The director of the stroke program at Marcus Neuroscience Institute discussed delays in calling 911 after stroke onset, gaps in awareness of atypical symptoms, and how to reach underserved populations.
Today marks World Stroke Day, observed annually on October 29 to raise awareness of stroke prevention, recognition, and treatment worldwide.1 The 2026 observance also marks 20 years of the World Stroke Organization’s World Stroke Campaign, which this year continues to focus on recognizing stroke symptoms and the need to act FAST in seeking emergency medical care.2,3
Every minute of an untreated large-vessel occlusion costs an estimated 1.9 million neurons,4 and despite advances in acute treatment, outcomes depend on how quickly patients reach care. According to stroke expert
In recognition of World Stroke Day, NeurologyLive® spoke with Snelling about where gaps in stroke awareness persist among both the public and clinicians, and how those gaps translate to outcomes. He also addressed how campaigns such as BE FAST have shaped time to treatment, and which populations remain most underserved. In addition, he discussed the role neurologists and advanced practice providers (APPs) can play in community education, and the core message he hopes clinicians carry back to their patients and institutions.
Brian Snelling, MD: The biggest gap is still time. Many people recognize the classic signs of stroke but don't act on them right away. They wait to see if it passes, take a nap, or call a family member instead of 911. Every minute of an untreated large-vessel stroke costs roughly 1.9 million neurons,4 so that hesitation directly affects whether someone walks out of the hospital independent or not.
A second gap is atypical presentations. Sudden dizziness, loss of balance, or vision loss can signal a posterior circulation stroke, and patients and clinicians alike often attribute them to something benign. Young patients and women are also more likely to be dismissed.
Finally, many people don't realize how much treatment has advanced. Thrombectomy can now help selected patients up to 24 hours after onset.5 When people believe "nothing can be done," they don't come in.
They're essential, and so is the whole care team. Every clinic visit with a patient who has hypertension, atrial fibrillation, diabetes, or a prior transient ischemic attack (TIA) is a chance to teach stroke recognition. APPs often have more time with patients and families than physicians do, which makes them some of our most effective educators.
The most important points to teach are simple: know the signs, note the time symptoms started, and call 911 rather than driving. Emergency medical services (EMS) can begin assessment, alert the stroke team, and route the patient to a center that can perform thrombectomy. Clinicians should also teach family members, because the patient is often not the one who recognizes the stroke.
BE FAST adds Balance and Eyes to the original FAST acronym, which helps capture posterior circulation strokes that FAST alone can miss. It has given the public and EMS a shared, memorable language, and it fits into a broader system of improvements: prehospital stroke scales, EMS prenotification, and faster door-to-needle and door-to-groin times.
Where we still fall short is the interval before anyone calls for help. Hospital systems have become very fast once the patient arrives, but awareness campaigns haven't fully closed the gap between symptom onset and the 911 call. Our messaging needs to emphasize action as well as recognition: don't wait, don't drive, call now. Even if symptoms improve, that is still an emergency.
Black and Hispanic Americans carry a disproportionate stroke burden and tend to have strokes at younger ages. Rural patients face long distances to comprehensive stroke centers. Non-English speakers, older adults living alone, and younger adults who don't think stroke can happen to them are also at risk of delayed care.
Reaching these groups means meeting people where they are. That includes education in multiple languages, partnerships with faith communities and local organizations, and blood pressure screening outside the hospital. Hypertension remains the single most important modifiable risk factor, and it is often undertreated in the communities at highest risk. At the system level, telestroke networks and efficient transfer agreements help ensure geography doesn't determine outcome.
Most strokes are preventable, and many strokes we treat today are far more survivable and recoverable than they were even 10 years ago. Both halves of that message matter.
For patients, that means aggressively controlling blood pressure, treating atrial fibrillation, addressing diabetes and smoking, and taking TIAs seriously as warning signs. For institutions, it means building systems in which every minute is accounted for, from the 911 call through reperfusion.
Above all, I'd want every clinician to leave patients with one instruction: if you notice the signs, note the time and call 911 immediately. Treatment works best when it starts early.
Transcript edited for clarity.
