Stroke symptoms usually begin suddenly. Warning signs can include facial drooping, weakness or numbness on one side, difficulty speaking, sudden vision changes, loss of balance or coordination, and an unexplained severe headache. A simple way to recognize a possible stroke is FAST: Face, Arms, Speech, Time. Newer stroke-awareness campaigns also use BE FAST, adding Balance and Eyes.

If any of these symptoms appear suddenly, treat the situation as a medical emergency. Do not wait to see whether the person improves. Note when symptoms started or when the person was last known to be normal and arrange emergency medical transport as quickly as possible. Stroke treatment is highly time-sensitive.

For patients in Bhaktapur and the Kathmandu Valley, Nagarik Hospital publicly lists a 24-hour emergency and ambulance service at +977-9801904640.

What Are the Main Symptoms of a Stroke?

Stroke symptoms are neurological problems caused by interruption of blood flow to part of the brain or bleeding in or around the brain. What makes them especially concerning is often their sudden onset.

Common warning signs include:

• Sudden weakness or numbness of the face, arm or leg, especially on one side
• Sudden difficulty speaking or understanding speech
• Sudden confusion
• Sudden vision loss, blurred vision or double vision
• Sudden difficulty walking
• Sudden dizziness or loss of balance or coordination
• Sudden severe headache without an obvious cause

The U.S. National Institute of Neurological Disorders and Stroke and the CDC list these sudden neurological changes among the major stroke warning signs.

A stroke does not always cause pain. A person may simply become unable to lift an arm normally, speak clearly, understand a sentence, walk steadily or see normally.

That is why recognising a sudden change in neurological function can be more useful than waiting for dramatic symptoms.

What Does FAST Mean for Stroke Symptoms?

FAST stands for Face, Arms, Speech and Time. It is a simple public-recognition tool designed to help people identify several of the most common stroke warning signs and respond urgently.

FAST does not diagnose a stroke. It identifies warning signs that warrant urgent medical assessment.

NINDS advises noting the time when symptoms first appear because treatment decisions depend partly on symptom timing.

What Is BE FAST?

Some stroke campaigns use BE FAST to capture additional neurological symptoms:

• B – Balance: sudden dizziness, loss of balance or poor coordination
• E – Eyes: sudden loss of vision, blurred vision or double vision
• F – Face: one-sided facial drooping or numbness
• A – Arms: weakness or numbness in one arm
• S – Speech: slurred, unusual or absent speech
• T – Time: seek emergency care immediately

The CDC and American Stroke Association both describe BE FAST as a useful recognition framework.

FAST is easier to remember, while BE FAST can help people remember balance and visual symptoms that may otherwise be missed.

Neither system captures every possible stroke presentation, so a sudden neurological problem should still be treated seriously even when it does not fit the acronym perfectly.

Stroke Warning Signs at a Glance

The practical message is not to determine the exact brain region at home. The priority is to recognize that sudden neurological dysfunction may represent a stroke and arrange urgent assessment.

Can Stroke Symptoms Be Mild?

Yes. A stroke does not need to cause complete paralysis or unconsciousness.

A person might only notice:

• Slight facial asymmetry
• Weakness in one hand
• Difficulty finding words
• Unusual clumsiness
• Numbness affecting one side
• New double vision
• Sudden inability to walk steadily

Mild symptoms can still be important.

The 2026 American Heart Association/American Stroke Association ischemic stroke guideline emphasizes that clinicians assess whether a neurological deficit is disabling, rather than relying only on a numerical stroke-severity score. A seemingly small deficit can have a major impact on an individual—for example, leg weakness that prevents normal walking.

Do not delay emergency assessment because the person can still speak, walk or move somewhat normally.

What If Stroke Symptoms Disappear?

Symptoms that disappear can still represent an emergency.

A temporary episode of stroke-like symptoms may be a transient ischemic attack, or TIA. A TIA happens when blood flow to part of the brain is temporarily interrupted.

