Complaints & connections · borters.ch
The brain suddenly lacks blood — every minute costs nerve cells, so call 144 without hesitating.
Also known as: stroke · cerebrovascular accident · ischemic/hemorrhagic · TIA
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Blood flow to a brain area suddenly stops — usually a clot (ischaemic), sometimes a bleed. Affected cells die within minutes, so every minute counts. FAST: Face, Arm, Speech, Time (call at once). Common sources: atrial fibrillation, high blood pressure and atherosclerosis.
Three things decide what remains possible afterwards.
**The time is the most important information.** Not "since this morning" but: when was the person last demonstrably normal? That time belongs written down and handed over, because treatment depends on it. Dissolving the clot is as a rule possible up to **four and a half hours** after onset, pulling it out through a catheter up to **six hours** — and longer in selected cases, if imaging still shows salvageable tissue.
**Waking up with the signs is not too late.** For a stroke that happened during sleep there is a procedure of its own: there imaging counts instead of the clock. Waiting until the next morning is therefore never the better choice.
**FAST does not catch everything.** The mnemonic catches the common cases but not occlusions in the back part of the brain’s blood supply. There the signs are different: sudden loss of vision or double vision, violent spinning dizziness with unsteady walking, slurred speech rather than disordered language, sudden trouble swallowing, and a headache of instant onset never experienced like that before. Neglect belongs here too — no longer attending to one half of one’s world without noticing it.
And two sentences on what to do: **do not drive yourself**, call the emergency number — and **call even when the signs have gone again.** A passing disturbance is no all-clear but the warning with the highest risk in the days that follow.
If the corner of the mouth droops but the forehead can still be wrinkled, that speaks for the brain and so for the emergency call. If the whole half of the face is affected, forehead and lid closure included, it usually lies in the facial nerve itself.
Less salt lowers blood pressure — processed foods, bread and ready meals are the main sources.
A vegetable-, fruit- and potassium-rich diet (DASH) lowers blood pressure — potassium counters sodium.
Every kilo lost lowers blood pressure a little — one of the most effective levers when overweight.
In the first hours, thrombolysis dissolves the clot or thrombectomy pulls it out — both save tissue that is not yet dead, and both count in minutes. After that it is about the next time: anticoagulation, blood pressure, statin. The recovery itself comes from therapy, not from a tablet.
Every minute without blood flow costs about two million nerve cells — which is why every minute counts here, not every hour. Thrombolysis is possible up to four and a half hours, mechanical removal for large vessels up to twenty-four. The greatest recovery happens in the first three to six months.
FAST — call at once even if it passes (a TIA is a warning shot).
Lower homocysteine — studies on prevention come out differently from one another.
In a large Chinese trial folic acid added to blood pressure medication lowered the stroke rate — in a country where flour is not fortified with folic acid. In countries with fortification this could not be repeated.
For stroke prevention the large studies at 1 g a day showed no difference. From about 3 g a day the bleeding time lengthens — after a brain haemorrhage that is the decisive point.
On warfarin-type blood thinners vitamin K is the medicine’s counterpart. Not forbidden, but steady — it is the change in amount that tips the value out of range, not the amount itself.
The sugar is among the very first values: a low blood sugar causes the same deficits and is immediately fixable. In the days afterwards, sugar that is too high measurably worsens the course.
Strokes cluster in the first hours after waking — cortisol, adrenaline and blood pressure rise together then, and the blood clots more readily. That is the same daily rhythm as with a heart attack.
The combined pill raises the risk of an ischaemic stroke — markedly when migraine with aura or smoking comes with it. That is one of the few points where a contraceptive decision is a vascular decision.
The earlier mobilisation starts the more function returns. The window for the greatest progress lies in the first 3–6 months, after which it continues more slowly.
The amount counts: in studies groups with more exercise hours a week did better. One of the few areas where more genuinely brings more.
Listed values: 20 · 72 · 95 · 125 · 428 · 522 · 600 · 625 · 650 · 727 · 787 · 880 · 1800 · 1865 · 5000 · 10000 Hz
AWMF 030-046 · S2e · 2022-11 — extended
Akuttherapie des ischämischen Schlaganfalls
checked 2026-09