Sudden slurred speech and arm drift — stroke; CT excludes bleed; alteplase within 4.5 hours. Ischemic stroke (thrombus/embolus — AF, carotid: sudden focal deficit — FAST: face droop, arm drift, speech): non-contrast CT (rule out hemorrhage) → IV alteplase <4.5h → thrombectomy <24h for large-vessel occlusion — every minute 1.9M neurons lost. Hemorrhagic (hypertensive bleed — headache, vomiting, coma: control BP, reverse anticoagulation; evacuate if large/cerebellar). TIA (transient — ABCD2 scores 7-day risk; urgent — DAPT short-term, carotid imaging, echo). Secondary — antiplatelets, high-dose statin, BP/diabetes control, lifestyle. The clock is brain — FAST, scan, treat.