Symptoms may last only minutes and then resolve. This can create false reassurance.

NINDS warns that people often ignore a TIA because the symptoms disappear, even though it can signal an important underlying vascular problem requiring medical attention.

Possible TIA symptoms include sudden:

• Weakness or numbness
• Facial drooping
• Speech difficulty
• Confusion
• Vision loss
• Imbalance
• Coordination problems

Do not simply book a routine appointment several weeks later because the person now feels normal. A recent suspected TIA deserves urgent medical evaluation.

What Should You Do If Someone Has Stroke Symptoms?

If you suspect stroke, the most useful actions are simple: recognize the symptoms, record the time and get the person to appropriate emergency care quickly.

1. Treat the symptoms as an emergency

Do not wait for a second episode or for weakness to become more severe.

Every minute of avoidable delay can reduce the opportunity for timely evaluation and treatment.

2. Note the symptom-start time

If you saw the symptoms begin, record the approximate time.

If the person woke with symptoms or you do not know exactly when they started, record the last time they were known to be normal, often called the “last known well.”

This information matters because several stroke treatments use time from symptom onset or last-known-well as part of eligibility assessment.

3. Arrange emergency medical transport

Whenever practical, use an emergency ambulance service rather than asking the affected person to drive.

Ambulance personnel can begin assessment and communicate with the receiving hospital before arrival. CDC notes that emergency treatment can begin during transport and that hospital teams can be alerted before the patient arrives.

Nagarik Hospital lists its 24/7 road and air ambulance service with the following hotline for ground ambulance service inside the valley:

+977-9801904640

The hospital also lists helicopter rescue coverage for all Nepal at +977-9801904643.

4. Keep the person safe

Help the person sit or lie somewhere safe if they are unstable.

Avoid unnecessary walking if they are weak, dizzy or uncoordinated.

5. Do not give food or drink until swallowing is assessed

Stroke may impair swallowing, sometimes without the patient realising it.

The 2026 AHA/ASA ischemic stroke guideline recommends swallowing screening before liquids or food are started in patients with acute ischemic stroke because dysphagia can increase aspiration risk.

6. Gather useful medical information

If it can be done without delaying transport, prepare:

• Current medicines
• Known allergies
• Previous stroke or TIA history
• Blood-thinning medicines
• Diabetes history
• High blood pressure history
• Recent surgery or major bleeding
• Previous medical reports

Do not spend excessive time searching for documents if doing so delays emergency care.

7. Tell the medical team about the exact symptoms

Report:

• What changed
• Which side was affected
• When the person was last normal
• Whether symptoms improved
• Whether the person takes anticoagulants or other major medicines

These details can influence diagnostic and treatment decisions.

What Should You Not Do During a Suspected Stroke?

Several common reactions can cause dangerous delay.

Do not “wait and see”

Stroke symptoms can fluctuate or temporarily improve.

Improvement does not prove the problem is harmless.

Do not let the affected person drive

Weakness, impaired vision, confusion and coordination problems can make driving unsafe.

Do not assume sleeping will make the symptoms disappear

A neurological emergency still requires assessment.

Do not give aspirin automatically

Aspirin is used in selected stroke-related situations, but not every stroke is caused by a clot.

Bleeding strokes require a different treatment strategy, and imaging is needed to distinguish hemorrhage from ischemia. The 2026 AHA/ASA guideline specifically states that aspirin is not a substitute for acute reperfusion treatment in otherwise eligible ischemic-stroke patients.

Medication decisions should therefore be made by qualified healthcare professionals after appropriate evaluation.

Do not give food or drink before swallowing safety is known

Difficulty swallowing can occur after stroke and may increase aspiration risk.

Do not waste time trying to diagnose the stroke type at home

Ischemic and hemorrhagic strokes can produce overlapping symptoms.

Brain imaging is needed to determine the type.

Why Does Time Matter So Much in Stroke Treatment?

