Stroke: Causes, Symptoms and Treatment

Stroke is the sudden death of brain cells caused by interruption of the blood supply to part of the brain. It is the second most common cause of death worldwide and the most common cause of serious long-term disability in adults. In China, stroke is the leading cause of death and disability — an estimated 1.3 million people die from stroke in China each year, and 7 million are living with its consequences.

The brain is uniquely vulnerable: unlike other organs, it cannot store oxygen or glucose. Brain cells begin dying within 4–6 minutes of losing their blood supply. Every 30 minutes of delay in treatment results in additional brain cells lost and worse functional outcomes. Time is brain.

Types of Stroke

Ischaemic Stroke (80% of cases)

A blood clot blocks an artery supplying the brain, cutting off blood flow to the region that artery feeds. The affected brain tissue — termed the ischaemic penumbra — is initially stunned but potentially salvageable; without reperfusion, it dies and becomes an infarct.

Mechanisms of ischaemic stroke:

• Cardioembolic — a clot forms in the heart (most commonly in atrial fibrillation, where the irregular rhythm allows blood to pool and clot in the left atrial appendage) and breaks off, travelling through the bloodstream to lodge in a brain artery. This is the most common mechanism in younger patients and causes larger, more devastating infarcts.
• Large artery atherothrombotic — atherosclerotic plaque in the carotid or vertebral arteries or within the brain arteries ruptures, triggers local clot formation, and occludes the vessel.
• Small vessel (lacunar) — lipohyalinosis of small penetrating arteries (caused by hypertension and diabetes) produces small, deep infarcts in the basal ganglia, internal capsule, pons and thalamus.
• Cryptogenic — no cause identified after full investigation (30–40% of cases); many are suspected to be cardioembolic from paroxysmal atrial fibrillation.

Haemorrhagic Stroke (20% of cases)

An artery within or around the brain ruptures, and blood enters the brain tissue (intracerebral haemorrhage) or the space surrounding the brain (subarachnoid haemorrhage).

• Intracerebral haemorrhage (ICH) — most commonly caused by chronic hypertension weakening small perforating arteries, which then rupture. Blood pours into the brain parenchyma, causing a haematoma that compresses surrounding structures and triggers oedema. ICH has the highest 30-day mortality of all stroke subtypes (40–50%).
• Subarachnoid haemorrhage (SAH) — rupture of a cerebral aneurysm (a localised balloon-like weakness in an artery wall) into the subarachnoid space surrounding the brain. Classic presentation: sudden-onset "thunderclap headache" — the worst headache of the patient's life — with neck stiffness. Medical emergency with high mortality and frequent rebleeding risk.

Transient Ischaemic Attack (TIA)

A TIA produces the same symptoms as an ischaemic stroke but lasts less than 24 hours (usually less than one hour) and causes no permanent brain damage because blood flow is restored before infarction occurs. TIA is a critical warning: 10–15% of patients suffer a stroke within 3 months of a TIA — most within the first 48 hours. TIA must be treated as an emergency.

Risk Factors

Major modifiable risk factors for both ischaemic and haemorrhagic stroke:

Risk Factor	Contribution
Hypertension	Single most important stroke risk factor; doubles stroke risk per 20 mmHg rise in systolic BP
Atrial fibrillation	5× increased stroke risk; anticoagulation prevents 60–70% of AF-related strokes
Diabetes mellitus	2–3× increased stroke risk from accelerated atherosclerosis and small vessel disease
Smoking	2× increased ischaemic stroke risk; particularly raises SAH risk
Hypercholesterolaemia	Promotes carotid and intracranial atherosclerosis
Obesity and physical inactivity	Independent risk factors for stroke
Heavy alcohol consumption	Increases both ischaemic and haemorrhagic stroke risk
Prior TIA or stroke	Highest single predictor of future stroke

Non-modifiable risk factors: Age (risk doubles each decade after 55), male sex, South Asian or Black African ethnicity, family history of stroke.

Symptoms — FAST Recognition

Stroke symptoms come on suddenly. The FAST mnemonic captures the three most common presentations:

• F — Face drooping: one side of the face droops or is numb; the smile is uneven
• A — Arm weakness: one arm is weak or numb; when both arms are raised, one drifts down
• S — Speech difficulty: slurred speech, unable to speak, or unable to understand speech
• T — Time to call emergency services immediately

Other stroke symptoms:

• Sudden severe headache with no known cause (SAH — thunderclap headache)
• Sudden vision loss or double vision
• Sudden dizziness, loss of balance, or incoordination
• Sudden numbness or weakness of face, arm or leg — typically on one side
• Sudden confusion or difficulty understanding

Important: even if symptoms resolve within minutes, call emergency services — this may be a TIA and stroke risk is highest in the hours that follow.

Diagnosis

Brain Imaging

CT scan — the first investigation in any suspected stroke. A non-contrast CT rapidly and reliably identifies haemorrhagic stroke (blood appears bright white) and rules out haemorrhage before thrombolysis can be given. CT is less sensitive for acute ischaemic infarction in the first hours.

CT angiography (CTA) — rapid imaging of cerebral arteries to identify large vessel occlusion (LVO), determine thrombectomy eligibility, and assess carotid stenosis.

MRI with diffusion-weighted imaging (DWI) — detects ischaemic infarction within minutes of onset; more sensitive than CT for small and posterior fossa strokes. Essential for TIA evaluation.

MR angiography and perfusion imaging — identifies salvageable brain tissue (mismatch between infarct core and penumbra) to guide late-window thrombectomy decisions.

