Why The First 72 Hours After A Stroke Are Crucial For Recovery And Saving Lives

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EVERY second counts when it comes to a stroke. For every minute that passes after the onset, approximately 1.9 million neurons are lost. Globally, stroke remains the second leading cause of death, with over 12.2 million new cases reported in 2019.
In Malaysia, the numbers are equally concerning, with 47,911 new stroke cases and nearly 20,000 deaths recorded that same year.
According to Sunway Medical Centre emergency medicine consultant Dr Aaron Lai Kuo Huo and consultant neurologist Dr Mohamad Imran Idris, the first 72 hours after a stroke are critical for recovery.
They highlight the importance of rapid intervention, careful monitoring, and a multidisciplinary approach to improving outcomes and reducing long-term disability.
Why every minute matters after a stroke
While public awareness campaigns focus on recognising stroke symptoms through the B.E. F.A.S.T. acronym, what happens after a patient reaches the hospital is equally crucial.
“The first 72 hours can determine whether a person recovers fully or faces long-term disability,” said Dr Lai.
“When a stroke strikes, the brain is deprived of oxygen, and damage starts immediately. Quick interventions, like clot-busting drugs or thrombectomy, can save lives and preserve brain function, but these must happen fast.”
Studies show that patients receiving thrombolytic therapy within the first 4.5 hours from the onset of stroke symptoms have a much higher chance of functional recovery. This “golden hour” dramatically improves the likelihood of a full recovery.
The importance of the first 72 hours
A multidisciplinary team ensures immediate and effective treatment once a stroke patient arrives at the hospital. The first 72 hours—often referred to as the “crucial window”—can mean the difference between life and death or between full recovery and permanent disability.
“In these 72 hours, we focus on preventing complications like secondary strokes or brain swelling. After treatments such as thrombolysis or thrombectomy, we closely monitor the patient, often repeating brain scans within the first 24 hours to check for bleeding or other complications,” said Dr Mohamad Imran.
“During this time, key health factors such as blood pressure, blood sugar, and hydration are stabilised, as they play a pivotal role in reducing brain damage. Early rehabilitation is also vital.
“The sooner we can begin therapy, usually within 48 to 72 hours, the better the patient’s chances of regaining mobility and independence.”
The urgency of immediate stroke care is underscored by success stories of patients who benefited from rapid treatment and care.
Dr Lai recalled treating a young man in his late twenties who suffered a stroke after a gym session.
“He arrived at the hospital within an hour of experiencing left-sided weakness and slurred speech. Thanks to quick recognition and a fast response, we administered clot-busting therapy within 40 minutes. He regained full function within days and was discharged without lasting damage,” he shared.
Harmful misconception about strokes
One harmful misconception is that a “mini stroke” or transient ischaemic attack (TIA), is not serious. Dr Mohamad Imran warned against this false sense of security.
“I try not to use the term ‘mini stroke’ because it downplays the severity. Even with a TIA, the risk of having a full-blown stroke is very high, particularly in the first 48 hours. It’s crucial to treat any stroke symptoms urgently,” he explained.
Dr Lai went on to highlight the risks associated with TIA: “Patients with a TIA must seek medical attention immediately, even if symptoms resolve quickly. Up to 1 in 5 patients with TIA will have a major stroke within the first 90 days, with half occurring in the first 48 hours,” he added.
Stroke rising among younger people
Strokes are increasingly affecting younger people in Malaysia, largely due to lifestyle factors like poor diet, obesity, smoking, and lack of physical activity. Studies have shown a 53.3% and 50.4% increase in stroke among men and women 35-39 years.
“We’re seeing more metabolic syndromes in younger people, and these are major contributors to strokes,” said Dr Lai who also noted that younger patients often fail to recognise early symptoms or delay seeking treatment, leading to worse outcomes.
A holistic and multidisciplinary approach to stroke recovery
Effective stroke care goes beyond immediate emergency interventions. A comprehensive, multidisciplinary approach is key to a patient’s recovery.
Teams of neurologists, physiotherapists, occupational therapists, and speech therapists work together to guide patients through recovery.
“Stroke patients benefit enormously from early rehabilitation. Whether regaining the ability to walk, swallow, or speak, starting therapy as soon as the patient is stable maximises their chances of regaining independence,” said Dr Mohamad Imran.
Family involvement also plays a critical role. Stroke survivors supported by loved ones throughout their recovery journey tend to experience better outcomes.
Dr Mohamad Imran shared, “Families are often guided on how to help their loved ones regain strength, manage medications, and cope with the emotional challenges of post-stroke recovery that could hinder their recovery journey.”
The first 72 hours after a stroke are crucial for shaping a patient’s future. With the rising prevalence of strokes in Malaysia and worldwide, awareness of early symptoms and the importance of post-stroke care is more critical than ever.
“It’s not just about saving lives, it’s about preserving the quality of life,” said Dr Mohamad Imran. ‒  Focus Malaysia

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