A stroke deprives brain tissue of normal circulation or exposes the brain to bleeding. Both can damage brain cells.

Because brain injury develops over time, the goal is not simply to reach a hospital “today.” The goal is to begin professional evaluation as rapidly as reasonably possible.

For eligible acute ischemic-stroke patients, the 2026 AHA/ASA guideline recommends intravenous thrombolytic treatment within a 4.5-hour treatment window, with treatment started as quickly as possible once eligibility is established. Certain carefully selected patients with unknown onset or later presentation may also qualify for treatment using advanced imaging criteria.

Mechanical thrombectomy also has time-sensitive eligibility criteria, although selected patients with certain large-vessel blockages may benefit many hours after onset, including some patients treated within 24 hours.

This does not mean someone should wait because they think they have “24 hours.”

The longer window applies only to selected patients after specialist assessment and imaging.

The correct response remains: seek emergency care immediately.

What Happens at the Hospital When Stroke Is Suspected?

Hospital teams need to answer several questions rapidly:

1. Are the symptoms caused by a stroke?
2. Is the stroke ischemic or hemorrhagic?
3. When did symptoms begin?
4. Is a major brain artery blocked?
5. Is the patient eligible for clot-dissolving treatment or mechanical thrombectomy?
6. Does the patient have another condition mimicking stroke?
7. Are airway, breathing, blood pressure or other vital functions unstable?

Neurological examination

The healthcare team evaluates neurological function, which may include:

• Alertness
• Language
• Speech
• Eye movements
• Facial movement
• Arm and leg strength
• Sensation
• Coordination
• Vision

This helps estimate the type and severity of neurological dysfunction.

Blood glucose testing

Abnormally low or high blood glucose can affect neurological function and may need urgent correction or consideration during evaluation.

CT scan

A non-contrast head CT is commonly used early because it can rapidly identify bleeding in the brain.

NINDS explains that CT is widely used to rule out intracranial bleeding before certain clot-dissolving medicines are considered.

CT angiography or other vessel imaging

When doctors suspect a blocked major cerebral artery, vessel imaging can help identify the location of the blockage and determine whether endovascular treatment could be appropriate.

MRI

MRI can provide detailed images of brain tissue and can identify ischemic injury in many situations.

NINDS lists both CT and MRI among the major brain-imaging techniques used in stroke diagnosis.

Additional investigations

Depending on the situation, doctors may order:

• Blood tests
• ECG
• Heart monitoring
• Echocardiography
• Carotid imaging
• Other vascular studies

These investigations can help determine why the stroke occurred and how future events might be prevented.

How Is an Ischemic Stroke Treated?

An ischemic stroke occurs when a blood clot or another blockage interrupts blood flow to part of the brain.

Emergency treatment focuses on restoring circulation when this can be done safely and effectively.

Intravenous thrombolysis

Thrombolytic medicines dissolve blood clots.

According to the 2026 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke, eligible adults with disabling ischemic-stroke deficits presenting within 4.5 hours may receive intravenous thrombolysis with alteplase or tenecteplase. Treatment should be started as rapidly as possible once eligibility is established.

Not everyone qualifies.

Doctors consider factors including:

• Symptom timing
• Brain imaging
• Stroke severity and disability
• Bleeding risk
• Recent medical history
• Medicines
• Blood pressure
• Other clinical factors

This is why patients should not try to determine eligibility themselves.

Can thrombolysis be used after 4.5 hours?

Sometimes, but only in selected patients.

The 2026 guideline supports extended-window thrombolysis for certain patients whose imaging shows potentially salvageable brain tissue, including some people presenting 4.5–9 hours after last known well or with stroke discovered after waking.

This is a specialist decision based on imaging and clinical criteria.

Mechanical thrombectomy

A mechanical thrombectomy is an endovascular procedure used to remove a clot from a blocked major brain artery.

A catheter is guided through the blood vessels toward the blocked artery, and specialized equipment is used to retrieve or aspirate the clot.

