trokes "come like the wind" and are very hard to prevent, but there are warning signs. Once family members discover that a loved one has grown suddenly numb and lacks strength, has impaired vision, feels dizzy, speaks unclearly, has a lopsided face or crooked mouth, or has even fallen deeply unconscious, then the chances are as high as 70% that their loved one has had a stroke.

At these moments, time is of the essence, and the first three hours after the stroke hits are key. Why three hours?

"People have 100 quadrillion brain cells," says Yin Jiu-haw of Cheng Hsin General Hospital. "When an ischemic stroke occurs, there is often a central area of the brain that is damaged because of a lack of blood. If those cells go without blood for more than 10 minutes, they will die and be impossible to recover. Because of the disruption to the metabolism, surrounding cells will shut down, but they can recover with treatment."Yin explains that the "three golden hours" refers to the period during which the surrounding cells can be saved. If thrombolytic agents are given within three hours to dissolve blood clots and restore circulation, a near 100% recovery is possible.

Yin stresses that if more than four and a half hours pass before the patient reaches the hospital, the same treatment will be much less effective. And after six hours, the use of thrombolytic agents isn't recommended. "That's because brain cells are tricky and fragile. Initially, they lacked blood. But if the blood flow were suddenly restored, the cells might not be able to handle so great a stimulation, and the brain might start hemorrhaging."

According to the Department of Health, only about 3.5% of patients in Taiwan with strokes caused by an acute lack of blood to the brain get thrombolytic agents within three hours. That compares to 5% in Japan and 6% in the United States.

The figure is so low because family members lack sufficient understanding. They mistakenly believe that the states of numbness or incapacity will soon improve or pass, and they don't immediately bring their loved one to the hospital. What's more, even if the victim is brought to the hospital, the emergency room often doesn't immediately ask neurologists, radiologists and physical therapists to consult on a diagnosis, thus delaying treatment. And finally, doctors take too long to examine patients, wasting precious time.

With this in mind, 40 medical centers located all over Taiwan have in recent years integrated medical resources to establish "stroke centers" that can provide treatment within that small window of time. Take the following case at National Cheng Kung University Hospital in Tainan. In 2009 a middle-aged man suddenly couldn't move the limbs on the right side of his body, had blurry vision and fell into a daze. His workmates urgently brought him to the hospital. Within 50 minutes the stroke team had performed a neurological assessment, conducting a CT scan and other tests. Then, after obtaining the consent of family members, they injected thrombolytic agents. Within 20 minutes the patient had markedly better vision and fuller consciousness. He then spent 24 hours in the intensive care ward before it was ascertained that his brain had suffered no hemorrhaging and he was transferred to a regular ward. A few days later he was released from the hospital able to perform all functions of daily living, with only a slight impairment of vision.

The methods employed for treating hemorrhagic strokes vary depending on the amount and location of the hemorrhaging. If the amount of blood is low, symptoms are mild, and the patient is alert, doctors usually take only conservative measures. But if the hemorrhaging is occurring somewhere extremely important, such as the subarachnoid space in the brainstem (for which the rate of death is over 30%), or the amount of blood is large and is already putting the brain under great pressure, then it is necessary to perform surgery or remove blood clots. In those cases, serious paralysis usually results, and it is necessary to put a lot of time and effort into physical therapy.

"If I could swallow the saliva that is continually dripping into my mouth, I would be the happiest man in the world," wrote Jean-Dominique Bauby, the author of The Diving Bell and the Butterfly. When the Taiwanese actor Zhao Shun had a stroke, he couldn't swallow a single cubic centimeter of water for one month. When he attempted drinking, he'd choke, so he had to be fed through a tube in his nostril. It was very painful.

But unlike elderly stroke victims, who typically endure slow recoveries, the younger the victim, the more plastic and resilient her brain.

In 1996, Jill Taylor, a 37-year-old Harvard University neurologist, experienced slight hemorrhaging in the blood vessels of the left temporal lobe. That in turn led to loss of language and immobility on the right side of her body. Within two weeks Taylor had undergone brain surgery. Then she began an active regime of physical therapy.

After her stroke, she found it very difficult even to turn over in bed. She had to split that movement into a series of many slow steps. She also couldn't speak a complete sentence, and didn't know how much one plus one was. For her daily living, she was completely reliant on her mother. As a neurologist, she became her own test subject, researching the difficulties she was experiencing as a result of a lacking full brain function over the course of her recovery. It took eight years before she regained all of the functions she had lost and could return to her post. In 2006 she published a book, My Stroke of Insight. Her case can be described as a model of recovery for young stroke victims.

Strokes have a high rate of recurrence, with an estimated one in 10 victims having a second stroke within a year. More than 30% have a second stroke within five years, and the aftereffects are typically more severe than the first time around.

As a reminder to patients and their families, Hu Han-hwa, director of the Neurological Institute at Taipei Veterans General Hospital and director general of the Taiwan Stroke Society, has proposed a "never twice" principle, meaning that no person should ever have a second stroke and no family should ever have a second stroke victim. As long as one takes one's medicine (including those to reduce the "three highs"), eats moderately, refrains from smoking, and gets exercise, one can keep the threat of a stroke at bay.