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STROKE SERIES · ARTICLE 1 OF 12
What is a stroke?
A plain-English guide for South African families.
About 130 South Africans have a stroke every single day. Of those, around 25 die from it. The rest — roughly 100 a day — wake up to a different life: a weak arm, slurred speech, a partial loss of vision, a memory that no longer cooperates, or simply a slower body that doesn’t move the way it used to. Stroke is the second-biggest cause of adult death in our country after HIV and TB combined, and the single biggest cause of acquired disability.
It is also one of the most preventable serious conditions in medicine. And — for the people who do have one — it is one of the most time-sensitive. Of all the medical emergencies you might face, stroke is the one where the gap between “ignored for an hour” and “treated within an hour” makes the biggest difference to the rest of your life.
This is the first article in a 12-part series. We’ll cover what a stroke is, how to recognise one, what happens in hospital, what recovery looks like, and the food, walking and medication that prevent the next one. The single most important article in the whole series is the next one — F.A.S.T. — and we recommend reading it the moment you finish this one.
Before you read on
This is information, not medical advice. If you or someone near you is having a stroke right now, stop reading and skip to the box below — every minute saves brain.
If you suspect a stroke is happening right now
Call 10177 for an ambulance immediately, or get to a hospital emergency department as fast as possible. Do not wait to see if symptoms pass. Do not drive yourself. The ambulance team can start treatment on the way and will take the patient to the right kind of hospital.
Watch for: face droop on one side, weakness or numbness in an arm or leg, slurred or confused speech, sudden severe headache, sudden trouble seeing, sudden loss of balance.
What a stroke actually is
Your brain is a hungry organ. Although it weighs only about 1.4 kg — less than 2% of your body weight — it uses about 20% of the oxygen and glucose your body consumes. Every cell in your brain needs a constant supply of blood, every second of every day. Stop that supply and the brain cells start dying within minutes.
A stroke is what happens when that blood supply is suddenly interrupted in a particular area of the brain. The brain cells in that area, deprived of oxygen, begin to die. The part of the body — or the speech, or the vision, or the memory — that those cells controlled stops working.
Stroke = brain cells dying, because blood stopped reaching them.
The two ways blood stops
There are two main ways the blood supply to part of the brain is interrupted, and they cause the two main kinds of stroke:
Kind What happens How common Ischaemic stroke A clot blocks one of the arteries that supplies the brain. Like a blocked drainpipe — nothing gets through. About 80% of strokes Haemorrhagic stroke An artery in the brain bursts. Blood floods the brain tissue instead of flowing through it. About 20% of strokes
The two kinds need different treatment — that’s why a CT scan is one of the first things that happens in hospital. We cover both in detail in article 3 of the series.
The pipes-and-blockage picture
Picture your brain as being fed by a tree of pipes — a few big ones that branch into thousands of small ones. When one of the big pipes blocks, a large area of brain loses its supply and the stroke is severe — major weakness on one side, severe speech problems, sometimes coma. When a small pipe blocks, a small patch of brain dies and the effect can be subtle — a slightly weak hand, a fleeting moment of confusion, a brief loss of vision in one eye.
Even the smallest stroke is important, because it tells you the plumbing is in trouble. We’ll return to this point.
How big a problem stroke is in South Africa
Some numbers from the Heart and Stroke Foundation:
• About 130 strokes happen every day in South Africa — close to 50 000 a year.
• About 25 South Africans die from a stroke each day — roughly 9 000 a year.
• About 75 000 South Africans are living with stroke-related disability at any given time.
• One in six South Africans will have a stroke at some point in their life.
• Black South Africans have the highest rate in the country — about double the average — driven mainly by higher rates of untreated high blood pressure.
• Stroke can happen at any age. About 20% of South African strokes are in people under 50. Stroke in young people is rising and the causes are different from older patients — we cover this in article 11.
Compared with other places, South Africa’s stroke numbers are high — partly because high blood pressure here is more common and less well controlled, partly because diabetes is rising fast, and partly because access to specialist stroke care is uneven. The South African public health system has done a lot to improve stroke care in the last 15 years, but a lot remains uneven.
Why minutes matter
This is the single most important thing to understand about stroke, and it is what separates stroke from most other medical conditions.
When a brain artery blocks, the brain tissue in the affected area starts dying immediately. Some of it dies within the first few minutes. Most of it dies within the first hour. By six hours, much of the salvageable brain is gone. The longer you wait, the more brain you lose — and brain tissue, unlike skin or muscle, does not grow back.
The treatments that work — clot-busting drugs (thrombolysis) and mechanical clot retrieval (thrombectomy) — only work if they happen quickly. Thrombolysis is most effective within 3 to 4.5 hours of symptom onset; some thrombectomy can be done up to 24 hours later in carefully selected patients, but the earlier the better.
Researchers describe the time-loss like this: every minute of stroke without treatment kills about 2 million brain cells. That’s 120 million brain cells lost per hour of delay.
Time is brain. The earlier treatment starts, the more of you survives.