The 2026 guideline recommends thrombectomy for appropriate patients with certain large-vessel occlusions. Eligibility depends on the blocked artery, neurological deficit, brain imaging, time since onset and other clinical criteria.

Selected patients can benefit within six hours, while certain appropriately selected patients may benefit during extended windows reaching up to 24 hours.

Again, this does not create a safe reason to delay seeking treatment.

Supportive stroke-unit care

Emergency stroke management also includes supportive measures such as:

• Airway and breathing assessment
• Blood-pressure management
• Blood-glucose management
• Temperature management
• Swallowing assessment
• Prevention and treatment of complications
• Early rehabilitation planning

Treatment is individualized to the patient.

How Is a Hemorrhagic Stroke Treated?

A hemorrhagic stroke happens when a blood vessel ruptures and bleeding occurs in or around the brain.

This is fundamentally different from an ischemic stroke.

Clot-dissolving medicines that may help selected ischemic strokes can worsen a hemorrhagic stroke, which is one reason brain imaging is essential before acute treatment decisions are made.

Emergency treatment may include:

• Stabilizing airway, breathing and circulation
• Carefully managing blood pressure
• Managing increased pressure or swelling in the brain
• Reversing certain anticoagulant effects when clinically appropriate
• Identifying the source of bleeding
• Neurosurgical or endovascular procedures in selected patients
• Intensive neurological monitoring

NINDS notes that hemorrhagic-stroke treatment focuses on finding and controlling the source of bleeding, reducing secondary injury and treating the underlying cause.

The AHA/ASA guideline for spontaneous intracerebral hemorrhage similarly emphasizes specialized acute management based on the cause, severity and characteristics of the brain bleed.

What Is the Difference Between Ischemic and Hemorrhagic Stroke?

The symptoms alone usually cannot reliably tell a patient or family which type is occurring.

That is why home treatment based on guessing the stroke type is unsafe.

What Is a Wake-Up Stroke?

A wake-up stroke is discovered when a person wakes with neurological symptoms but the exact onset time is unknown.

For example, someone may go to sleep normally at 10 p.m. and wake at 5 a.m. unable to move one arm.

The time the person was last known well may therefore be before sleep.

Wake-up stroke still requires immediate emergency assessment.

Modern brain imaging can identify certain patients who may remain candidates for reperfusion treatment despite an unknown exact onset time. The 2026 AHA/ASA guideline includes advanced-imaging pathways for selected patients with unknown-onset stroke.

Never assume that treatment is impossible simply because symptoms were discovered after waking.

Can Severe Headache Be a Stroke Symptom?

Yes. A sudden severe headache with no known cause is one of the recognized warning signs of stroke, particularly when accompanied by other neurological symptoms.

A severe abrupt headache can occur with bleeding in or around the brain, although headaches have many other possible causes.

Seek urgent medical evaluation especially when a sudden severe headache occurs with:

• Weakness
• Numbness
• Speech difficulty
• Loss of consciousness
• Confusion
• Vomiting
• Vision problems
• Difficulty walking
• Seizure

Do not attempt to diagnose the cause of a sudden severe neurological headache at home.

Can Dizziness Be a Stroke Symptom?

Yes, but dizziness alone has many causes.

Stroke becomes more concerning when dizziness appears suddenly together with neurological symptoms such as:

• New difficulty walking
• Severe imbalance
• Double vision
• Speech difficulty
• Limb weakness
• Facial weakness
• Loss of coordination
• New numbness

BE FAST specifically includes Balance and Eye symptoms because certain strokes may prominently affect coordination or vision.

Sudden severe imbalance with neurological changes deserves urgent evaluation.

Who Is at Greater Risk of Stroke?

A stroke can affect adults of different ages, but some medical and lifestyle factors increase risk.