Further Investigation

• ECG and cardiac monitoring — detects atrial fibrillation (including paroxysmal AF requiring prolonged monitoring)
• Echocardiography — identifies cardiac sources of embolism (thrombus, valvular disease, patent foramen ovale)
• Carotid Doppler ultrasound — evaluates ipsilateral carotid stenosis for possible endarterectomy
• Blood tests — full blood count, coagulation, glucose, lipids, HbA1c

Treatment

Emergency Treatment — Ischaemic Stroke

Intravenous thrombolysis (IV alteplase)

Alteplase (tPA) dissolves the clot and restores blood flow. It must be given within 4.5 hours of symptom onset (3 hours in some guidelines). Thrombolysis reduces the risk of death or major disability by approximately 30%. Haemorrhagic stroke must be excluded by CT before administration. Contraindications include recent surgery, anticoagulant use, and very high blood pressure.

Mechanical thrombectomy

For strokes caused by large vessel occlusion (LVO) — blockage of a major brain artery — mechanical thrombectomy is transformative. A catheter is threaded from the femoral artery into the brain under fluoroscopy, a stent retriever or aspiration device is deployed across the clot, and the clot is physically removed.

Thrombectomy is indicated up to 24 hours from symptom onset in selected patients (based on imaging showing salvageable brain tissue). It achieves recanalisation in over 80% of cases and doubles the proportion of patients who are functionally independent at 3 months. It is the most effective acute stroke treatment for LVO.

Thrombectomy and thrombolysis are not mutually exclusive — many LVO patients receive both ("drip and ship" or "drip and drive").

Emergency Treatment — Haemorrhagic Stroke

Intracerebral haemorrhage: blood pressure control (rapid lowering to systolic <140 mmHg); reversal of anticoagulation; neurosurgical evacuation for cerebellar haematomas or large lobar haematomas with mass effect.

Subarachnoid haemorrhage: emergency neurosurgical or endovascular treatment of the ruptured aneurysm (surgical clipping or endovascular coiling) to prevent rebleeding; nimodipine to prevent cerebral vasospasm.

Secondary Prevention

After TIA or ischaemic stroke, the priority is preventing the next event:

• Antiplatelet therapy (aspirin + clopidogrel for 21 days, then monotherapy) for non-cardioembolic stroke
• Anticoagulation (direct oral anticoagulants — apixaban, rivaroxaban) for AF-related stroke
• Statin therapy — high-intensity statin to reduce LDL and stabilise atherosclerotic plaque
• Antihypertensive therapy — target BP <130/80 mmHg; reduces stroke recurrence by 25–30%
• Carotid endarterectomy or stenting — for symptomatic carotid stenosis >50–70%
• Lifestyle: smoking cessation, alcohol reduction, weight loss, exercise, diabetic control

Stroke Rehabilitation

Rehabilitation begins in the acute phase — early mobilisation within 24 hours of stable ischaemic stroke is associated with better outcomes. Recovery continues for months to years through neuroplasticity — the brain's ability to form new connections.

Rehabilitation components:

• Physiotherapy — retraining walking, balance, coordination, and limb function
• Occupational therapy — restoring ability to perform daily activities; upper limb rehabilitation; assistive equipment
• Speech and language therapy — for aphasia (language disorder) and dysphagia (swallowing difficulty)
• Cognitive rehabilitation — for post-stroke cognitive impairment, memory, and attention
• Neuropsychological support — depression affects approximately 33% of stroke survivors and impairs recovery; treatment with antidepressants and psychotherapy is beneficial

Stroke Care in China

China's cerebrovascular centres offer:

• 24/7 stroke unit care: dedicated stroke teams with immediate CT/MRI, thrombolysis protocols and catheter laboratory access for thrombectomy
• High-volume thrombectomy centres: among the highest volumes of mechanical thrombectomy in Asia, with rapid door-to-reperfusion times
• Advanced imaging: CT perfusion and MR perfusion to identify late-window thrombectomy candidates beyond standard time windows
• Comprehensive TIA clinics: fast-track assessment within 24 hours with full vascular imaging, cardiac monitoring, and risk factor intervention
• Multidisciplinary rehabilitation: inpatient and outpatient rehabilitation combining physiotherapy, occupational therapy, speech therapy, and neuropsychology
• Cost: care in China is generally less expensive than UK private treatment, but the hospital prices each case individually — ask us for the written quote before you commit.

Contact a ChinaMedicalTour care navigator to arrange a stroke assessment, second opinion on stroke prevention, or rehabilitation consultation.

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Medical content based on MSD Manuals, authored by Andrei V. Alexandrov MD (University of Arizona) and Balaji Krishnaiah MD (University of Tennessee). Reviewed June 2025.

Frequently Asked Questions

Can overseas neurological patients have their MRI or EEG scans evaluated remotely?

Yes. Foreign neuroimaging scans, EEG recordings, and specialist consult notes can be submitted through pre-consultation coordination for detailed evaluation by Chinese cognitive neurology and movement disorder teams.

What multidisciplinary care is offered for chronic neurological conditions in China?

Tertiary neurology departments provide structured clinical assessments, cognitive battery testing, advanced biomarker diagnostics, individualized pharmacological management, and specialized neurorehabilitation planning.

How are medications and ongoing neurological care managed after returning home?

The treating medical team issues a comprehensive bilingual medical summary and prescription guidance to facilitate safe care continuity with the patient's domestic neurologist.