Warning signs of stroke in older parents, and what to do in the first hour

How to recognise a stroke: BE FAST

A stroke happens when blood supply to part of the brain is cut off, either by a blocked blood vessel or by bleeding. Brain cells start to die within minutes, so the faster your parent gets to hospital, the less damage there is likely to be.

Doctors teach a simple check called BE FAST. If you see any one of these signs, act immediately:

• Balance: sudden loss of balance, dizziness or trouble walking
• Eyes: sudden blurred vision, double vision or loss of sight in one or both eyes
• Face: ask them to smile. Does one side of the face droop?
• Arms: ask them to lift both arms. Does one arm drift down or feel weak?
• Speech: is their speech slurred, strange or hard to understand, or are they confused?
• Time: call for help straight away, and note the time the signs started

The older FAST check (Face, Arms, Speech, Time) is still used by the NHS and works well. Adding Balance and Eyes catches more strokes. In one study, the extra two checks cut the share of strokes missed from about 14 in 100 to about 4 in 100.

Other sudden signs include a severe headache unlike any before, numbness on one side of the body, and sudden confusion. The key word is sudden. Stroke symptoms usually appear within seconds or minutes, not over weeks.

Are there warning signs a month before a stroke?

Many people search for the warning signs a month before a stroke. The honest answer is that most strokes come without any reliable warning that far ahead.

What does sometimes come first is a transient ischaemic attack (TIA), often called a mini-stroke. It causes the same signs as a stroke, but they pass, usually within minutes and always within 24 hours. Because the signs disappear, families often brush it off. That is a mistake.

• In a large study of people who had a stroke, about 23 in 100 had a mini-stroke beforehand.
• Of those mini-strokes, 17 in 100 happened on the day of the stroke and 43 in 100 within the seven days before.
• In another study, about 10 in 100 people seen in an emergency department with a mini-stroke went on to have a full stroke within 90 days, and about half of those strokes came in the first two days.
• The CDC says as many as 10 to 15 in 100 people have a major stroke within three months of a mini-stroke.

So the real warning is not a slow build-up over a month. It is a sudden episode that goes away. If your parent has stroke signs that disappear, treat it as an emergency that day. In the UK, guidance is that anyone with a suspected mini-stroke should see a specialist within 24 hours.

What to do in the first hour

If you think your parent is having a stroke, do these things in this order:

• Call 112 or 767, the Lagos emergency numbers, and say you think it is a stroke. If an ambulance will take too long and you can get there faster, go to the nearest hospital with an accident and emergency department
• Note the exact time the signs started, or the last time your parent was seen well. Doctors need this to decide on treatment
• Do not give them anything to eat or drink. A stroke can affect swallowing, and food or water can go into the lungs
• Do not give aspirin. About a third of strokes in Nigeria are caused by bleeding, and aspirin can make a bleed worse. Doctors only give it after a brain scan
• Keep them comfortable and reassure them. Loosen tight clothing
• If they become unresponsive but are breathing, put them on their side in the recovery position and keep checking their breathing
• Gather their medicines list, ID and any insurance card to take to hospital

If you live abroad and hear about the signs by phone, tell whoever is with your parent to call 112 or 767 first, then call you back. Do not spend the first minutes on calls to relatives.

Why time matters so much

The most effective stroke treatments only work within a short window after the symptoms start:

• Clot-busting medicine can be given up to about four and a half hours after a stroke caused by a blocked vessel starts, once a scan has shown there is no bleeding.
• A procedure to pull out the clot (thrombectomy) can be done within six hours, and in some people up to 24 hours.
• The CDC reports that people who reach the emergency room within three hours of their first symptoms often have less disability three months later.

These treatments need a hospital with a brain scanner and stroke specialists. Not every hospital in Lagos has them, which is why choosing your parent's hospital in advance matters.

Read our guide to hospitals in Lagos for older parents

The types of stroke

There are two main types of stroke, plus the mini-stroke described above:

• Ischaemic stroke: a blood vessel to the brain is blocked by a clot. Worldwide this is the most common type, about 65 in 100 new strokes.
• Haemorrhagic stroke: a blood vessel in or around the brain bursts and bleeds. In a large study across Nigeria and Ghana, 32 in 100 strokes were of this type, a much higher share than in the US.
• Transient ischaemic attack (TIA): a short blockage that clears on its own. It does not usually cause lasting damage, but it is a strong warning.

You cannot tell the type of stroke by looking at someone. Only a brain scan can. That is another reason not to give aspirin at home.

What causes stroke, and the risk factors in Nigeria

High blood pressure is the leading cause of stroke. The SIREN study, which looked at stroke patients across Nigeria and Ghana, found that high blood pressure was linked to about 91 in 100 strokes. It often causes no symptoms at all, so many people do not know they have it.

In Nigeria, about one in three adults has high blood pressure. A 2021 study estimated that of the 27.5 million Nigerians with it, only 29 in 100 knew, 12 in 100 were being treated, and fewer than 3 in 100 had it under control.

Other risk factors include:

• Being over 50
• Diabetes
• An irregular heartbeat (atrial fibrillation)
• High cholesterol
• Smoking and heavy drinking
• Being overweight and not active
• Eating a lot of salt, including adding salt at the table
• Sickle cell disease
• A previous stroke or mini-stroke

How to lower your parent's risk

Most strokes are linked to things that can be changed. For an older parent, the most important steps are:

• Check their blood pressure regularly. A home blood pressure monitor is a good investment
• If they are prescribed blood pressure medicine, make sure they take it every day, even when they feel well
• Ask their doctor about diabetes and cholesterol checks
• Cut down on salt and seasoning cubes, and eat more vegetables
• Encourage walking or gentle exercise most days
• Help them stop smoking and keep alcohol low
• If they have had a mini-stroke, make sure they see a doctor and take any medicine prescribed to prevent another

Missed blood pressure tablets are one of the most common problems we see with older people living alone. A caregiver who records every dose, with a nurse checking the record, closes that gap.

How Home Care Nigeria helps

Our caregivers check blood pressure and other readings at each visit and record them against safe ranges set in your parent's care plan. A reading outside the range is flagged to our nurse straight away. Every care plan includes an emergency plan with your parent's preferred hospital and an emergency number that works for their address, so in a stroke nobody has to search for information.

If your parent has already had a stroke, our guide to caring for a stroke patient at home explains what recovery involves.

Caring for a stroke patient at home in Lagos

Common questions