Important modifiable factors include:

• High blood pressure
• Tobacco use
• Diabetes
• High LDL cholesterol
• Physical inactivity
• Excess body weight
• Diet high in sodium
• Harmful alcohol use
• Certain cardiovascular conditions

WHO identifies high blood pressure as one of the most important modifiable contributors to stroke burden and also highlights smoking, elevated LDL cholesterol, high blood glucose, kidney dysfunction, excess weight, physical inactivity, high-sodium diets and air pollution.

Atrial fibrillation and other heart conditions can also increase the likelihood of clot formation and ischemic stroke.

Risk factors are important for prevention, but they should not be used to decide whether sudden symptoms are a stroke.

A person without known risk factors can still experience one.

What Happens After the Emergency Phase?

Stroke care does not end after the clot is treated or bleeding is stabilized.

Depending on the part of the brain affected, rehabilitation may address:

• Walking
• Strength
• Balance
• Arm and hand function
• Speech
• Language
• Swallowing
• Memory
• Attention
• Daily activities
• Emotional and psychological adjustment

NINDS describes stroke treatment as including emergency care, prevention of another stroke and rehabilitation to manage changes in function.

The exact rehabilitation plan depends on the severity and location of brain injury and the individual's medical condition.

How Can Another Stroke Be Prevented?

Secondary prevention depends on why the first stroke or TIA happened.

Medical evaluation may identify problems such as:

• Uncontrolled hypertension
• Diabetes
• High cholesterol
• Atrial fibrillation
• Carotid artery disease
• Smoking
• Other vascular conditions

Treatment may involve combinations of:

• Blood-pressure management
• Cholesterol management
• Diabetes treatment
• Tobacco cessation
• Appropriate physical activity
• Nutrition changes
• Antiplatelet medicines in suitable patients
• Anticoagulation for appropriate conditions such as some cases of atrial fibrillation
• Treatment of significant vascular disease when indicated

Medication should be individualized by the patient's clinician.

WHO emphasizes effective management of hypertension and other modifiable risk factors as important components of stroke prevention.

For ongoing neurological evaluation after the emergency phase, patients can explore Nagarik Hospital’s Neurology Department. The department lists Dr. Krishna Dhungana, Senior Consultant, Department of Neurology, whose published qualifications include MBBS, MD (Internal Medicine) and DM (Neurology).

For cardiovascular risk-factor assessment, appropriate patients may also require coordinated cardiovascular or internal-medicine care, including the hospital’s Cardiology Department.

When Should You Seek Emergency Stroke Care in Nepal?

Seek emergency medical care for any new, sudden neurological symptom suggestive of stroke, including:

• One-sided facial drooping
• Arm or leg weakness
• One-sided numbness
• Slurred speech
• Inability to speak
• Sudden difficulty understanding speech
• Sudden visual loss or double vision
• Sudden severe imbalance
• Sudden unexplained severe headache
• Sudden loss of coordination

Do not wait for all FAST symptoms to appear.

One significant new neurological symptom can be enough to justify emergency assessment.

Nagarik Community Teaching Hospital is located in Gatthaghar, Bhaktapur, within the Kathmandu Valley, and describes itself as a multispecialty hospital with emergency care, ICU support and pre-hospital services.

For Nagarik Hospital’s emergency transport:

24-hour emergency/ambulance: +977-9801904640

The hospital’s Road and Air Ambulance service states that road ambulance service is available inside the valley, with helicopter rescue offered across Nepal.

Important: During possible acute stroke, do not delay emergency care in order to arrange a routine neurology appointment.

Key Takeaways

• Stroke symptoms usually appear suddenly.
• Remember FAST: Face, Arms, Speech, Time.
• BE FAST adds Balance and Eye/vision changes.
• Sudden weakness, numbness, confusion, visual change, imbalance or severe unexplained headache can also indicate stroke.
• Symptoms that disappear may be a TIA and still need urgent assessment.
• Record when symptoms began or when the person was last known well.
• Use emergency medical transport whenever practical.
• Do not give food, drink or medicines such as aspirin automatically before appropriate medical evaluation.
• CT or other brain imaging is needed to distinguish ischemic stroke from bleeding.
• Eligible ischemic-stroke patients may receive thrombolysis and/or mechanical thrombectomy.
• Hemorrhagic stroke requires a different strategy focused on controlling bleeding and secondary brain injury.
• Stroke discovered after waking still needs immediate emergency evaluation.
• After the emergency phase, rehabilitation and prevention of another stroke are important parts of care.

