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Stroke

A stroke is when the blood supply to your brain is cut off. It happens suddenly and can cause immediate loss of feeling and weakness, usually on one side of your body. A stroke can also affect your speech, vision, memory and emotions.

Stroke is the third most common cause of death in the UK and the leading cause of severe disability. It's a medical emergency, so it’s vital that you can recognise the symptoms quickly and get treatment in hospital as soon as possible.

If your brain doesn’t get enough blood to provide the oxygen and nutrients it needs, your brain cells will become damaged or die. This is what happens if you have a stroke.

Every year in the UK, around 150,000 people have a stroke. Most people who have a stroke are over 65, but it can happen at any age.

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  • Types Types of stroke

    • Ischaemic stroke happens when the blood supply to part of your brain is blocked by a blood clot or a piece of fatty material. This is the most common type of stroke.
    • Haemorrhagic stroke is caused by bleeding inside your brain. This can happen when a blood vessel bursts inside your brain or, more rarely, on the surface of your brain.
    • Transient ischaemic attack (TIA or ‘mini-stroke’) is when the blood supply to your brain is interrupted for a short time. The symptoms are only temporary – they won’t last for more than 24 hours – but it’s still important to get treatment.
    • Stroke from cervical artery dissection is caused when the lining of one of the arteries in your neck is torn. This can restrict the blood supply to your brain.

    This topic gives a general overview of stroke.

  • Symptoms Symptoms of stroke

    The symptoms of a stroke vary depending on what type you have and the part of your brain it affects. The symptoms usually come on suddenly, within seconds or minutes.

    A good way to recognise if you or someone you’re with has had a stroke is to use the ‘FAST’ test.

    • Face. If you have had a stroke, you may have facial weakness and won’t be able to smile. Your face may also look odd, for example, your mouth or eye may droop down on one side.
    • Arm. You won’t be able to raise both arms and hold them there.
    • Speech. You may have slurred speech or find it difficult to remember the names of common objects.
    • Time to call 999. If you or anyone else has one or more of these symptoms, it’s vital to call for emergency help straight away.

    For more information about FAST, see our FAQs.

    Other symptoms of stroke may include:

    • weakness or numbness on one side of your body
    • feeling confused or having problems with words
    • feeling dizzy or unsteady
    • problems with your sight
    • a severe headache

    Although headaches can be a symptom of stroke, it’s important to remember that they are common and most aren’t caused by stroke.

  • Diagnosis Diagnosis of stroke

    You’ll have a number of tests in hospital. These will aim to find out what type of stroke you had and which part of your brain has been affected. This information will help your doctor to plan your treatment.

    Your blood pressure will be measured and you’ll have an electrocardiogram (ECG) to record the rhythm and electrical activity of your heart. You may then have blood tests to measure your cholesterol and blood sugar levels.

    You’ll also have a brain scan (for example, a CT or MRI) as soon as possible. This will help to find out if your stroke happened because of a bleed or a blockage.

  • Treatment Treatment of stroke

    You may be treated in a specialist stroke unit at hospital.

    If you can’t swallow, you’ll be given fluid through a drip in your arm to stop you becoming dehydrated. And you may have a tube in your nose to give you the nutrients and medicines you need. You may also be given oxygen through a face mask to help you breathe.

    As soon as you can, you’ll be helped to sit up and encouraged to move around. If you can’t move, your healthcare team will regularly help you to turn in your bed. This will reduce your risk of getting bed sores and deep vein thrombosis (DVT). You may also be given a mechanical pump to use on your feet and legs. This is called an intermittent compression device. The pump automatically squeezes your feet and lower legs to help keep your blood moving and circulating well.

    The length of time people need to stay in hospital after a stroke varies. It will depend on how severely you have been affected – ask your doctor when you can expect to go home.

    Medicines

    Any medicines you need to take will depend on the type of stroke you had. For example, if you had an ischaemic stroke, you may be given a medicine called alteplase. This breaks up blood clots and restores blood flow to your brain. You may need to take medicines such as aspirin or clopidogrel to prevent further blood clots. On the other hand, if you had a haemorrhagic stroke, you won’t be given these medicines as they can make bleeding worse.

    You’re likely to need to take medicines to control your blood pressure and possibly also to reduce the cholesterol in your blood.

    Surgery

    Your doctor may recommend that you have surgery. This will depend on the type of stroke you had so won’t be an option for everyone. You may have an operation to:

    • remove fatty deposits from the carotid artery that takes blood to your brain (carotid endarterectomy)
    • drain blood from your brain
    • relieve swelling in your brain

    Rehabilitation

    A stroke can damage your brain so you may need to relearn how to do certain things, or adapt how you do them. This is known as stroke rehabilitation.

    It can be difficult to predict how well you’ll recover from a stroke. You may make most of your recovery in the early weeks and months afterwards. But it’s possible that you’ll carry on improving for long after this time.

