Stroke prevention and follow-up
Stroke Care: act quickly, then plan for recovery
Stroke care starts with recognizing an emergency. After the hospital stay, understanding the cause of the stroke helps guide prevention, rehabilitation, and follow-up.
Sudden symptoms? Call 911.
A stroke interrupts blood flow to the brain or causes bleeding in or around it. Symptoms can begin suddenly and may include a combination of the following signs. Remember BE FAST:
B · Balance
Sudden loss of balance, coordination, or ability to walk.
E · Eyes
Sudden loss of vision or double vision.
F · Face
New facial drooping or an uneven smile.
A · Arms
New arm or leg weakness or numbness, especially on one side.
S · Speech
New trouble speaking, understanding, or finding words.
T · Time
Call 911 and note when the person was last known to be well.
Ischemic stroke: a blocked blood vessel
An ischemic stroke occurs when a blood vessel supplying the brain becomes blocked. A clot may form locally or travel from the heart or another artery. Emergency brain and blood-vessel imaging helps determine the cause and treatment options.
Clot-dissolving medicine
Eligible patients may receive intravenous alteplase or tenecteplase. The 2026 AHA/ASA guideline supports either medicine in the usual 4.5-hour treatment window. Selected patients with unknown onset or later presentation may qualify using advanced imaging criteria.
Mechanical thrombectomy
A catheter procedure can remove a clot from a blocked large artery. Selected patients may benefit up to 24 hours after symptom onset, depending on the artery, symptoms, imaging, and other factors. The 2026 guideline expands eligibility for some large-core and basilar artery strokes.
Earlier treatment remains critical. These selection windows are not a reason to wait or to assume treatment is unavailable. Emergency teams decide eligibility; not every patient benefits from every treatment.
TIA: symptoms that resolve still need emergency assessment
A transient ischemic attack (TIA) is a temporary episode of neurological symptoms caused by reduced blood flow without acute infarction. Symptoms alone cannot reliably distinguish a TIA from a completed stroke; examination and imaging are needed.
The AHA scientific statement reports that stroke risk after TIA can be as high as 17.8% over 90 days, with almost half of those strokes occurring within two days. Individual risk varies, and prompt evaluation and prevention matter.
Call 911 for sudden stroke-like symptoms even when they disappear. Do not wait days for a routine neurology appointment to evaluate a new suspected TIA.
Hemorrhagic stroke: bleeding in or around the brain
An intracerebral hemorrhage is bleeding within brain tissue. A subarachnoid hemorrhage is bleeding in the space around the brain, sometimes caused by a ruptured aneurysm. Both require urgent hospital assessment.
Treatment depends on the source and severity of bleeding. Care may include blood-pressure treatment, reversal of blood-thinning medication when appropriate, neurocritical monitoring, management of pressure or fluid buildup, and selected surgical or catheter procedures. Aneurysm treatment is tailored to the anatomy and clinical situation.
A prevention plan based on the cause
Identify what led to the stroke
Follow-up may review brain and vessel imaging, heart rhythm monitoring, blood pressure, cholesterol, diabetes, tobacco exposure, and other relevant factors. Antiplatelet medicines, anticoagulants, and procedures have different roles; the right choice depends on the diagnosis.
Support recovery and daily life
We review symptoms and coordinate with rehabilitation and other treating clinicians. Follow-up can address medication questions, residual weakness, speech or swallowing problems, cognition, mood, and the need for further testing.
Bring to your appointment
- Hospital discharge summary and imaging reports; imaging files if available.
- Current medication list, including blood thinners.
- Completed heart-monitor, laboratory, and referral results.
- A list of persistent symptoms and practical recovery goals.
When more detailed vessel imaging helps
After a stroke or TIA, finding the cause helps guide prevention. Evaluation may include brain imaging, CTA or MRA of the head and neck, carotid ultrasound, heart-rhythm monitoring, and laboratory testing. Many people do not need a catheter angiogram.
A cerebral angiogram may help when noninvasive imaging leaves an important question unanswered, when an unusual blood-vessel disorder is suspected, or when detailed anatomy would affect a procedure plan. Your specialist should explain what question the test will answer and how the result could change treatment.
Imaging informs prevention.
The angiogram is a diagnostic test. Stroke prevention comes from acting on the cause: appropriate medication, blood-pressure and cholesterol management, healthy habits, and a carefully selected procedure when indicated.
New or returning stroke symptoms need emergency assessment, even if they go away. Call 911; do not wait for an outpatient test.
Further reading: ACR/RSNA stroke diagnosis and imaging.
Sources and further reading
- AHA/ASA: 2026 acute ischemic stroke guideline — key recommendations
- American Heart Association: TIA diagnosis, evaluation and risk reduction
- National Institute of Neurological Disorders and Stroke: cerebral aneurysms
General education from Neurovascular Centers. Your clinician will discuss the options appropriate for your diagnosis and medical history.