A 26-year-old man who thought he was fit and healthy suffered a devastating stroke after collapsing while walking his dogs in Manchester. Alex Karalius had transformed his health, lost almost three stone, and was training for the London Marathon when his life changed in minutes.
On June 23, Alex was walking his two dachshunds in Spinningfields, Manchester, when he suddenly became unwell. His balance went first, followed by his speech and vision, before he eventually lost consciousness.
Emergency Treatment and Uncertain Hours
Alex, who was born in Ormskirk and now lives in Salford, was rushed to Salford Royal, where doctors discovered he had suffered a large stroke on the right side of his brain and another affecting his brain stem. He required emergency clot-busting treatment and a mechanical thrombectomy, a procedure to remove a clot from a blood vessel supplying the brain.
He was unconscious for around seven hours. While Alex was unable to understand what was happening, his family were being prepared for the possibility that he might never wake up—and that, if he did, he could be left permanently paralysed. Alex remembers nothing of the hours that followed his collapse. He later learned that doctors had struggled to wake him after surgery and had warned his family that they did not know what would happen.
Doctors later told him he had arrived at hospital within a crucial window for the procedure. Had he arrived around half an hour later, he was told, too much brain tissue may have been lost for the surgery to be effective.
Early Warning Signs and Recovery
The severity of what had happened only became clear to Alex later. He had not initially even realised he had suffered two strokes and was stunned to learn just how serious his condition had been. Doctors had to prepare for the worst, but Alex's recovery surprised even those caring for him. The morning after his surgery, medical staff gathered around him to see whether he could speak. According to Alex, some were visibly shocked when he was able to respond.
"I was obviously asleep during some of the worst bits," he said. "It's a lot on the people near you as well. I was asleep during some of the worst bits, but it's the people around you who have to deal with it as well."
The strokes did not come completely without warning. In the two years before the attack, Alex had experienced several unexplained episodes, including collapsing at an Oasis concert in Manchester and later at Manchester Victoria station while travelling home from work in Leeds. He also suffered an episode at a work party which lasted long enough for him to be assessed by doctors hours later. It was eventually considered to have been a transient ischaemic attack, or TIA. Alex said he had repeatedly raised concerns with hospitals across the North West, but no cause was identified. "I'd been flying a flag for a long time that something wasn't quite right," he said.
Despite those incidents, Alex had never considered himself someone at risk of a major stroke. He had never smoked, says he had never taken drugs, and describes himself as someone who was not a big drinker. He had also been working hard on his fitness, losing almost three stone and training for the London Marathon. "I'd never thought that a stroke could happen to me at 26," he said. "I was in good shape as well, so for it to hit me was a massive shock."
Impact on Confidence and Relationships
At first, Alex struggled to walk and speak and experienced severe fatigue, dizziness, and anxiety. He also found himself dealing with emotions he could not always control, sometimes bursting into tears without warning. The physical recovery was only part of the battle. Alex, who describes himself as naturally talkative and sociable, said the stroke also stripped away much of his confidence. "I was quite talkative before it and it took a lot away from me," he said. "There was a lot of confidence that I lost. But I'm starting to rebuild that now."
He initially did not want to talk about what had happened and wanted to forget about the experience and move on. But he has since found speaking about it has helped him begin to rebuild his confidence. The experience has also left Alex dealing with the psychological aftermath, including anxiety and trauma. His partner Lucy became his main carer, helping with everyday tasks that Alex had previously taken for granted. Things as simple as putting on socks, walking the dogs, or going out alone suddenly became difficult or impossible.
For Lucy, the experience meant suddenly seeing the person who had always made her feel safe become the person who needed looking after. The couple have been together for almost seven years and have known each other for around 17 years. Alex said Lucy, along with his family and medical teams, has been crucial to his recovery. "She was the person that made me feel safe and suddenly, because it's a massive thing for her, she's thrown into this thing of, 'Can you help me put my socks on? Can you help me? I can't walk the dogs. I can't go anywhere,'" he said.
Ongoing Investigations and a Proposal in Yosemite
Alex is now working with neurophysiotherapists, occupational therapists, and psychologists as he continues to rebuild both his physical abilities and his confidence. He has a patent foramen ovale, or PFO—a hole between the chambers of the heart which is present in around one in four people. While it causes no problems for most people, doctors believe a blood clot may have travelled through the opening in Alex's heart before reaching his brain. The exact source of the clot remains unclear, but Alex is awaiting surgery to close the PFO and will remain on lifelong medication while doctors continue investigating what happened.
His ordeal did not end with his return home from hospital. While in the US, Alex experienced another episode which is still being investigated, with doctors identifying what he describes as a third, much smaller stroke on the opposite side of his brain. He continues to have regular scans and investigations as doctors try to establish exactly what caused the clots and assess his risk of another stroke.
Despite everything, one thing Alex refused to give up on was a trip to California that he and Lucy had planned long before his stroke. The couple had spent almost a year planning the trip, but after his strokes doctors initially told him there was no chance he would be able to fly just weeks later. Medical teams were divided over whether it was safe, but after further discussions Alex was eventually cleared to travel.
There was another reason the trip meant so much. Alex had secretly been planning to propose to Lucy before his stroke. He had bought the engagement ring in January, had it engraved with the names of their two dogs, and had arranged for a photographer to secretly capture the moment at Yosemite National Park. But the first 10 days of the trip were difficult. Alex was still suffering from severe dizziness, nausea, and fatigue and had been warned about the risks of travelling so soon after his strokes.
Then, at Lake Tenaya in Yosemite, everything changed. Alex spotted the photographer he had secretly arranged. Lucy was facing away and the photographer winked at him. In that moment, Alex realised he had actually made it there. "All this has happened against all the odds of what could have been," he said. "The only thing standing between me and doing that now was me going over and doing it."
So, despite still feeling dizzy and unsteady, Alex proposed. It was a moment he had feared he might never reach when he was lying in hospital just weeks earlier. "It was just such a relief," he said. "I just never thought it was going to happen."
Looking Ahead to Marriage and the Marathon
Now, as he continues his recovery, Alex is looking ahead to marriage, returning to work, and rebuilding his fitness. He estimates he is around 80 per cent back to how he was before the stroke, although busy environments can still leave him struggling with his speech and dizziness because some of his eye movement has not fully recovered. He has also been advised not to return to the gym for the time being. His ambition remains to run the London Marathon in 2027, this time raising money for the Stroke Association. Alex had applied for a place before his strokes, and his confirmation arrived just days after he returned home from hospital. He remembers looking at the message and wondering how he could possibly run a marathon after everything that had happened.
He hopes his experience can challenge the perception that strokes only happen to older people and show that recovery can look very different from what people might expect. "I think it's really important that people, especially young people, know that it can happen," Alex said. "I feel quite isolated with it. There aren't a lot of young people you can speak to who have been through the same thing."
For someone who was 26, fit, training for a marathon, and planning his future, the warning came without the certainty he thought he had about his own health. Now, after two major strokes, a third smaller stroke, months of rehabilitation, and a proposal he once feared he would never get to make, Alex is determined to keep moving forward.
