Published Oct 29, 2026 | 7:00 AM ⚊ Updated Oct 29, 2026 | 7:00 AM
Though heart attacks have become a familiar subject in public-health messaging, stroke symptoms remain poorly recognised,
Synopsis: India recorded 86,300 deaths from cerebrovascular diseases in 2024, nearly matching the 88,776 deaths attributed to heart attacks. Yet neurologists say stroke symptoms are often mistaken for fatigue or low blood pressure, delaying treatment. This World Stroke Day, experts explain the awareness gap, emergency care challenges, and lasting disability caused by stroke.
A sudden chest pain is widely recognised as a medical emergency. But when a person’s face droops, an arm goes weak or speech slurs, families often mistake them for symptoms of tiredness, low blood pressure or a temporary condition that will improve with some rest.
Such a difference in perception — of a medical emergency and a temporary problem — can cost valuable time, and even life.
India recorded 88,776 deaths due to acute myocardial infarction, or heart attack, and 86,300 deaths due to cerebrovascular diseases in 2024, according to the Report on Medical Certification of Cause of Death – 2024. The difference was 2,476 deaths.
Though heart attacks have become a familiar subject in public-health messaging, stroke symptoms remain poorly recognised, neurologists said. The consequences may not always be death: survivors may experience paralysis, speech and swallowing difficulties, memory problems and a prolonged loss of independence.
“Awareness of stroke is nowhere near as strong as for heart attack,” Dr Swathi Thangiah, Consultant, Neurology, SRM Prime Hospital, Chennai, told South First.
“Most people know chest pain means ‘rush to the hospital’ because the pain is intolerable,” she said.
But stroke can present differently. “A family usually thinks it is because of low BP or fatigue and that if they sleep, they may become better.”
For World Stroke Day on Thursday, 29 October, the comparison between recorded deaths from heart attacks and cerebrovascular diseases raises a critical public-health question: does stroke receive the attention its burden demands, and what happens when people fail to recognise it as an emergency?
The mortality figures do not, by themselves, establish how much public attention either condition receives. But neurologists’ shared experiences point to a recurring clinical challenge: people may recognise that something is wrong without understanding that it requires immediate specialist care.
Also Read: Reminding urgency in recognising, preventing life-threatening condition
Dr Thangiah has encountered patients who attributed weakness or numbness to everyday circumstances rather than a neurological emergency.
“I have received patients with numbness or weakness in both hand and leg,” she said. “They, for instance, reason that they had carried a shoulder bag, or the air-conditioner was on full blast that could have made their limbs go numb.”
Some patients, she said, would wait for a sleep to see whether the symptoms had disappeared. Others visited a nearby clinic ill-equipped to diagnose and treat a stroke.
Transient symptoms could be particularly misleading. Dr Thangiah said that when the symptoms disappear, people assume that the danger has passed. However, a transient ischaemic attack, or TIA, could be a warning sign of a subsequent stroke that requires urgent medical assessment.
Dr J. Alex, Consultant, Neurology, SRM Global Hospital, Chennai, also said people often confuse stroke symptoms with tiredness, low blood sugar, vertigo or a temporary problem.
“Even if the symptoms disappear within a few minutes, the person needs urgent medical assessment because this could represent a transient ischemic attack, which may warn of a future stroke,” he told South First.
The common warning signs include sudden facial drooping, weakness or numbness on one side of the body, difficulty speaking or understanding speech, sudden loss of vision, severe imbalance and, sometimes, a sudden severe headache.
An easy way to remember the warning signs is BE FAST: Balance, Eyes, Face, Arms, Speech and Time.
Dr Roopesh Kumar, Director of Neurosurgery at MGM Healthcare, Chennai, said people sought help only after the condition had worsened.
“People must understand that stroke symptoms can be painless, or may disappear temporarily. But still, they need attention, especially even though the symptoms have improved,” he told South First.
