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We hear a great deal about heart attacks, but far less about their equally dangerous counterpart in the brain — the stroke. In this episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, host Jitendra Hariyan speaks with Dr. Azad Irani, a renowned neurologist at Jaslok Hospital with specialized expertise in stroke management, about warning signs, treatment windows, and prevention.
Watch the full conversation here: Stroke Explained by Dr. Azad Irani – Jaslok Hospital
A stroke occurs when a part of the brain is deprived of blood supply, causing the corresponding part of the body it controls to stop functioning. Dr. Irani describes the brain as the body's control center: the right side of the brain controls the left side of the body, and vice versa, with different regions specializing in specific functions — movement of the arms, legs, eyes, speech, swallowing, and balance. When blood supply to a particular region is cut off, the function it governs is affected.
Stroke is becoming alarmingly common. According to 2020 figures, 1.5 crore (15 million) people worldwide suffer a stroke every year — meaning someone experiences a stroke roughly every minute, and someone dies from one every four minutes, reflecting a 25% mortality rate. Even more concerning: stroke incidence has tripled between 1990 and 2020.
Strokes fall into two main categories:
The remaining 3–4% are rarer causes, such as venous sinus thrombosis (blockage in the brain's drainage system) or subarachnoid hemorrhage (rupture of a weakened, balloon-like blood vessel).
Dr. Irani notes that when a patient arrives with paralysis, doctors cannot immediately tell whether it's a clot or a bleed without imaging. However, larger bleeds tend to cause unconsciousness or coma more often, while clot-related strokes are more associated with longer-term disability affecting movement.
The two leading causes of stroke are:
Other established risk factors include stress, smoking, obesity, and excessive alcohol consumption. In addition, Dr. Irani highlights three risk factors added to medical guidelines more recently:
While high blood pressure and diabetes can occur even in younger people, Dr. Irani identifies smoking and recreational drug use as the most common risk factors driving the rise in strokes among people aged 30–35. Rarer causes in young people include genetic or hereditary conditions — such as congenitally weak blood vessels or a hole in the heart present since childhood, which can allow a clot to travel to the brain.
According to Dr. Irani, the split is roughly 90% lifestyle and 10?mily history — underscoring how much stroke risk is actually within an individual's control.
The defining feature of stroke symptoms is that they appear suddenly. Dr. Irani recommends the internationally recognized mnemonic BE FAST to help identify a stroke quickly:
Some people experience temporary weakness or numbness that resolves within minutes, leading them to dismiss it as unimportant. Dr. Irani clarifies that this is, in fact, still a stroke — specifically a Transient Ischemic Attack (TIA), or "mini-stroke." In a TIA, the body dissolves the clot quickly on its own, restoring blood flow before lasting damage occurs. However, a TIA still requires the same diagnostic workup and treatment as a full stroke, since it's a strong warning sign that a larger stroke could follow. It should never be ignored.
Historically, a stroke ("lakwa") was considered a life sentence — patients often remained bedridden permanently because no effective treatment existed beyond blood thinners, which could only prevent future strokes, not reverse damage already done.
This changed around 1995, with the introduction of a clot-busting injection that could actively dissolve the clot causing the stroke — not just thin the blood. For this treatment to work, patients need to reach the hospital within a golden window of 4.5 hours from symptom onset (though earlier is always better). A decade later, another treatment emerged: thrombectomy, a procedure similar to cardiac angiography, where doctors navigate a wire through the blood vessels to physically remove the clot — typically usable up to 6–9 hours after onset in eligible patients.
Beyond these windows, treatment options become significantly more limited, which is why speed to the hospital is the single most important factor in outcome.
The two stroke types require completely opposite initial treatments:
Despite the different acute treatments, longer-term rehabilitation — physiotherapy and exercise — follows a similar path for both types.
According to Dr. Irani, a genuinely stroke-ready hospital needs:
Having all of this under one roof — as is the case at Jaslok Hospital — matters because transferring a patient between facilities wastes precious time, and every minute directly impacts outcomes. Starting treatment in the first hour versus the fourth hour can mean the difference between full recovery and lasting paralysis.
Dr. Irani offers a reassuring perspective: the human brain uses only about 20% of its total capacity in daily life, leaving roughly 80% as a "reserve" that can be activated when a damaged area needs support. This reserve capacity is why stroke patients can often make significant recoveries — but it requires active stimulation through physiotherapy to encourage the brain to "reroute" function to unaffected areas.
Dr. Irani emphasizes that patience, willpower, and consistent effort matter — recovery should not be given up prematurely.
Caregiver burnout is common, as family members supporting a recovering stroke patient can become physically and emotionally exhausted. Dr. Irani stresses that motivation from both the medical team and family is essential throughout recovery, and encourages families to see the recovery period as an opportunity to spend meaningful time together.
Dr. Irani highlights several key advancements transforming stroke care:
Above all, Dr. Irani stresses that the single biggest advancement in stroke care is prevention through health education.
Lifestyle factors touch every part of the day — from what you eat, to how you handle work stress, to how much physical activity and sleep you get:
Dr. Irani compares blood vessels to plumbing pipes: high blood pressure causes them to stretch and eventually rupture over time, effectively shortening their functional lifespan. Diabetes, meanwhile, thickens the blood and slows circulation, increasing the likelihood of clot formation.
Dr. Irani's closing advice for stroke prevention and recovery centers on three key messages:
He urges everyone to remember BE FAST, the golden window, and the importance of choosing a stroke-ready hospital — steps that can protect not just a patient's life, but their family's long-term health and financial wellbeing.
This article is based on an episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, featuring Dr. Azad Irani, neurologist specializing in stroke management. Watch the full video interview here: Stroke Explained by Dr. Azad Irani
For consultation regarding stroke risk assessment, emergency stroke care, or neurological rehabilitation, please reach out to Jaslok Hospital's Department of Neurology.