A stroke is an acute disturbance of blood flow to the brain that suddenly deprives part of the brain of its blood supply. Worldwide, it is the second leading cause of death and the leading cause of disability among adults. In Ukraine, about 128,000 strokes are recorded every year. According to the World Stroke Organization (WSO), nearly 12 million new strokes occur worldwide each year, and one in four adults over the age of 25 will have a stroke during their lifetime. About 60% of patients are left with some degree of disability, and only up to 25% return to full working capacity. It is a medical emergency: every minute counts.
The brain is supplied with oxygen and glucose through a network of blood vessels. When that blood supply is interrupted, neurons begin to die within minutes. Research shows that during a stroke, the brain loses roughly 1.9 million neurons every minute. Without rapid restoration of blood flow, irreversible cell death occurs in the affected area.
At the center of the damage, an ischemic core forms — the area of most severe and irreversible tissue injury. Around it lies the penumbra, tissue with reduced blood flow that may remain viable if circulation is restored in time. This is the tissue that may still be salvaged when blood flow is restored promptly — which is why emergency stroke care is measured not in hours, but in minutes.
There are two main types of stroke. Ischemic stroke is caused by a blood clot blocking a vessel and is by far the more common type. Hemorrhagic stroke occurs when a blood vessel ruptures and bleeds into brain tissue; it is less common but carries a higher mortality rate.
Ischemic stroke accounts for about 85% of all cases. A blood vessel is blocked by a thrombus — a blood clot — or, in some cases, by material from an atherosclerotic plaque. Deprived of oxygen, the affected area of the brain can begin to sustain irreversible damage within minutes.
Hemorrhagic stroke occurs when a blood vessel ruptures and bleeds into brain tissue, increasing pressure inside the skull. Mortality from hemorrhagic stroke is roughly twice as high as that from ischemic stroke, even when the affected area is smaller.
Stroke symptoms appear suddenly. To quickly check for signs of a suspected stroke, the FAST acronym is widely used:
In Ukraine, a similar mnemonic promoted by the Public Health Center of the Ministry of Health of Ukraine is MOZOK — the Ukrainian word for “brain,” built from the first letters of five Ukrainian words:
The causes of stroke are mostly vascular and cardiac conditions that impair blood supply to the brain. Doctors divide risk factors into modifiable ones, which can be influenced, and non-modifiable ones.
Modifiable risk factors:
Non-modifiable risk factors:
Stroke treatment is always a race against time. The sooner blood flow is restored, the greater the chance of salvaging viable brain tissue around the site of damage.
In ischemic stroke, a CT or MRI scan is performed first to confirm the type of stroke and determine which treatments are available. If no more than 4.5 hours have passed since symptoms began, thrombolysis may be possible — the intravenous administration of a drug that dissolves the clot and restores blood flow. If the clot is blocking a large vessel, mechanical thrombectomy may be indicated within 6–24 hours, depending on the findings of the diagnostic evaluation. During the procedure, the clot is removed mechanically using a catheter. The earlier the intervention, the less brain tissue is irreversibly damaged.
In hemorrhagic stroke, the priority is to stop the bleeding and lower the pressure inside the skull; surgery is sometimes needed. Rapid hospitalization improves the chances of preserving brain tissue.
The consequences of a stroke depend on which part of the brain is affected and how extensive the damage is. The most common effects are weakness or paralysis of the limbs, speech and swallowing difficulties, changes in memory and concentration, vision problems, and anxiety or depression.
The degree of recovery differs from person to person and depends, among other things, on how severe the stroke was and how promptly rehabilitation begins.
Recovery after a stroke is a long process that combines several approaches: therapeutic exercise and physical therapy to restore movement, speech therapy for speech and swallowing difficulties, cognitive rehabilitation for memory and concentration, and psychological support for the patient and family.
The sooner rehabilitation begins and the more consistently it is carried out, the better the chances of regaining lost function. The brain remains able to form new neural connections even years after a stroke.
To help speed up recovery, doctors may also prescribe cell therapy with mesenchymal stem cells — at present the method is used in ischemic stroke, as there is not yet enough clinical data for hemorrhagic stroke. It may serve as an addition to standard rehabilitation. The brain retains the ability to respond to stimulation even years after a stroke, so rehabilitation or cell therapy can be considered at any stage of recovery.
“Stroke is a manageable disease of risk factors, not a matter of chance. Up to 80% of first strokes could potentially be prevented by controlling risk factors,” says Viktoriia Berezniuk, neurologist at ReoCell Clinic.
Primary prevention is for people who have not yet had a stroke or a transient ischemic attack. Secondary prevention begins after a stroke and continues for life — managing risk factors remains an ongoing part of care.
The general guidance below is based on the American Heart Association/American Stroke Association’s 2024 guideline on primary prevention and its 2021 guideline on secondary prevention after stroke or TIA:
This guidance is intended for the long term and complements rehabilitation rather than replacing it. Practical steps for the active recovery stage are covered separately.
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