Article 2 — the most important article in this series — is about recognising a stroke in the first place. Spending five minutes learning the F.A.S.T. test could be the most valuable five minutes you ever invest.
Who tends to have a stroke
Stroke is more common in some people than others. The main risk factors:
• High blood pressure — by far the biggest risk factor for stroke in South Africa. Roughly half of all strokes here are driven by high BP. The Phila Today High Blood Pressure Series covers this in detail.
• Age. Stroke risk doubles every decade after age 55. But it can happen at any age — see article 11.
• Diabetes. Diabetics have roughly double the stroke risk of non-diabetics.
• High cholesterol. Drives plaque in the arteries that supply the brain.
• Smoking. Doubles stroke risk; quitting halves it within 5 years.
• Atrial fibrillation (an irregular heartbeat). The most common heart-related cause of stroke. Often undiagnosed.
• Family history. Stroke or early heart attack in a parent or sibling raises your risk.
• Black South African ancestry. Roughly double the average rate.
• HIV. Both the virus itself and some of the older antiretroviral medications raise stroke risk modestly. Modern HIV care reduces this significantly.
• Sickle cell disease. A major cause of stroke in children and young adults of African ancestry.
• Pregnancy and the post-partum period. Stroke risk is higher during and just after pregnancy, particularly with pre-eclampsia.
• Heavy alcohol use, illicit drug use (especially cocaine and methamphetamine).
Article 4 covers each of these in more detail. The important point is that most of them are modifiable — meaning you can do something about them.
What you can actually feel before a stroke
For most strokes, the answer is: nothing. The stroke itself is the first symptom. There is no headache, no chest pain, no warning ache that builds up for hours. One minute you’re fine; the next, half of your face has gone numb or you can’t get a word out.
The exception is a TIA — transient ischaemic attack, sometimes called a “mini-stroke”. This is a brief stroke — the artery blocks momentarily, brain function goes wrong for a few minutes to a few hours, and then the blockage clears and everything goes back to normal. People often dismiss a TIA because it “got better on its own”. This is one of the biggest mistakes in medicine.
A TIA is a warning. About 1 in 5 people who have a TIA will go on to have a full stroke within 3 months — most of them in the first week. With urgent investigation and treatment after a TIA, most of those second strokes can be prevented. We cover TIA in detail in article 3.
If you have ever had stroke-like symptoms that resolved on their own
Even if it was years ago, mention it at your next clinic visit. Even if it lasted only minutes. The treatment we can offer to prevent a future stroke depends on knowing about the past one.
The good news
Strokes are frightening. But the modern story of stroke is overwhelmingly hopeful:
• Stroke is highly preventable. About 80% of strokes are prevented by managing blood pressure, blood sugar, cholesterol, smoking and AFib. Almost everything else in this series is about those levers.
• Stroke is highly treatable in time. Thrombolysis given within the first 3 – 4.5 hours of ischaemic stroke prevents disability in roughly 1 in every 8 patients treated. Thrombectomy in selected patients does even better.
• Recovery is real. Most people regain meaningful function. The brain rewires itself in extraordinary ways. The first six weeks are the steepest part of the recovery, but improvement continues for two years and sometimes longer.
• Second strokes can be prevented. Aspirin, statins, BP control and atrial fibrillation treatment cut second-stroke risk by roughly 80%. We cover all of these in articles 9 and 10.
• Public clinic care is good. Most South African public hospitals can give thrombolysis and provide stroke unit care. Major centres can do thrombectomy. The care has improved enormously in the last decade.
Stroke is not a sentence. It is an emergency, then a journey, then a manageable condition.
The bigger picture
Stroke sits at the intersection of three Phila Today series — high blood pressure, cholesterol, and diabetes — all of which feed into stroke risk. Almost everything you have read in those series, if you have read them, applies here. Walking, salt, food, medication — these aren’t separate stroke-prevention strategies. They are the same strategies, viewed from a different angle.
If you have any of those three conditions, this series gives you the missing piece. If you’ve never had a stroke but have someone in your family who has, this series helps you understand what they went through and what comes next. If you have had a stroke yourself, this series is for you — recovery, rehabilitation, prevention of the next one.
The next article in the series is the most important one. Five minutes of reading. The F.A.S.T. test. If you only read one Phila Today article ever, make it that one.
Where to get more help
Heart and Stroke Foundation South Africa — heartfoundation.co.za · 021 422 1586 — patient information, stroke support groups, a stroke helpline, and resources for family members.
In an emergency — 10177 for an ambulance, or get to your nearest hospital emergency department.
Stroke Survivors South Africa (StrokeSSA) — survivor and caregiver community.
Phila Today High Blood Pressure Series, Cholesterol Series, and Diabetes Series — recommended companion reading. The three together cover the biggest preventable causes of stroke.
Phila Today Stroke Series — next: spotting a stroke — F.A.S.T. and the golden hour. The most important article in this series.
Phila Today · Article 1 of 12 in the Stroke Series