Stroke

Published by Bupa's Health Information Team, February 2011.

This factsheet is for people who have had a stroke, or who would like information about it.

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

About stroke

A stroke happens when the blood supply to your brain is cut off. If your brain doesn't get enough blood to provide the oxygen and nutrients it needs, your brain cells will become damaged or die.

Every year in the UK, around 110,000 people have a stroke. It's the third most common cause of death in the UK, and also the leading cause of severe disability.

Most people who have a stroke are over 65, but many are younger than this. Anyone can have a stroke, including babies and children.

A stroke is a medical emergency, so recognising the symptoms quickly and getting early treatment in hospital is important.

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.
• 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 a stroke in which the symptoms are only temporary. TIAs happen when the blood supply to your brain is interrupted for a short time.
• Stroke from cervical artery dissection is caused when the lining in one of the arteries in your neck is torn, restricting the blood supply to your brain.

This factsheet gives a general overview of stroke.

Symptoms of stroke

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

A good way to recognise if someone has had a stroke is to use the ‘face–arm–speech–time to call 999’ test (abbreviated to FAST). This involves checking for any one of the three main symptoms of stroke – facial weakness, arm weakness or speech problems. If you notice that someone has any one of these symptoms, you should call for emergency help straight away.

Other common symptoms of stroke may include:

• sudden loss of sight in one or both eyes, or blurred vision
• confusion or difficulty understanding
• loss of balance or coordination
• severe headache

Although headaches are a symptom of stroke, it's important to realise that they are common and most headaches aren't caused by stroke.

Complications of stroke

Some strokes may be quite mild and the effects only temporary, whereas others may be more severe and cause lasting damage. Complications of stroke include:

• weakness or paralysis, usually on one side of your body
• lack of awareness of one side of your body (usually the left side)
• loss of sensation on one side of your body
• difficulty swallowing
• extreme tiredness and sleep problems
• problems with speech, reading and writing
• problems with vision – for example, double vision or partial blindness
• memory and concentration difficulties
• difficulty controlling your bladder and bowel movements (incontinence), or constipation
• behavioural changes

Problems such as anxiety, depression and seizures (fits) can often improve as you recover.

If you are unable to move because of stroke, you could be at risk of:

• bed sores (pressure ulcers)
• deep vein thrombosis (DVT)
• pneumonia
• contractures (altered position of your hands, feet, arms or legs because of muscle tightness)

Causes of stroke

A stroke happens when the blood supply to your brain is cut off. This can be by a blood clot blocking an artery in your brain (ischaemic stroke) or a blood vessel bursting in your brain (haemorrhagic stroke). A stroke can also happen after an injury to an artery in your neck. This is called cervical artery dissection.

Risk factors for stroke include:

• older age
• smoking
• high blood pressure
• high cholesterol
• not being very active
• overweight and obesity
• diabetes
• a family history of stroke or heart disease
• abnormal heart beat (often a condition known as atrial fibrillation)
• conditions that increase your bleeding tendency (eg haemophilia)
• regular, heavy drinking
• using illegal drugs such as cocaine

Diagnosis of stroke

You will have a number of tests in hospital to try and find out what type of stroke you had and which part of your brain is affected. This will allow your doctor to plan your treatment.

You will have your blood pressure measured and an 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, and to check for clots. You will also have a brain scan (eg 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.

Later on, you may have some other tests on your heart and blood vessels to find out what caused your stroke.

Treatment of stroke

When you go to hospital, you may be treated on a general ward or in a specialist stroke unit.

If you're unable to swallow, you will be given fluid through a drip in your arm to stop you becoming dehydrated. You will have a tube in your nose to give you all the nutrients and medicines you need. You may also be given oxygen through a face mask, if you need it, to help you breathe.

You will be helped to sit up and move around as soon as you are able. If you're unable to move, you will be helped to regularly turn in your bed, to reduce your chance of getting bed sores and DVT.

Medicines

The type of medicine you have will depend on the type of stroke you had. For example, if you had an ischaemic stroke or a TIA, you may have medicines to prevent further blood clots, such as aspirin or clopidogrel. Or, if you had a haemorrhagic stroke, you may have medicines to promote blood clotting and/or medicines to control your blood pressure. You may be given medicines to help prevent DVT, but this will depend on the cause of your stroke.

Surgery

Your doctor may advise that you have surgery. This will depend on the type of stroke you have and isn't suitable for everyone. You may have:

• surgery to remove fatty deposits from an artery (carotid endarterectomy)
• surgery to drain blood from your brain

Rehabilitation

After a stroke, you may need to relearn skills and abilities, or learn new skills and adapt to the damage a stroke has caused. This is known as stroke rehabilitation.

Stroke recovery can be difficult to predict. Most people will make most of their recovery in the early weeks and months following the stroke. However, recovery can continue after this time.

The stroke team at the hospital will work out a rehabilitation programme for you that will be designed around your particular needs. This will continue after you leave the hospital. Your rehabilitation programme may involve physiotherapists, speech and language therapists, occupational therapists, ophthalmologists and psychologists, as well as doctors and nurses.

Prevention of stroke

You can take steps to lower your risk of stroke by making changes to your lifestyle. Some examples are listed below.

• Stop smoking. This can greatly reduce your risk of stroke, no matter how old you are or how long you have been smoking.
• Don’t exceed the recommended alcohol intake limits. By reducing the amount of alcohol you drink, you can reduce your blood pressure, which in turn reduces your risk of stroke.
• Improve your diet. Reducing your cholesterol levels and salt intake can reduce your risk of stroke.
• Increase the amount of activity you do. You should aim to do some physical activity every day. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week. Alternatively, you can do 75 minutes of vigorous intensity activity. Regular activity can help to lower your blood pressure and regulate the fat levels in your body.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.