The distinction is important because stroke is not a single condition with a single treatment. It occurs when blood flow to part of the brain is interrupted or when a blood vessel ruptures and causes bleeding. The resulting damage depends on the area affected and the duration for which its blood supply is disrupted.
Dr Alex explained that ischaemic stroke, which accounts for the majority of strokes, occurs when a blood vessel supplying the brain becomes blocked. Haemorrhagic stroke occurs when a blood vessel ruptures and blood leaks into brain tissue or surrounding spaces.
“The distinction is very crucial because the treatment differs,” he said. “This is why urgent brain imaging is essential before deciding on treatment.”
Also Read: Virtual and interactive games speed up stroke recovery
For an eligible patient with an ischaemic stroke, clot-busting medication can help restore blood flow. Another option, mechanical thrombectomy, involves removing a clot from a major blood vessel. These treatments are not suitable for every patient; the decision depends on clinical assessment, brain imaging and the time since symptoms began.
Dr Alex said intravenous thrombolysis using medications such as alteplase or tenecteplase is generally considered within four and a half hours of symptom onset. Mechanical thrombectomy may be possible up to 24 hours after onset in selected patients who meet specific criteria.
“Time is one of the most important determinants of stroke outcome,” he said. “The longer the brain artery remains blocked, the greater the potential disability for the patient.”
Dr Thangiah described how patients often lose valuable time by first visiting a nearby clinic, and then going to a scanning centre before reaching a hospital equipped to provide stroke treatment.
“A significant amount of time is lost,” she said.
The challenge, therefore, is not simply whether medical facilities exist nearby. It is whether patients and their families recognise the symptoms, reach an appropriate hospital quickly and receive the necessary assessment and treatment without delay.
Dr Kumar said patients in smaller towns and rural areas may have to travel considerable distances, sometimes without reliable ambulance services. They may reach the nearest facility only to discover that it lacks the necessary diagnostic or treatment facilities.
“We must therefore strengthen the entire chain of survival from symptom recognition, ambulance services to hospital treatment and rehabilitation,” he said.
His recommendations included a clearly defined stroke-care pathway at every district hospital, designated stroke-ready hospitals, trained emergency personnel, tele-stroke support where appropriate, and reliable referral and transfer protocols.
“We should measure the success not merely by the number of hospitals established, but by how quickly patients receive the treatment and how many patients survive with less disability,” he said.
The word “survey” in the original response appears to be a transcription error; the intended meaning is likely survival with less disability. It should be confirmed with the doctor before publication rather than silently corrected inside a direct quotation.
Also Read: Kerala launches India’s first ‘Mission Stroke’ to combat stroke mortality, disability
The national comparison is striking, but the state-level figures show substantial variation in the recorded numbers of deaths attributed to cerebrovascular diseases and acute myocardial infarction.
Tamil Nadu recorded 9,040 deaths from cerebrovascular diseases, compared with 29,740 from acute myocardial infarction. West Bengal, by contrast, recorded 14,603 cerebrovascular disease deaths and 7,743 acute myocardial infarction deaths.
The figures also showed more recorded cerebrovascular disease deaths than acute myocardial infarction deaths in Keralam, Andhra Pradesh and Telangana. Keralam recorded 2,375 deaths from cerebrovascular diseases against 342 from acute myocardial infarction; Andhra Pradesh recorded 2,830 against 564, and Telangana 2,065 against 736.
These figures were drawn from medically certified deaths, not a complete count of all deaths in the country. The differences do not establish that stroke is more common than heart attacks in some states, or that residents face a higher individual risk of stroke there. Population age, risk factors, access to healthcare and the completeness and accuracy of death certification can all affect the recorded numbers.
Dr Amit Kulkarni, Director of Neurology and Clinical Lead of Stroke Services at Fortis Hospital, Bengaluru, cautioned against concluding the actual disease burden from the figures alone.
