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Ischaemic stroke

An ischaemic stroke is when the blood supply to your brain is blocked by a blood clot or clump of fat. This starves your brain of the oxygen and nutrients it needs, which damages your brain cells. The sooner you get treatment for an ischaemic stroke, the less damage is likely to happen.

An image showing ischaemic stroke

Details

  • Types Types of ischaemic stroke

    There are different types of stroke. This topic is about ischaemic stroke but we also have information about haemorrhagic stroke

    Ischaemic stroke is the most common type – about 85 people out of every 100 who have a stroke have this type. And there are two different ways that it can happen.

    • Arterial thrombosis (also called thrombotic stroke or cerebral thrombosis). This is when a blood clot forms in an artery that supplies your brain and blocks the blood supply.
    • Cerebral embolism (also known as an embolic stroke). This is when a blood clot forms somewhere else in your body and travels to your brain and blocks the blood supply. The clot usually forms in your heart or one of the large arteries that supplies your brain.
  • Symptoms Symptoms of ischaemic stroke

    The symptoms of an ischaemic stroke usually come on suddenly, within seconds or minutes. Sometimes you can have a transient ischaemic attack (TIA) before a full blown stroke. See FAQ: Transient ischaemic attacks for more information.

    It’s vital that you can recognise if you, or someone you’re with, is having a stroke so you can get immediate treatment. A good way to remember the signs of one is to use the ‘FAST’ test.

    • Face. If you’ve had a stroke, your face may feel weak and you won't be able to smile. Your mouth or eye may droop down, usually just on one side.
    • Arm. You won't be able to raise your arm and hold it there.
    • Speech. You may have slurred speech or find it difficult to remember the names of common objects.
    • Time to call 999. If you have one or more of these symptoms, or you see them in anyone else, get emergency help straightaway.

    Other symptoms of an ischaemic stroke depend on where in your brain the blood supply is blocked. This is because different areas of your brain control different things and they all get blood through different arteries. Symptoms may include:

    • feeling weak or numb on one side of your body
    • a headache
    • feeling dizzy or unsteady
    • feeling sick
    • a sore neck or face
    • double vision – or difficulty seeing at all
    • feeling confused
  • Diagnosis Diagnosis of ischaemic stroke

    When you get to hospital, you’ll have some tests to find out what type of stroke you’ve had and how your brain is affected. This will help your doctor to plan your treatment. 

    These include:

    • a brain scan, such as a computerised tomography (CT) or magnetic resonance imaging (MRI) scan to find out whether you’ve had an ischaemic stroke or a haemorrhagic stroke
    • an electrocardiogram (ECG) to record the rhythm and electrical activity of your heart
    • blood tests to measure your pressure, cholesterol and blood sugar levels, and to check how well your blood clots 

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

    • an ultrasound scan of the carotid arteries in your neck
    • an angiogram, to help see the blood supply to your brain in more detail
  • Treatment Treatment of ischaemic stroke

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

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

    Nurses will help you to sit up and encourage you to move around as soon as you can. If you can’t move, they’ll help you to turn in your bed regularly. 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 called an intermittent compression device. The pump automatically squeezes your feet and lower legs to help keep your blood moving and prevent a blood clot from forming.

    How long you’ll need to stay in hospital will depend on how severe your stroke was, how you’ve been affected by it, and your recovery. For more information about how long people tend to stay in hospital for see our FAQ: Hospital stay after an ischaemic stroke.

  • Medicines Medicines for ischaemic stroke

    Your doctor may prescribe you the following medicines for ischaemic stroke. 

    • Alteplase is a medicine that can break up blood clots, and will help restore the blood flow to your brain. You’ll need to have it within four and a half hours of your symptoms starting for it to work but the sooner the better. Alteplase isn’t suitable for everyone – ask your doctor if it’s an option for you.
    • Antiplatelet medicines like aspirin can reduce your risk of blood clots forming after a stroke.
    • Anticoagulant medicines such as heparin or warfarin can also prevent blood clots forming.

    Your doctor might also prescribe you some other medicines to control your blood pressure and lower your cholesterol.

  • Surgery Surgery for ischaemic stroke

    You might need to have an operation to reduce your risk of having another stroke. This may involve an operation called a carotid endarterectomy to remove blood clots and fatty deposits from one of the carotid arteries in your neck.

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  • Rehabilitation Rehabilitation after ischaemic stroke

    A stroke can damage your brain. Since your brain controls everything you do, you may need to relearn skills and abilities, or learn to adapt to new ways of doing things. This is known as stroke rehabilitation. 

    It can be difficult to know how well you’ll recover from a stroke. You might make most of your recovery in the first weeks and months after the stroke. But you might continue to get better and carry on improving for years afterwards.

    A multidisciplinary team of health professionals will work out a rehabilitation programme for you that’s designed around your needs. The team may include physiotherapists, speech and language therapists, occupational therapists, ophthalmologists and psychologists, as well as doctors and nurses. They’ll work together to help you stay as independent as possible. For more information, see FAQ: Hospital stay after an ischaemic stroke.

  • Causes Causes of ischaemic stroke

    An ischaemic stroke is caused by a blood clot or clump of fat blocking the flow of blood to your brain. The blockage might start in one of the arteries in your brain. Or, it might develop somewhere else in your body and travel in your blood to your brain.

    Some people are more likely to have an ischaemic stroke than others. For example, people with a black or Asian background are more likely. And most people who have an ischaemic stroke are over 65 although you can have one at any age.

    If you have an abnormal heartbeat called atrial fibrillation, you’re more likely to have an ischaemic stroke. This is because it could cause a blood clot to form in your heart which could travel to your brain.

