Stroke
Your health expert: Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician
Content editor review by Pippa Coulter, Freelance Health Editor, September 2021.
Next review due September 2024.
A stroke is when the blood supply to part of your brain is cut off. A stroke is a medical emergency. It's vital to recognise signs of a stroke quickly and get treatment in hospital as soon as possible.
Causes of stroke
There are two main types of stroke; they are caused by different things.
- Ischaemic stroke. This happens when the blood supply to part of your brain is blocked by a blood clot or a clump of fatty material. It’s the most common type of stroke.
- Haemorrhagic stroke. This is caused by bleeding inside or around your brain. It can happen when a blood vessel bursts.
You can also have something called a transient ischaemic attack (TIA, also sometimes known as a ‘mini stroke’). This is when you have a blockage of blood to your brain, like an ischaemic stroke, but it’s only temporary. The symptoms last for less than 24 hours.
Risk factors for stroke
Your risk of having a stroke increases as you get older. There are also certain medical conditions and lifestyle factors that can increase your risk of having a stroke. These include:
- high blood pressure
- high cholesterol
- other conditions that affect your heart or how your blood clots
- diabetes
- a family history of stroke
Lifestyle factors that increase your risk of stroke include:
- smoking
- being inactive (not doing much exercise)
- being overweight or obese
- having a poor diet
- drinking alcohol to excess
- using certain illegal drugs – for example, cocaine
If you’ve already had a stroke or a TIA (‘mini stroke’), you’re at greater risk of having another one.
Symptoms of stroke
Stroke symptoms usually come on suddenly, within seconds or minutes. A good way to recognise the signs of a stroke is to use the ‘FAST’ test.
- Face. The affected person’s face may feel weak, and they may not be able to smile. Their face may also look odd – their mouth or eye may droop down on one side.
- Arms. The person may not be able to raise their arms and hold them there.
- Speech. They may have slurred speech or find it difficult to remember the names of common objects.
- Time to call 999. If the affected person has one or more of these symptoms, get emergency help straight away.
Bupa's FAST test infographic (PDF, 0.5 MB), illustrates the signs of a stroke. Click on the FAST image below to download the PDF (0.5MB).
There can be other symptoms of stroke too. These can vary depending on the type of stroke and the part of the brain affected. But they can include:
- weakness, numbness or paralysis on one side of body, including in the legs, hands or feet
- blurred vision or loss of sight in one or both eyes
- feeling confused
- headache – this may come on gradually or be sudden and severe
Diagnosis of stroke
If you have a suspected stroke, you’ll be admitted to a specialist stroke unit to be assessed. Here, you’ll have a brain scan (usually a CT scan of your head). This is to confirm whether or not you’ve had a stroke and if so, what type it is. You may have other types of scan too. For example, an MRI and an angiogram, which uses a dye to show up blood vessels in your brain.
You may have other tests, including blood tests and tests to check for heart problems which could have caused your stroke. Your doctor may monitor the electrical activity of your heart over a period of time, using an ECG (electrocardiogram). You may also have an echocardiogram (scan of your heart).
Treatment of stroke
Your treatment will begin while you’re in hospital. You’ll be cared for by a team of doctors and nurses on a specialised stroke unit. The exact treatment you have will depend on the type of stroke you’ve had and how severe it is. If you’re having trouble breathing, you may have oxygen therapy and a tube in your mouth or nose to help with your breathing. You may also have a tube in your nose to give you nutrients and medicines.
Treatment of ischaemic stroke
If you’ve had an ischaemic stroke, your doctor might give you a medicine to dissolve any blood clot and restore blood flow to your brain. You can only have this treatment if it’s within a few hours of your stroke symptoms starting.
Some people with ischaemic stroke may have a procedure called a thrombectomy, to remove a blood clot. In this procedure, your doctor will thread a tube into an artery in your groin, and direct it up to where the clot is in your brain. They will then use a device to remove the clot. You may have this if the blood clot is in a large artery in your brain.
You’ll usually be offered aspirin or an alternative medicine after your stroke, to stop your blood clotting. You’ll also be offered ongoing treatments to help reduce your risk of having another stroke over the long-term. These may include medicines to prevent your blood clotting, and to reduce your blood pressure and cholesterol level.
Treatment of haemorrhagic stroke
If you’ve had a haemorrhagic stroke and you take anticoagulant medicine, your doctor will give you medicines to reverse the effects of the anticoagulant. If you have high blood pressure, they’ll give you medicines to lower it.
