revolutionised the treatment of ischaemic stroke due to large-vessel occlusion and can be performed up to 24 hours after onset in selected patients with advanced imaging. How long after a stroke can treatment be given? Intravenous thrombolysis is usually given within the first 4.5 hours and mechanical thrombectomy up to 6-24 hours depending on the case and imaging findings. But the principle is always the same: the sooner, the better the prognosis. "Time is brain". Can movement be recovered after a stroke? Yes. Thanks to neuroplasticity, early and intensive rehabilitation allows many patients to recover function. Neurophysiotherapy, speech therapy and occupational therapy are key during the first months, when the greatest scope for improvement exists. How is stroke prevented? By controlling risk factors: high blood pressure, atrial fibrillation, diabetes, high cholesterol, smoking and sedentary lifestyle. In people who have already had a stroke or a TIA, preventive treatment (antiplatelets or anticoagulants) significantly reduces the risk of recurrence. ## What our patients say 5,0 Average rating on Doctoralia · testimonials anonymised with consent "I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well." "For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away." "I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique." _**A multidisciplinary team by your side.** Neurosurgeons, neurologists and nursing staff working together on every case. 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