If you think you had a stroke, call 911 immediately, even if your symptoms have improved or gone away. Every minute a stroke goes untreated, roughly 1.9 million brain cells die. There is no safe way to “wait and see” with stroke symptoms, and several treatments only work within tight time windows.
Call 911 Instead of Driving
The single most important thing you can do is call emergency services rather than drive yourself or have someone drive you to the hospital. Patients transported by EMS reach brain imaging in a median of about 3 hours and 20 minutes from symptom onset, compared to nearly 6 hours for those who arrive by personal vehicle. That difference matters because the primary clot-dissolving treatment for the most common type of stroke must be given within 4 hours of symptoms starting. Drive yourself, and you may arrive too late to qualify.
Paramedics also pre-notify the hospital’s stroke team while you’re still in the ambulance. That means doctors, nurses, and a CT scanner can be ready the moment you roll through the doors. If your area has both a basic and a more advanced stroke center, EMS can route you to the facility best equipped to treat you.
Recognize the Warning Signs: BE FAST
Use the acronym BE FAST to check for stroke symptoms, whether you’re evaluating yourself or someone else:
- Balance: Sudden trouble with coordination or balance
- Eyes: Blurred or double vision, or sudden vision loss in one or both eyes
- Face: One side of the face droops or feels numb (try to smile and see if one side sags)
- Arm: One arm is weak or numb (raise both arms and see if one drifts downward)
- Speech: Slurred or garbled words, or difficulty repeating a simple sentence
- Time: Call 911 right away
You don’t need to have all of these symptoms. Even one is enough to warrant an emergency call.
Note the Exact Time Symptoms Started
One of the most critical pieces of information doctors need is what’s called your “last known well” time. This is the last moment you were definitely symptom-free. It determines whether you’re eligible for time-sensitive treatments, and getting it wrong in either direction can cause real harm. In one study, inaccurate time reporting would have led to nearly 30% of eligible patients being wrongly denied treatment, and about 70% of ineligible patients being treated outside the safe window.
Be as specific as possible. “Around 2:15 p.m.” is useful. “About an hour ago” is not, because that estimate shifts every time it’s repeated to a new provider. If you woke up with symptoms, the last known well time is when you went to sleep, not when you woke up. If someone was with you, have them ready to share exactly when they last saw you acting normally.
What Happens at the Hospital
The first test is almost always a non-contrast CT scan of the head. This scan takes minutes and answers the most urgent question: is this a stroke caused by a blood clot (ischemic), or by bleeding in the brain (hemorrhagic)? About 87% of strokes are ischemic and 13% are hemorrhagic. The distinction is critical because the treatments are opposite. A clot-dissolving drug that saves your life during an ischemic stroke could be fatal during a hemorrhagic one.
If doctors suspect a clot, they’ll likely follow with a CT angiogram, which uses contrast dye to map the blood vessels in your brain and pinpoint exactly where the blockage is. This helps the team decide between medication and a physical clot-removal procedure. A CT perfusion scan may also be done to identify areas of the brain that are damaged versus areas that are still struggling but salvageable.
Time-Sensitive Treatments
For ischemic strokes, the standard clot-dissolving medication must be given within 4 hours of symptom onset. The sooner it’s administered, the better it works. This is the main reason speed matters so much.
For strokes caused by a large clot blocking a major brain artery, doctors can physically remove the clot using a catheter threaded through the blood vessels. This procedure is recommended within 6 hours of symptom onset, but thanks to advanced brain imaging that can identify salvageable tissue, some patients remain eligible up to 16 or even 24 hours later. Not everyone qualifies for the extended window. It depends on the size and location of the clot, the amount of brain tissue already damaged, and several other factors visible on imaging.
None of these options are available if you stay home. And none of them work as well the longer you wait.
If Your Symptoms Already Went Away
Symptoms that resolve on their own may indicate a transient ischemic attack, sometimes called a “mini-stroke.” A TIA happens when a clot temporarily blocks blood flow to the brain and then clears. The symptoms can be identical to a full stroke but last only minutes to hours.
Do not take relief from fading symptoms as a sign that you’re fine. A TIA is a warning. Between 10% and 15% of people who experience a TIA go on to have a full stroke within 3 months, and roughly half of those strokes happen within the first 48 hours. The risk is highest in the hours and days immediately following the event, which is why emergency evaluation is essential even after symptoms resolve. Doctors can identify the underlying cause (a narrowed artery, a heart rhythm problem, a clotting issue) and start treatment to prevent the larger stroke that may be coming.
What Not to Do
Do not take aspirin or any medication before getting to the hospital. If the stroke is caused by bleeding rather than a clot, aspirin will make things worse. Do not eat or drink anything, because stroke can impair your ability to swallow safely, and you may need a procedure that requires an empty stomach. Do not go to sleep hoping you’ll feel better in the morning.
Do not let embarrassment or uncertainty stop you from calling 911. Stroke teams evaluate and rule out strokes every day. If it turns out to be something else, that is the best possible outcome. If it turns out to be a stroke, the minutes you saved by acting fast could be the difference between full recovery and permanent disability.