    A multidisciplinary team of health professionals will work out a rehabilitation plan that’s designed around your particular needs. The team may include physiotherapists, speech and language therapists, occupational therapists, dietitians, ophthalmologists and psychologists, as well as doctors and nurses. Your rehabilitation will aim to help you get back to your usual activities as far as possible, and to stay as independent as you can.

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  • Causes Causes of stroke

    A stroke happens when the blood supply to your brain is cut off. This can be caused by a blood clot in an artery in your brain (ischaemic stroke) or the blood vessel bursting (haemorrhagic stroke). Other things that can increase your risk of having a stroke include:

    • smoking
    • high blood pressure
    • high cholesterol
    • not doing enough exercise
    • being overweight or obese
    • regularly drinking too much alcohol
    • using illegal drugs, such as cocaine
    • getting older
    • diabetes
    • a family history of stroke or heart disease
    • an abnormal heartbeat (often a condition known as atrial fibrillation)
    • conditions that affect how your blood clots, such as haemophilia
  • Complications Complications of stroke

    Some strokes can be quite mild and the effects only temporary, whereas others may be more severe and cause lasting damage. Some can even be fatal.

    Complications of a stroke may include:

    • weakness or paralysis
    • lack of awareness of one side of your body (usually the left-hand side)
    • loss of sensation on one side of your body
    • difficulty swallowing
    • having trouble sleeping
    • problems with your speech, reading and writing
    • sight problems, such as double vision or partial blindness
    • problems with your memory and concentration
    • difficulty controlling your bladder and bowel movements (incontinence or constipation)
    • problems having sex because of both emotional and physical problems
    • changes in personality and behaviour
    • anxiety or depression
    • pain, often in your shoulder
    • seizures (fits)

    If you can’t move because of stroke, you could be at risk of:

    • bed sores (pressure ulcers)
    • deep vein thrombosis (DVT) – this is a blood clot in a vein in your leg
    • pneumonia
    • contractures (this is when muscles and tendons, particularly in your hands, feet, arms or legs, become tight, making it hard to straighten them)

    Stroke affects everyone differently. Some people may find complications improve gradually over time, whereas for others they may not.

  • Prevention Prevention of stroke

    About one in four people who recover from a stroke will have another one within five years. You can take steps to lower your risk of stroke by making changes to your lifestyle. We’ve put together some suggestions here.

    • Stop smoking. This can greatly reduce your risk of stroke, no matter how old you are or how long you’ve been smoking.
    • Don’t exceed the recommended alcohol limits. By cutting down the amount of alcohol you drink, you can reduce your blood pressure, which in turn lowers your risk of stroke.
    • Improve your diet. Reducing how much cholesterol and salt you eat can lower your risk of stroke.
    • Increase the amount of physical activity that you do. Aim to do 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more.
  • FAQs FAQs

    After a stroke, will I recover and be able to get back to my life as it was before?

    Answer

    Every stroke is different, which means that everyone’s recovery is different. A rehabilitation plan can help you to regain as much of your independence as possible.

    Explanation

    How well people recover after a stroke is very variable and there are no hard-and-fast rules. It depends on many things, including which part of your brain was affected and what kind of stroke you had.

    You might get back much of the movement and abilities that you lost as a result of stroke within the first few weeks or months. But this process can take much longer. You may never be able to do everything that you used to before your stroke.

    Your rehabilitation programme put together by the stroke team at the hospital will be designed to help you regain as much independence as possible. This may involve relearning skills that have been affected by stroke and finding ways to adapt.

    If I think someone is having a stroke, what should I do?

    Answer

    A stroke is a medical emergency so if you think that someone is having a stroke, you need to act quickly. Getting help as soon as possible can help to ensure that the person has the best chance of making a full recovery.

    Explanation

    If you think someone is having a stroke, call for an ambulance straight away. To help you recognise the symptoms of stroke, use the ‘FAST’ test, which stands for the following.

    • Facial weakness. Can the person smile? Also look at their face – has their mouth or eye drooped?
    • Arm weakness. Can they raise both arms?
    • Speech problems. Can the person speak ok and can they understand you?
    • Time to call 999. If the person has one or more of these symptoms, call for an ambulance straight away.

    The right treatment early on helps to prevent stroke from getting any worse and more brain cells being damaged. For every minute that a stroke goes untreated, your brain loses almost two million of its nerve cells, which are vital for your body to function properly.

    What can I do to help my recovery after a stroke?

    Answer

    There are a number of things you can do to help your recovery. Although it’s a good idea to set goals for yourself, it’s important to be realistic at the same time.

    Explanation

    Here are some suggestions that may help to make your recovery more manageable.