    You’re also more at risk of getting a blood clot if your arteries have become narrowed and ‘furred up’ with fatty deposits. This is known as atherosclerosis and can happen as you get older. You’re more likely to get atherosclerosis and a stroke if you:

  • Complications Complications of ischaemic stroke

    An ischaemic stroke can be very severe and cause lasting damage to your brain. Sometimes they can even be fatal. Complications of ischaemic stroke may include: 

    • weakness or paralysis, often on one side of your body
    • difficulty swallowing
    • problems sleeping
    • problems with your speech, reading and writing
    • problems with your sight – for example, you might get double vision or find it hard to see
    • problems with your memory and difficulty concentrating
    • difficulty controlling your bladder and bowel movements (incontinence or constipation)
    • problems having sex
    • changes in your personality and behaviour
    • anxiety and 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 (where your hands, feet, arms or legs become so tight that it’s hard to straighten them)
  • Prevention Prevention of ischaemic stroke

    You can take the following steps to lower your risk of stroke. 

    • Stop smoking, as it raises your blood pressure and your risk of developing atherosclerosis (narrow, furred arteries).
    • Eat a healthy diet and cut down on how much fat and salt you eat. Too much fat in your diet can fur up your arteries and too much salt can increase your blood pressure.
    • Do more exercise to help lower your blood pressure and keep your weight down.
    • Drink less alcohol as it can raise your blood pressure and the likelihood of fatty deposits forming in your arteries, as well as your risk of atrial fibrillation.

    See Related information for tips and advice on achieving these.

  • FAQ: Aspirin and strokes Can taking aspirin prevent an ischaemic stroke?

    Aspirin is a type of medicine called an antiplatelet, which means it helps to prevent blood clots forming. But it can also increase the risk of bleeding in your stomach and bowel.

    If you’ve never had a stroke before, the benefits of taking aspirin might not outweigh the risks of taking it long term. It's more important to make changes to your lifestyle, such as improving your diet and doing more exercise. Only take aspirin to prevent a stroke if your doctor has recommended you do so.

  • FAQ: Hospital stay after an ischaemic stroke How long do people stay in hospital for?

    It’s difficult to say as it depends on how severe your stroke was and how well you recover but the average hospital stay is 17 days.

    More information

    The time you need to stay in hospital after an ischaemic stroke will depend on how severe your stroke was. Depending on how well you recover in hospital, it may be that returning home isn’t the best solution. Before you leave hospital, you’ll see a team of health professionals, which will include a physiotherapist, a social worker and a speech and language therapist. They’ll help you decide how much care you need and consider all available options. If you can’t go back to live in your own home, there are other options, such as a care home.

  • FAQ: Family history Can ischaemic strokes run in families?

    You’re more at risk of having a stroke if another member of your family has had one. But this doesn't necessarily mean that you’ll have a stroke. Your risk depends  on factors that you can’t change (such as your age, race and family history) and lifestyle factors that you can. For tips on how to improve your lifestyle to reduce your risk of a stroke, see Prevention of ischaemic stroke and Related information.

  • FAQ: Transient ischaemic attacks Are TIAs different to an ischaemic stroke?

    Transient ischaemic attacks (TIAs) are also known as ‘mini-strokes’. Like strokes, they happen when the blood supply to your brain is interrupted, but with TIAs, it’s just for a short time.

    More information

    TIAs happen when a clot blocks your blood vessel; but unlike an ischaemic stroke, the clot quickly breaks down. They still cause stroke-like symptoms but they usually won’t last for more than 24 hours. In fact, most TIAs last less than an hour.

    Some people have a TIA before an ischaemic stroke – usually a couple of days before – so if you notice any symptoms, get emergency medical help. Treat this as a possible warning that you’re at risk of a stroke so you get the help you need.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Ischaemic stroke. BMJ Best Practice. bestpractice.bmj.com, last updated 3 December 2015
    • Ischemic stroke. Medscape. emedicine.medscape.com, updated 23 November 2015
    • Stroke and transient ischaemic attack in over 16s: Diagnosis and initial management National Institute for Health and Care Excellence (NICE), 23 July 2008. www.nice.org.uk
    • Map of medicine. Stroke and transient ischaemic attack (TIA). International view. London: Map of medicine; 2016 (issue 2)
    • Stroke and TIA. Nice Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2013
    • National clinical guideline for stroke. Royal College of Physicians. www.rcplondon.ac.uk, published September 2012
    • Carotid endarterectomy technique. Medscape. emedicine.medscape.com, updated 9 December 2014
    • Cerebrovascular event rehabilitation. PatientPlus. www.patient.info/patientplus, last checked 2 August 2013
    • Atherosclerosis pathology. Medscape. reference.medscape.com, updated 10 March 2015
    • Noncoronary atherosclerosis overview of atherosclerosis. Medscape. emedicine.medscape.com, updated 24 April 2014
    • NINDS stroke information page. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov, last modified 26 May 2016
    • Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning. Scottish Intercollegiate Guidelines Network (SIGN), June 2010. www.sign.ac.uk
    • Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. J Am Coll Cardiol 2013; 63(25):2960–84. doi: 10.1016/j.jacc.2013.11.003
    • Atrial fibrillation. PatientPlus. www.patient.info/patientplus, last checked 26 June 2014
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 23 August 2016
    • Stroke prevention. PatientPlus. www.patient.info/patientplus, last checked 19 July 2012
    • How good is stroke care? First SSNAP annual report. Royal College of Physicians. www.strokeaudit.org, published 2014
    • Transient ischaemic attack. BMJ Best Practice. bestpractice.bmj.com, last updated 9 November 2015
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  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, October 2016
    Expert reviewer Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician
    Next review due October 2019

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