Stroke (apoplexy): how to recognize it and how to help

High blood pressure increases the risk of having a stroke-medically known as apoplexy. Other terms include brain attack or cerebral stroke-formerly also called an apoplectic fit and often referred to colloquially simply as a stroke. Stroke is the third most common cause of death in Germany. Most strokes are caused by a blood clot, the formation of which is often due to atrial fibrillation. Atrial fibrillation, in turn, is usually associated with excessively high blood pressure. Although stroke primarily affects older people, children, adolescents and young adults can also have a stroke.

In 2024, a study showed that high blood pressure particularly increases the risk of a severe stroke. Apoplexy is classified as severe if the affected person is subsequently no longer able to walk or care for themselves, or even dies as a result of the event. Of those who had suffered a severe stroke, 74% had high blood pressure. Those who had suffered a mild to moderate stroke also had a pre-existing diagnosis of hypertension. This risk was also observed, although to a lesser extent, in participants who had atrial fibrillation or were smokers.

What is a stroke?

A stroke is caused by a circulation disorder in the brain. As a result, brain cells in the affected area receive too little oxygen and nutrients and die. There are two main types of stroke: ischemic (non-bleeding) stroke and hemorrhagic (bleeding) stroke.

Ischemic (non-bleeding) stroke

An acute lack of blood flow (ischemia) occurs - often caused by a blood clot. This form accounts for about 80 to 85 percent of all strokes. How severe the stroke is depends on which part of the brain is affected.

Hemorrhagic (bleeding) stroke

In this form, the circulatory disorder is caused by bleeding in the brain. Because the brain is protected by the skull from impacts and similar forces, bleeding in the brain cannot, for example, cause an outward bulge. The escaping blood therefore presses on the brain and causes reduced blood flow - or, more precisely, reduced blood flow occurs in this way because the downstream region does not receive enough blood. This is the cause of 15 to 20 percent of strokes.

How do I recognize a stroke?

Certain signs are very common with a stroke.

The most well-known is paralysis on one side of the body, which can be recognized by these symptoms:

drooping corner of the mouth, drooping eyelid - typically, drinks or saliva may dribble uncontrollably out of the mouth;
an arm feels weak, cannot be lifted and the palm cannot be turned upward;
slurred, unclear speech and/or difficulty understanding spoken words;
unsteady walking, trouble walking, one leg not cooperating.

People may also have the following problems:

Loss of balance, dizziness;
Loss of vision in one half of the visual field - certain areas of the normal field of vision can no longer be perceived;
Double vision or blurred vision;
Sudden severe headache;
Nausea, possibly vomiting (Caution: risk of choking!);
Confusion, disorientation - questions about the person's name, date of birth, today's date and location cannot be answered or can only be answered inadequately;
Reduced consciousness or even loss of consciousness.

What to do if you suspect a stroke?

If you suspect that you or the person in front of you may have had a stroke, call the emergency number 112 immediately! „Time is brain“!

Follow the FAST method:

F – Face (the face): Ask the person to smile. If one side of the face does not move when the person smiles, or if one corner of the mouth or an eyelid droops, paralysis is likely, indicating a stroke.
A – Arms: Ask the person to extend their arms in front of them and turn their palms upward, either one arm first and then the other, or both arms at the same time. If one arm hangs limply, paralysis is likely, suggesting a stroke.
S – Speech: Ask the person to repeat a sentence. Or ask them a simple question. If you notice slurred speech and/or the person no longer knows, for example, their name or date of birth, this is a sign of a stroke.
T – Time: Do not waste any time! If you have noticed any abnormalities under F, A or S, immediately call the emergency number 112. „Time is brain“!

Stay with the person, position them with their upper body elevated, and keep observing them. Do not let them eat or drink - the risk of choking due to the paralysis is high! Provide first aid if needed. If the person becomes unconscious but is breathing, place them in the recovery position. Check their breathing repeatedly. If they stop breathing, begin CPR.

If you are the one affected, and it is possible, call someone nearby for help. Wake your partner, call a neighbor, inform your children or relatives. Do everything you can not to be alone in this situation. Do not eat or drink! Do not exert yourself!

Wait for the ambulance! Do not drive yourself to the hospital! This puts you and others at risk.

What else is important?

Open the door for the arriving emergency medical service. If necessary, wedge a shoe or similar object in the door to prevent it from closing. Be prepared for the possibility that the situation may have worsened by the time the emergency medical service arrives, meaning that you may then no longer be able to open the door.

For emergencies such as a stroke, it is helpful to have an up-to-date medication list at hand and any allergies documented. A great way to store this information and, for example, a doctor's letter listing known diagnoses for a potential emergency is the so-called Notfalldose (emergency canister). It is available from pharmacies, medical supply stores, or online. The documents or copies of them are placed in the canister, which is then stored in the refrigerator door. A sticker is placed on the inside of the house or apartment door to indicate the presence of the emergency canister. This allows emergency personnel to find the important information quickly in an emergency. You should, of course, keep the contents of the canister up to date and record any changes in medication, new diagnoses, or allergies there as well.

“Time is brain” - time is brain. That means the faster a stroke can be treated medically, the better the chances of survival and of having as few lasting impairments as possible. The best window to start a so-called thrombolytic (clot-busting) treatment is up to 4.5 hours after the stroke.

What happens next?

The emergency medical service will take the person affected to hospital as quickly as possible - preferably to a specialised stroke unit. In more remote areas, the quickest option may require a rescue helicopter. A stroke unit is a specialist department for stroke patients.
At the hospital, a CT (computed tomography) scan of the head will be performed. This imaging procedure shows whether a stroke has occurred, where it is located, what type it is and how severe it is. Treatment will be started depending on the indication - potentially thrombolysis, which can dissolve the blood clot blocking the vessel.

Smile - speak - arms up

Cartoonist Ralph Ruthe made a funny music video about this serious topic. Humor helps to remember the symptoms:
https://www.youtube.com/watch?v=SmZZLGnbWxc

Sources:

This article is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 04/2026).

Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.