Around 100,000 to 117,000 people have a stroke in the UK each year, with figures showing about 111,000 admissions in England alone for 2023/24, and projections suggesting around 117,600 new cases annually across the UK, according to Stroke Association, Nice CKS, and NHS England, National Institutes of Health (NIH) | (.gov), The House of Commons Library, Oxford Academic.
A stroke occurs when the blood supply to part of the brain is interrupted, either due to a blockage (ischaemic stroke) or bleeding (haemorrhagic stroke). Brain tissue is highly sensitive to oxygen deprivation, and irreversible damage can begin within minutes. The phrase “time is brain” reflects the urgency of early recognition and intervention.
Public education initiatives, such as the FAST campaign, have improved awareness; however, stroke symptoms are still frequently missed or misinterpreted. This article aims to reinforce key warning signs, challenge common misconceptions, and outline appropriate first aid actions.
Recognition
The FAST campaign has been extremely successful in improving awareness regarding stroke symptoms, with recent guidelines adding additional signs and symptoms to the mnemonic.
Even one of these symptoms may indicate a stroke.
B – Balance Loss of balance, dizziness, difficulties with walking
E – Eyes Sudden difficulty seeing out of one or both eyes
F – Face Facial drooping / weakness on one side
A – Arms Difficulties raising both arms
S – speech Slurred speech, confusion, or trouble speaking
T – Time Time to call 999
Other symptoms may include:
Memory loss, nausea or vomiting or a sudden, reduced level of consciousness, severe headache with no known cause.
First Aid Actions
1. Call Emergency Services Immediately
Dial 999 (UK) and state clearly that you suspect a stroke. Note the exact time symptoms started (or the last time the person was seen well), as this information is critical for hospital treatment decisions.
2. Position the Person Safely
- If conscious: Help them sit or lie down comfortably with their head and shoulders slightly supported.
- Loosen tight clothing around the neck.
- Consider using a towel to help control saliva if required
- Reassure them and keep them calm.
3. Monitor Airway and Breathing
- Check that the airway is clear.
- Monitor breathing continuously.
- Be prepared to begin CPR if they become unresponsive and stop breathing normally.
4. Do Not
- Do not give food or drink (swallowing may be impaired).
- Do not give medication unless advised by emergency services.
- Do not leave the person alone.
5. If They Become Unconscious
- If breathing normally: Place in the recovery position (on their side), ideally with the affected side down if possible.
- Continue monitoring until help arrives.
Why Time Matters
In ischaemic stroke, rapid hospital treatment (such as thrombolysis or thrombectomy) can significantly reduce brain damage. These treatments are time-dependent and may only be given within specific time windows from symptom onset.
The faster emergency services are activated, the better the potential outcome.
Common Misconceptions About Stroke
Despite widespread education, several myths persist:
Strokes only affect older adults
While age is a risk factor, strokes can and do occur in younger adults, including those with no prior medical history.
All FAST symptoms need to be present
Although the BE FAST test is useful, it is important to note that not all symptoms need to be present.
Symptoms must be dramatic or involve collapse
Most people experiencing a stroke remain conscious and may appear outwardly well, aside from subtle neurological deficits.
Stroke is always painful
Many strokes occur without pain. The absence of pain often leads to an underestimation of symptom severity.
If symptoms resolve, medical help is unnecessary
Transient symptoms may indicate a Transient Ischaemic Attack (TIA), which is a significant predictor of future stroke and requires urgent assessment.
Speech problems are due to fatigue, alcohol, or anxiety
Sudden speech changes should always be treated as neurological until proven otherwise.
Facial drooping must be present
Stroke may present with isolated arm weakness or speech disturbance alone.
These misconceptions frequently contribute to dangerous delays in accessing emergency care.
Case Presentation
At 33 years old, my brother, a fit and active individual, strained his neck at the gym. A week later, he suffered an ischaemic stroke due to an arterial dissection, which his doctors believed was the result of the trauma he sustained at the gym.
He has no immediate neurological symptoms at the time of injury, however, over the following week he continued to experience some neck discomfort.
Approximately one week after the initial injury, whilst at home, he experienced a sudden onset of neurological symptoms. These included:
- Loss of motor power on one side of the body
- Weakness affecting the arm and leg on the same side
- Significant speech difficulties (dysphasia)
The severity of motor impairment required initial mechanical hoisting for mobilisation during the acute phase of hospital care.
Diagnosis and Management
Emergency medical assessment confirmed the presence of an ischaemic stroke. Further imaging identified a cervical arterial dissection in the neck as the underlying cause
Outcome
Despite the severity of the initial presentation, he has made a near full recovery. This favourable outcome highlights the benefits of prompt medical intervention and structured rehabilitation following stroke
Discussion
This case demonstrates several important clinical and educational considerations.
Stroke in Younger Adults
Although stroke is more common in older populations, cervical arterial dissection accounts for a notable proportion of strokes in individuals under 45 years of age. The absence of traditional cardiovascular risk factors may contribute to delayed recognition.
Minor Trauma as a Risk Factor
Cervical artery dissection has been associated with minor mechanical trauma, including sports injuries, sudden neck movements, and manual therapies. The initial symptoms are frequently limited to neck pain or headache, which may be incorrectly attributed to musculoskeletal injury.
Delayed Symptom Onset
Neurological symptoms associated with arterial dissection may develop hours to days after the initial injury. This delay can reduce clinical suspicion and delay diagnosis.
Implications for Healthcare and Fitness Professionals
This case emphasises the importance of thorough assessment when individuals present with recent neck injuries, particularly when symptoms are persistent or atypical. Practitioners should consider referral or further medical evaluation if red flag symptoms are present, including:
- Severe or unusual neck pain
- Neurological symptoms
- Visual disturbances
- Dizziness or balance difficulties
- Speech or swallowing problems
Healthcare providers and manual therapy practitioners should remain aware that treatment interventions involving the cervical spine may aggravate underlying vascular conditions in rare cases.
Conclusion
Cervical arterial dissection is an important cause of ischaemic stroke in younger individuals and may follow minor neck trauma. This case highlights the potential progression from seemingly benign musculoskeletal injury to serious neurological emergency. Increased awareness among healthcare professionals, fitness practitioners, and first aid providers is essential to support early recognition, timely referral, and improved patient outcomes.
Article written by Sonja Blackburn
Owner of Branch Training, Trained First Responder & 2009 AECC Graduate
Branch Training
Offering first aid courses specifically tailored to those in therapeutic practice.
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