- The most effective strategy for preventing paralysis secondary to ischemic stroke is blood pressure control.
- Elevated blood pressure is a major modifiable risk factor that contributes to both the occurrence and progression of ischemic stroke by promoting further vascular damage and reducing cerebral perfusion.
- Maintaining optimal blood pressure reduces the risk of recurrent stroke and limits the extent of ischemic injury, thereby preventing permanent neurological deficits such as paralysis.
- Other interventions like routine anticoagulants or corticosteroids are not universally recommended due to bleeding risks or lack of efficacy.
- Vitamin B12 supplementation does not have a direct role in acute stroke management or prevention of paralysis.

Reference: Davidson’s Principles and Practice of Medicine, 24th Edition, Chapter: Neurology, Page 724.