    • Think positively and focus on what you want to achieve.
    • Practise the exercises and tasks that you have been given, but don't overdo it – some days will be easier than others.
    • If you’re not sure why you’ve been asked to do certain exercises and tasks, ask. Understanding this may help you to stay motivated.
    • Keep in mind that your recovery may be gradual, so don’t be put off if it feels like you’re making slow progress.
    • Get help when you need it but try to do as much as you can for yourself. Some tasks may seem as though they are taking forever, but the more you can do on your own, the more independent you will become.
    • Be realistic and specific about your goals.

    Why does a stroke usually affect only one side of your body?

    Answer

    Each side of your brain controls the opposite side of your body. So damage to an area in your brain usually affects only the corresponding side of your body.

    Explanation

    For the most part, the right-hand side of your brain controls the left side of your body. The left-hand side of your brain controls the right side of your body. This means that the area of your body affected by the stroke will depend on where in your brain the blood supply has been interrupted. If a stroke affects the blood supply to the left-hand side of your brain, this will cause symptoms on the right side of your body.

    Although stroke commonly results in symptoms on just one side of the body, it’s possible for both sides to be affected. This can happen if the stroke occurs in your brainstem (at the base of your brain).

    Can I drive after having a stroke?

    Answer

    You won’t be allowed to drive for a month after you have had a stroke. After this time, you’ll need to speak to your doctor about whether or not it’s safe for you to start driving again.

    Explanation

    Having a stroke can affect your vision, coordination, concentration and the way that you move so it may not be safe for you to drive. You won’t be allowed to drive for one month after you’ve had a stroke or a transient ischaemic attack (TIA). After this time, you may be able to start driving again if your doctor believes your symptoms have improved enough for it to be safe.

    If your symptoms have lasted for over a month, your doctor may decide that it’s still unsafe for you to drive. You will need to inform the Driver and Vehicle Licensing Agency (DVLA). The DVLA will make a final decision as to whether or not it’s safe for you to start driving again. You’ll usually be asked to fill in a questionnaire and your doctor may be asked for further information about your condition.

    If you’re not fit to drive and you carry on doing so and don’t notify the DVLA, you risk getting a fine. You might also have your licence taken away as you will be risking the lives of others.

    The DVLA may take several months to make a decision. If they decide that it’s unsafe for you to drive, it doesn’t mean you won’t ever be able to drive again. If your condition improves, you can re-apply for your licence, but don’t begin driving again until your licence has been re-issued.

    You must also always tell your insurance company about your condition and let them know of the decision that the DVLA has made.

  • Resources Resources

    Further information

    Sources

    • NINDS stroke information page. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov, published 14 October 2014
    • National clinical guideline for stroke. Royal College of Physicians. www.rcplondon.ac.uk, published September 2012
    • Cerebrovascular events. PatientPlus. www.patient.co.uk/patientplus.asp, published 16 May 2012
    • Overview of stroke. BMJ Best Practice. www.bestpractice.bmj.com, published 23 May 2013
    • Stroke and TIA. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2013
    • Ischemic stroke. Medscape. www.emedicine.medscape.com, published 10 September 2014
    • Ischemic stroke. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Hemorrhagic stroke. Medscape. www.emedicine.medscape.com, published 6 October 2014
    • Stroke: diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). National Institute for Health and Care Excellence (NICE), July 2008. www.nice.org.uk
    • Haemorrhagic stroke. BMJ Best Practice. www.bestpractice.bmj.com, published 31 October 2014
    • Ischaemic stroke. BMJ Best Practice. www.bestpractice.bmj.com, published 24 October 2014
    • Headache. PatientPlus. www.patient.co.uk/patientplus.asp, published 5 November 2012
    • Stroke rehabilitation. National Institute for Health and Care Excellence (NICE), June 2013. www.nice.org.uk
    • Alteplase for treating acute ischaemic stroke (review of technology appraisal guidance 122). National Institute for Health and Care Excellence (NICE), September 2012. www.nice.org.uk
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 18 November 2014
    • Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events. National Institute for Health and Care Excellence (NICE), December 2010. www.nice.org.uk
    • Hypertension. Medscape. www.emedicine.medscape.com, published 30 September 2014
    • Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42(2):517–84. doi:10.1161/STR.0b013e3181fcb238
    • Why quit smoking? American Heart Association. www.heart.org, published 30 May 2014
    • National stroke strategy. Department of Health. www.gov.uk, published 5 December 2007
    • Hope. A stroke recovery guide. National Stroke Association. www.stroke.org, published 2010
    • Brain anatomy. Medscape. www.emedicine.medscape.com, published 15 February 2013
    • Effects of stroke. American Stroke Association. www.strokeassociation.org, published 23 October 2012
    • Stroke and driving. Driver and Vehicle Licensing Agency. www.gov.uk, accessed 12 November 2014
    • Car or motorcycle drivers who have had a stroke or transient ischaemic attacks (TIA). Driver and Vehicle Licensing Agency. www.gov.uk, published September 2014
    • Driving after stroke. Stroke Association. www.stroke.org.uk, published September 2012
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