Stroke, often dubbed a "brain attack," is one of the fastest-rising neurological emergencies today hence, World Stroke Day on October 29 each year urges people to recognise the early signs of a stroke and act within the golden window of 4.5 hours, when lifesaving treatments are most effective. A stroke can strike anyone, anytime and every minute of delay costs nearly 20 lakh brain cells. World Stroke Day 2025 campaign's message is clear: know the warning signs -- BEFAST (Balance loss, Eye vision loss, Face drooping, Arm weakness, Speech difficulty and Time to call emergency services) -- and respond immediately. In an interview with the Times of India, Dr Pooja Anand, Consultant - Neurology at Paras Health in Gurugram, shared, "Stroke is one of the fastest-rising neurological emergencies in India and emerging evidence shows that air pollution is a silent but significant contributor." When we think of air pollution, we picture smoggy skylines, coughing fits and watery eyes but there is a far more dangerous consequence unfolding quietly inside our bodies and one that is claiming lives and leaving millions disabled every year. Doctors now warn that air pollution is not just an environmental issue; it is a neurological emergency.Fine particles such as PM 2.5 are so tiny, they can bypass the lungs' defences, enter the bloodstream, inflame blood vessels and thicken or block them. This can trigger a stroke, even in people without traditional risk factors like hypertension or diabetes. A 2024 BMC Public Health study reported that nearly two million stroke-related deaths globally were linked to air pollution. Meanwhile, The Lancet Neurology found that one in four stroke deaths in low- and middle-income countries, including India, can be attributed to polluted air.The danger is no longer confined to the elderly as younger adults in urban areas are increasingly falling victim. It is a warning sign that experts say we can no longer afford to ignore.Stroke incidence in India has soared dramatically over the past three decades, with new cases increasing from 650,000 in 1990 to over 1.25 million in 2021 -- a 51% jump, according to studies published in Lancet Neurology and Indian medical journals. As per a comprehensive study using Global Burden of Disease 2021 data, the cumulative stroke incidence is estimated between 105 and 152 per 100,000 persons annually, higher than in many high-income countries. Alarmingly, around 20-30% of strokes happen in adults under 50, highlighting a shift towards younger populations at risk. Stroke is the leading cause of death and disability in India, with 50% of survivors left with permanent impairments."Brain stroke occurs in one in four adults during their lifetime, and often happens without warning," explained Dr P Vijaya, Senior Neurologist and President at Indian Stroke Association (ISA). It is one of India's leading causes of death and disability, with 50% of survivors left permanently disabled. A stroke, often described as a "brain attack", occurs when blood flow to part of the brain is interrupted due to a blockage (ischemic stroke) or bleeding (haemorrhagic stroke). What makes it deadly is time as brain cells begin to die within minutes.Once a stroke begins, 2 million neurons die every minute. That is why ISA's theme this year is "Brain Stroke: Time to Act" and it emphasizes urgency. If a person reaches a stroke-ready hospital within 4.5 hours, doctors can administer a clot-busting drug (IV thrombolytic therapy) that can save lives and prevent disability."Unfortunately, less than 1% of stroke patients in India receive this treatment because they arrive too late," noted Dr Vijaya.In severe cases, patients may also require Mechanical Thrombectomy, an advanced procedure to remove larger clots but this is possible only within that narrow time window.Stroke symptoms can be sudden and frightening: loss of balance, vision problems, face drooping, arm weakness, speech difficulty. Recognising symptoms quickly can mean the difference between life and death. Use the BEFAST acronym:If any of these appear, rush to the nearest stroke center immediately. Early detection within the 'golden hour' can significantly improve recovery outcomes.Stroke prevention begins long before an emergency. According to Dr Anand, "Early detection is key: sudden weakness on one side of the body, slurred speech, facial drooping, or loss of balance are red flags that demand immediate medical attention within the 'golden hour', when timely treatment can save lives and reduce disability."She added, "Preventive measures go hand in hand. Controlling blood pressure, diabetes, and cholesterol, avoiding smoking, maintaining an active lifestyle and reducing exposure to polluted air can dramatically lower stroke risk. Clean air is not just an environmental demand; it's a public health necessity and a powerful stroke-prevention strategy."While genetic and health factors like hypertension, diabetes, high cholesterol, smoking and atrial fibrillation elevate stroke risk, environmental risk from air pollution adds another dimension. According to research published in BMC Public Health (2024) and The Lancet Neurology, millions of global stroke deaths can be attributed to polluted air, particularly fine particulate matter PM2.5.Simple steps like checking daily Air Quality Index (AQI) levels, using air purifiers indoors, avoiding outdoor exercise during high pollution hours and eating antioxidant-rich foods (like berries, nuts, and leafy greens) can help counteract inflammation triggered by toxins in the air.A stroke can happen to anyone at any time but awareness, quick action and preventive care can dramatically lower risk.As both neurologists emphasize, time truly is brain. The faster you act, the more of yourself you can save. In the long run, protecting the brain starts with protecting the air we breathe because in every puff of polluted air, the clock on our neurons is quietly ticking.Stroke is no longer a disease only associated with old age; it can affect young adults and children too, driven by lifestyle changes and environmental hazards like air pollution. Both Dr Anand and Dr Vijaya underline that every minute counts in stroke management where early recognition and swift action can save millions of lives and prevent disability. Clean air is more than an environmental goal, it is an essential public health measure and a critical stroke prevention strategy in India's fight against this silent killer.Note: The information provided in this article is for educational purposes only and is not intended as medical advice. Always consult with a healthcare professional before starting any new medication or treatment.