Stroke and transient ischemic attack (TIA) are neurological emergencies requiring immediate recognition and rapid intervention. A stroke occurs when blood flow to part of the brain is interrupted, either by a blocked artery (ischemic stroke) or bleeding within the brain (hemorrhagic stroke). A TIA involves temporary blockage with symptoms that resolve but indicate significant future stroke risk. Early emergency evaluation dramatically improves neurological outcomes and reduces long-term disability.

Stroke symptoms typically develop suddenly. Patients may experience weakness or numbness affecting one side of the body, facial drooping, difficulty speaking or understanding speech, sudden visual disturbances, imbalance, confusion, or severe headache. The FAST principle—Face drooping, Arm weakness, Speech difficulty, Time to act—highlights the urgency of immediate medical attention.

Emergency assessment begins with stabilization of airway, breathing, and circulation. Oxygen saturation is monitored, and blood glucose levels are checked immediately since hypoglycemia can mimic stroke symptoms. A focused neurological examination evaluates strength, speech, coordination, and consciousness level. The severity of neurological impairment guides urgency and intervention planning.

Urgent brain imaging is performed to distinguish ischemic stroke from hemorrhagic stroke. This distinction is critical because treatment strategies differ significantly. In eligible ischemic stroke patients within the therapeutic window, clot-dissolving medication may be administered to restore blood flow. In selected cases, mechanical clot retrieval procedures may be considered. For hemorrhagic stroke, blood pressure control and neurosurgical evaluation may be required.

Continuous monitoring in the emergency department ensures early detection of neurological deterioration, airway compromise, or cardiovascular instability. Blood pressure management, oxygen support, and cardiac rhythm monitoring are integrated into care. Early coordination with neurology teams ensures timely progression to definitive treatment pathways.

TIA evaluation is equally important. Although symptoms resolve, the event indicates high risk of subsequent stroke. Emergency assessment includes imaging, vascular evaluation, and risk factor identification. Preventive strategies are initiated promptly to reduce recurrence.

Structured stroke protocols emphasize speed, precision, and multidisciplinary coordination. The concept of “time is brain” reflects the reality that delayed treatment leads to irreversible brain injury. Rapid emergency care protects neurological function, improves survival, and reduces long-term disability.