“Differences in population age, risk factors, access to healthcare and the reporting of causes of death may contribute to these patterns,” he told South First. “However, the reported figures alone cannot explain why the numbers differ between states. More information is needed before concluding the actual burden of either condition.”
Dr Kumar also stressed the importance of age structure and certification. States with older populations may record more heart-related deaths, making age-standardised mortality rates more useful than absolute numbers for comparisons.
He said the prevalence and control of hypertension, diabetes, tobacco use and other cardiovascular risk factors may also contribute to differences between states.
The report’s figures therefore provide a starting point, rather than a definitive ranking of states by stroke risk. They also reinforce the need to distinguish between the number of deaths recorded and the underlying burden of disease.
Also Read: How can monitoring blood pressure and diabetes help in preventing stroke?
For stroke patients, surviving the emergency is only one part of the journey. Depending on the location and extent of brain damage, survivors may need months of physiotherapy, speech and swallowing therapy, occupational therapy and cognitive rehabilitation.
Dr Thangiah said the public often has little awareness of the challenges that follow a stroke. Patients may lose their ability to speak, swallow normally, remember things or perform routine activities independently. Families, meanwhile, can face prolonged caregiving responsibilities.
She explained that rehabilitation can help other parts of the brain take on functions affected by the injury, a process known as neuroplasticity.
“But we have to train the other areas of the brain to do that particular activity,” she said. “How do we do that by means of a physiotherapy by neuro rehabilitation, swallow therapy, speech therapy by doing all those therapies we try to train then other the other cells to take up this activity and do it that’s what we call is neuroplasticity.”
Recovery varies from patient to patient, and rehabilitation does not guarantee a complete return to previous functioning. However, it can help improve independence and quality of life.
Dr Alex said rehabilitation includes both physical and cognitive support.
“The aim is not only survival but also the reduction of disability, the maintenance of functional independence, and the preservation of quality of life for these patients,” he said.
Access to rehabilitation is another challenge, particularly outside major cities. Dr Thangiah said physiotherapy, occupational therapy, speech therapy, and swallowing therapy are not easily available in many rural areas. Emotional support also matters, as patients may experience depression and families may struggle with the demands of long-term care.
The disability burden is an important part of the comparison with heart attacks. A death count captures only one outcome; it does not show how many people survive a stroke with disabilities, how long they need rehabilitation, or how much support their families must provide.
Neurologists said stroke prevention requires sustained attention to modifiable risk factors, particularly high blood pressure. Diabetes, high cholesterol, smoking, obesity, physical inactivity, unhealthy dietary habits and certain heart conditions can also raise risk.
Dr Alex highlighted atrial fibrillation, an irregular heart rhythm that can lead to clot formation in the heart and subsequently cause an ischaemic stroke.
Dr Kumar said prevention should be integrated into routine primary healthcare rather than addressed only after a stroke occurs.
“High blood pressure is one of the major modifiable risk factors for stroke, yet many people do not know that they have it and many who receive a diagnosis do not achieve sustained control,” he said.
He called for community-based screening, regular blood pressure monitoring, better adherence to treatment, diabetes management, tobacco cessation, healthier diets and regular physical activity.
Dr Kulkarni also emphasised the need to make stroke awareness a regular part of public-health communication, rather than limiting it to an annual awareness day.
“People should know that sudden weakness or speech difficulty requires the same sense of urgency,” he said.
For Dr Kumar, the message is straightforward: prevention, recognition and timely treatment must work together. He called for a sustained nationwide awareness campaign using local languages and reaching schools, workplaces, villages, community health workers and older adults.
The message, he said, should be to recognise symptoms, seek emergency help immediately and never wait to see whether they improve.
The challenge is not simply to make stroke more visible. It is to ensure that people recognise its warning signs, know where to seek emergency care and understand that treatment and rehabilitation can make a difference long after the initial event.
(Edited by Majnu Babu).