The single most important message is simple:

If stroke symptoms appear suddenly, act immediately. Do not wait for them to become severe or permanent.

FAQs

What are the five main warning signs of a stroke?

Five major warning signs are sudden one-sided weakness or numbness, sudden difficulty speaking or understanding speech, sudden vision problems, sudden difficulty walking or loss of balance, and a sudden severe unexplained headache. Facial drooping and arm weakness are especially useful FAST warning signs.

What does FAST stand for in stroke?

FAST means Face, Arms, Speech, Time. Check whether one side of the face droops, one arm cannot stay raised, or speech becomes slurred or unusual. “Time” means arranging emergency medical care immediately if any of those warning signs appear.

What does BE FAST mean?

BE FAST expands FAST by adding B for Balance and E for Eyes. Sudden loss of balance, coordination or vision can also occur with stroke. The remaining letters represent Face drooping, Arm weakness, Speech difficulty and Time to seek emergency help.

What are the first signs of a stroke?

There is no single symptom that always appears first. A stroke may begin suddenly with facial weakness, arm or leg weakness, numbness, slurred speech, confusion, visual loss, imbalance or another neurological change. Any sudden focal neurological problem should be taken seriously.

Can stroke symptoms come and go?

Yes. Temporary stroke-like symptoms can occur with a transient ischemic attack or with fluctuating neurological problems. Symptoms disappearing does not make the event safe to ignore. A suspected TIA requires prompt medical assessment because it can indicate an underlying vascular problem.

Can you have a stroke without knowing it?

Some people may not fully recognize their own neurological changes. Stroke itself can interfere with awareness, communication or judgment. Family members or bystanders may therefore be the first to notice facial asymmetry, unusual speech, weakness or confusion.

Should I give aspirin during a suspected stroke?

Do not give aspirin automatically unless a qualified healthcare professional instructs you to do so. Some strokes are caused by bleeding rather than a clot, and treatment differs substantially. Brain imaging is needed to establish the stroke type before key acute treatment decisions are made.

Should someone with stroke symptoms eat or drink?

It is safer to avoid food or drink until swallowing has been evaluated because stroke can cause dysphagia and increase aspiration risk. Current AHA/ASA ischemic-stroke guidance recommends swallowing screening before liquid or food intake in acute stroke patients.

Can a person have a stroke while sleeping?

Yes. A stroke discovered upon waking is often called a wake-up stroke. The exact onset time may be unknown, but the person still needs immediate emergency assessment. Advanced imaging allows certain carefully selected patients with unknown onset to receive time-sensitive treatments.

How long do you have to treat a stroke?

There is no safe “waiting period.” Emergency evaluation should begin immediately. Some eligible ischemic-stroke patients may receive intravenous thrombolysis within 4.5 hours, while selected patients may qualify for later thrombolysis or mechanical thrombectomy based on imaging and clinical criteria.

What is the difference between a stroke and a TIA?

A stroke causes neurological injury from blocked blood flow or bleeding, while a TIA causes temporary stroke-like symptoms from brief interruption of blood flow without the same persistent injury pattern. Because the symptoms can initially look identical, both require prompt medical evaluation.

Which doctor treats stroke?

Neurologists commonly play a central role in stroke diagnosis, treatment planning, secondary prevention and follow-up. Acute stroke care may also involve emergency physicians, radiologists, neurointerventional specialists, neurosurgeons, intensivists, cardiologists, rehabilitation physicians, therapists and nurses depending on the case.