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A 26-year-old man thought he was fit and healthy before a devastating diagnosis after collapsing while walking his dogs. Alex Karalius had transformed his health and fitness, lost almost three stone and was training for the London Marathon when his life changed in a matter of minutes.
But on June 23, the 26-year-old was walking with his two dachshunds in Spinningfields, Manchester, when he suddenly fell ill. His balance went first, followed by his speech and vision, before he eventually lost consciousness.
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 chemotherapy and a mechanical thrombectomy, a procedure used to remove a clot from a blood vessel that supplies the brain.
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He was unconscious for about seven hours. While Alex couldn’t understand what was happening, his family was prepared for the possibility that he might never wake up—and that, if he did, he would be permanently paralyzed.
Alex remembers nothing of the hours that followed his collapse. He later learned that doctors had struggled to wake him up after the operation and warned his family that they did not know what was going to happen.
Doctors later told him he had arrived at the hospital in a crucial window for the procedure. When he arrived about half an hour later, he was told that too much brain tissue might have been lost for the operation to be effective.
The gravity of what happened only became clear to Alex later. He had not even realized at first that he had suffered two strokes and was amazed to learn how serious his condition was.
Doctors had to prepare for the worst, but Alex’s recovery surprised even those who cared for him. The morning after his surgery, medical staff gathered around him to see if he could speak. According to Alex, some were visibly shocked at how he could react.
“I was obviously sleeping in some of the worst bits,” he said. “It’s also a lot on the people close to you. I was asleep during some of the worst bits, but it’s the people around you who have to deal with it too.”
‘I never thought it could happen at 26’
The blows did not come 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 traveling home from work in Leeds. He also suffered an episode at a work party that lasted long enough for him to be evaluated by doctors hours later. It was eventually deemed a transient ischemic attack, or TIA.
Alex said he has repeatedly raised concerns with hospitals in the North West, but no cause has been identified. “I have been flying a flag for a long time that something is not quite right,” he said.
But despite those incidents, Alex had never considered himself one to risk a major blow. He had never smoked, said he had never taken drugs and described himself as someone who was not a heavy drinker. He also worked hard on his fitness, losing almost three stone and training for the London Marathon.
“I never thought a stroke could happen to me at 26,” he said. “I was in good shape as well, so for it to beat me was a massive shock.”
At first, Alex struggled to walk and talk and experienced severe fatigue, dizziness and anxiety. He also found himself dealing with emotions he couldn’t 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 took away a lot of his confidence. “I was quite boisterous before and it took a lot out of me,” he said. “It was a lot of confidence that I lost. But I’m starting to rebuild that now.”
At first he didn’t want to talk about what happened and wanted to forget the experience and move on. But he has since found that talking about it has helped him start to build his confidence.
The experience also left Alex with the psychological aftermath of what happened, including anxiety and trauma. His partner Lucy became his main carer, helping with daily 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, becoming the person she needed. The couple have been together for almost seven years and have known each other for around 17 years. Alex said that Lucy, along with his family and medical teams, was crucial to his recovery.
“She was the person who made me feel safe and suddenly, because it’s a massive thing for her, she threw herself into this thing: ‘Can you help me pick up my socks?’ Can you help me? I can’t go with the dogs.
Alex’s assignment didn’t end when he got home
Alex now works with neurophysiologists, occupational therapists and psychologists as he continues to build his physical skills and confidence.
He has a patent foramen ovale, or PFO – a hole between the chambers of the heart that is present in about one in four people. Although it doesn’t cause problems for most people, doctors believe a blood clot traveled 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 remains on life-long medication while doctors continue to investigate what happened.
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His assignment did not end with his return home from the hospital. While in the US, Alex suffered another episode, which is still being investigated, with doctors identifying what he describes as a third, much smaller stroke on the other side of his brain. He continues to have regular scans and investigations as doctors try to determine exactly what caused the lump and assess his risk of another stroke.
Despite everything, one thing Alex refused to give up was a trip to California that he and Lucy had planned long before his stroke. The couple had been planning the trip for almost a year, 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 about 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 planned to propose to Lucy before the blow. He had bought the engagement ring in January, engraved it with the names of their two dogs and arranged for a photographer to secretly capture the moment in Yosemite National Park.
But the first 10 days of the trip were difficult. Alex still suffered from severe dizziness, nausea and fatigue and was warned about the risks of traveling so soon after his strokes.
Then, at Lake Tenaya in Yosemite, everything changed. Alex saw the photographer he had secretly arranged. Lucy stood away and the photographer snapped at him. In that moment, Alex realized that he really made it there.
“All this happened against all odds of what could have been,” he said. “The only thing standing between me and doing it now was for me to go over and do it.”
So, despite still being dizzy and unsteady, Alex proposed. It was a moment he had feared he would never be able to achieve when he was lying in the hospital just weeks before. “It was just such a relief,” he said. “I just never thought it would happen.”
“Young people need to know that it can happen”
Now, as he continues his recovery, Alex is looking forward to marriage, returning to work and building up his fitness. He estimates that he is about 80 percent back to where he was before the stroke, although busy environments can still cause him to struggle with his speech and dizziness, as some of his eye movement has not fully recovered.
He was also advised not to go back to the gym for the time being. His ambition remains to run the London Marathon in 2027, this time to raise money for the Stroke Association. Alex had applied for a place before his stroke, and his confirmation came just days after he returned from the 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 challenges the perception that strokes only happen to the elderly and shows that recovery looks very different from what people expect.
“I think it’s really important that people, especially young people, know that it can happen,” Alex said. “I feel very isolated with it. There aren’t many young people you can talk to who have been through the same thing.”
For someone who was 26, fit, trained for a marathon and planning his future, the warning came without the security he thought about his own health. Now, after two major strokes, a third minor stroke, months of rehabilitation and a proposal he once feared he would never make, Alex is determined to keep going.
