When to worry after a stroke

⚠️ Read this box first. It is the only part you must remember.

If you see face drooping, arm weakness, or speech difficulty come on suddenly — go to the nearest hospital immediately. Note the time it started. Do not wait to see if it passes. Do not wait for morning. Do not give food, drink or medicine first.

That is true whether it is the first stroke or the fifth. Everything else in this guide is detail.

🚑 Emergency — call now, any time, day or night

0886 422 004 0770 459 386

Call as you go — do not wait at home for advice. Head for the nearest hospital, and write down the time the symptoms started.

Go to hospital now

Any one of these, on its own, is enough. You do not need to be sure — being wrong and sent home is a good outcome.

New face drooping, arm or leg weakness, or numbness — especially on one side
New difficulty speaking, slurred speech, or suddenly not understanding what people say
Sudden loss or blurring of vision, in one eye or on one side
A sudden severe headache — the worst they have ever had, arriving in seconds
Sudden loss of balance, or the room spinning, with difficulty walking
Any fit or seizure — shaking, stiffening, or a blank unresponsive spell
Becoming very drowsy, confused, or hard to wake
Choking, or struggling to breathe
Fever with cough or fast breathing — a chest infection after stroke is dangerous and moves quickly
A head injury while on a blood thinner — even a mild knock, even feeling fine afterwards
Black tarry stools, or blood in vomit, urine or stool
No urine passed for a whole day
A hot, swollen, painful calf on one side

Two things people get wrong, again and again.

"It went away, so it was nothing." Weakness or speech trouble that comes and goes within minutes is a warning that a bigger stroke may be days away. It is a reason to go to hospital today, not a reason to relax.
"We will go in the morning." Stroke treatment is decided by the hour. The time the symptoms started is the single most important piece of information you can carry with you — write it down.

Contact your clinic within a day or two

Not emergencies, but not things to sit on either.

💊

Medicine problems

Ran out, cannot afford the next month, or a side effect you cannot live with. Speak to someone before you stop anything.

📉

Common

Blood pressure staying high

Readings above target for several days running, with no symptoms. Take your record with you.

🤕

A fall

Even without injury. A fall usually has a treatable cause — a medicine dose, low pressure on standing, weak vision.

🍲

Coughing at meals

Or a wet gurgly voice after swallowing, or food staying in the mouth. This is how chest infections start.

🛏️

Skin going red over a bony place

Hip, tailbone, heel, elbow — redness that does not fade when you press it is the beginning of a pressure sore.

😔

Low mood lasting weeks

Especially if they have stopped eating, stopped trying, or stopped talking. This is treatable and very common.

Watch, write down, and mention at the next visit

These are usually part of recovery rather than signs of danger — but a pattern written down is worth far more to your doctor than a memory.

Tiredness that is out of proportion to what they did. Extremely common in the first months and often the last thing to improve.
Tearfulness, or laughing and crying that comes from nowhere and does not match how they feel inside. This has a name and a treatment.
Stiffness in the weak arm or leg slowly increasing, or the hand curling closed.
Shoulder pain on the weak side. Mention it early — it is much easier to settle before it becomes established.
Forgetfulness, losing the thread, or difficulty following conversation in a busy room.
Disturbed sleep, or sleeping all day and lying awake at night.
Constipation. Very common after stroke, and worth sorting before it becomes a problem of its own.
Slow improvement, or a plateau. Recovery is not a straight line, and a flat few weeks is not failure.

What to take with you to hospital

Keep these together somewhere you can grab them in a hurry. When it matters, nobody can think clearly enough to gather them.

All the medicine packets in one bag
The time the symptoms started — written on paper
Your blood pressure record, if you keep one
Any previous hospital papers, scans or discharge notes
The name and number of someone who knows the full history

If you are unsure, go.

Nobody has ever been blamed for bringing someone in who turned out to be fine. The mistake that costs people is the other one — waiting through the night to see whether it settles. A journey made for nothing is a good day.

Where this comes from: American Heart Association / American Stroke Association guidance on stroke recognition and on secondary stroke prevention (2021); the AHA/ASA adult stroke rehabilitation and recovery guideline; American Stroke Association patient guidance on swallowing difficulty and on shoulder pain after stroke; and everyday practice at Liberia's national referral hospital.

This guide helps you judge urgency. It does not replace being seen. If something frightens you and it is not on this list, that is still a reason to seek advice.