Some people develop epilepsy after having a haemorrhagic stroke. If this happens to you, you may need to take anticonvulsants (medicines to prevent seizures).
Sometimes, surgery can be an option for haemorrhagic stroke. Surgery can help to relieve a build-up of pressure in your skull, caused by the burst blood vessel. If your stroke is caused by a burst aneurysm (a bulge in a blood vessel), you may be able to have a procedure called endovascular coiling. This is where metal coils are placed into the burst blood vessel to stop the bleeding. Sometimes, the best choice may be to not have any treatment. Your doctor will discuss the risks and benefits with you or your family members.
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Complications of stroke
Some strokes can be quite mild and you recover from them quickly. Others can be more severe and cause a range of ongoing problems. Some people don’t survive having a stroke.
Long-term complications can include:
- physical problems – for example, weakness on one side of your body, difficulties with co-ordination or balance, and stiff, tight muscles
- sensory problems with changes in how you feel touch, temperature and pain
- difficulty swallowing, which can make it hard to eat and drink
- feeling exhausted and having problems sleeping
- communication problems including difficulties with your speech, reading and writing
- problems with your vision – for example, you might have double vision, blurry vision or find it hard to see
- cognitive problems – this means difficulties with thinking, memory and concentration
- difficulty controlling your bladder and bowel movements (incontinence or constipation)
- emotional difficulties – for example, those close to you may notice changes in your behaviour or you may feel anxious or depressed
- sexual problems due to both the physical and emotional effects of your stroke
These problems can make it difficult to carry on with your normal daily activities after having a stroke. You may find it a struggle to take care of yourself and to live independently.
Recovering from stroke
Having a stroke can lead to a number of long-term problems. You may need to relearn how to do certain things or change the way you do them. This is known as stroke rehabilitation. With the right help and support, you can begin to enjoy life again and may be able to regain some independence. The doctors and nurses looking after you in hospital will assess you before you leave and work out a rehabilitation plan. You’ll have follow-up appointments to check how you’re getting on. You may see various different health professionals, including:
- physiotherapists to help strengthen your muscles and improve your mobility, balance and coordination
- occupational therapists who can help you to relearn everyday skills like dressing and caring for yourself
- speech and language therapists to help with any problems you’re having with speech or swallowing
- a dietitian to make sure you’re still able to get all the nutrients you need
- counsellors who can help provide emotional support
Recovery and rehabilitation can take a long time, and it can be hard to keep motivated. Here are some suggestions that may help.
- Try to think positively and focus on what you want to achieve.
- Set achievable goals that mean something to you and will help to keep you motivated.
- Get friends or family members on board with what you’re trying to do. They can help support you.
- Try to work any exercises you need to do into your everyday tasks.
- Keep a record of the progress you’re making.
Prevention of stroke
There are a number of lifestyle changes you can make to help reduce your risk of having a stroke. If you’ve already had a stroke, they’ll reduce your risk of having another. They include the following.
- Being more active, and reducing the time you spend sitting down.
- If you smoke, stopping smoking.
- Making sure you’re following a healthy diet, with at least five portions of fruit and vegetables every day. Reducing how much saturated fat and salt you have.
- Maintaining a healthy weight, and losing excess weight if you need to.
- If you drink alcohol, making sure you keep within recommended limits.
The main types of stroke are ischaemic stroke and haemorrhagic stroke. An ischaemic stroke is when something blocks the blood supply to your brain. A haemorrhagic stroke is due to bleeding in your brain. For more information, see our section on Causes.
A stroke can happen if something blocks the blood supply to your brain or if a blood vessel in your brain bursts. Strokes are more likely as you get older. They can also be linked to various medical conditions and lifestyle factors. To find out more, see our section on Causes.
You’ll need hospital treatment immediately after having a stroke, to treat the cause of your stroke. You may have a number of long-term problems afterwards. These may include physical, communication and emotional problems. You’ll have help and support to help you recover. To find out more, see our section on Recovery.
Exactly how a stroke affects you is very individual to you. However, fewer people survive haemorrhagic strokes than ischaemic strokes. Whichever type of stroke you have, it’s really important to seek medical help quickly. This will improve your chances of surviving the stroke and having a full recovery. For more information on how to recognise signs of stroke, see our section on Symptoms.
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