Stroke Prevention: Risk, Recognition, and Action

A practical overview of stroke and TIA, key modifiable risks, and prevention strategies. Up to 80% of strokes are preventable.

Topic: Vascular Neurology Level: Intro / Intermediate Tags: stroke, TIA, prevention, hypertension, AFib, cholesterol, diabetes

Overview

A stroke is brain injury caused by sudden interruption of blood and oxygen supply. It is sometimes called a “brain attack,” analogous to a heart attack. Most strokes are preventable by addressing modifiable risks and optimizing cardiovascular health.

Clinician tip: Every TIA is a medical emergency—evaluate within 24–48 hours to reduce early recurrent stroke risk.

Types of stroke

Transient ischemic attack (TIA)

Stroke-like symptoms that resolve within 24 hours. No single “proof test”; diagnosis is clinical. TIAs warn of high early stroke risk—prompt workup is essential.

Ischemic stroke

Most common type; caused by arterial blockage from clot or plaque. Rapid reperfusion therapy may restore perfusion in eligible patients.

Hemorrhagic stroke

Bleeding within the brain due to vessel rupture—often related to long-standing hypertension, aneurysm, or vascular malformation.

Major risk factors

  • High blood pressure (hypertension): #1 modifiable risk.
  • Cigarette smoking: accelerates vascular injury and thrombosis.
  • Atherosclerosis/dyslipidemia: plaque buildup and vessel narrowing.
  • Diabetes mellitus: micro‑ and macrovascular damage.
  • Atrial fibrillation: cardioembolic clots; consider anticoagulation when appropriate.
  • Others: obesity, sedentary lifestyle, unhealthy diet, excess alcohol, sleep apnea, and family history.

Prevention at a glance

Action What to do Why it matters
Control blood pressure Lifestyle + medications to reach targets Largest reduction in stroke risk
Quit smoking Counseling, NRT, pharmacotherapy Rapid and sustained risk reduction
Manage lipids & diabetes Diet, exercise, statins, glucose control Slows atherosclerosis and thrombosis
Treat atrial fibrillation Anticoagulate eligible patients Prevents cardioembolic stroke
Healthy lifestyle DASH/Mediterranean diet, activity, limit alcohol, weight control Comprehensive vascular protection

Teaching & safety notes

  • New focal neurologic deficits that start suddenly: activate emergency stroke pathways.
  • Do not dismiss transient symptoms—TIA warrants urgent imaging and secondary prevention.
  • Screen for sleep apnea and alcohol overuse in cryptogenic or recurrent stroke.
Red flag: Rapidly worsening headache, vomiting, or decreased consciousness suggests hemorrhage—seek emergent care.

References

  1. Kleindorfer DO, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke. American Heart Association/American Stroke Association.
  2. American Stroke Association. Stroke Prevention – Patient Education Resources.

Educational discussion. Not a substitute for clinical judgment. Consider local protocols and individual factors.