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 an episode 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.
• Stroke from cervical artery dissection is caused when the lining of one of the arteries in your neck is torn, restricting the blood supply to your brain.

The symptoms of stroke vary depending on what type 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 ‘FAST’ test. FAST stands for:

• face
• arm
• speech
• time to call 999

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 one or more of these symptoms, you should call for emergency help straight away. For more information, see our frequently asked questions.

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 co-ordination
• severe headache

Although headaches are a symptom of stroke, it's important to remember that they are common and most headaches aren't caused by 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, often on one side of your body
• lack of awareness of one side of your body (usually the left-hand side)
• seizures (fits)
• loss of sensation on one side of your body
• difficulty swallowing
• extreme tiredness and sleep problems
• problems with your speech, reading and writing
• problems with your vision – for example, double vision or partial blindness
• memory and concentration difficulties
• difficulty controlling your bladder and bowel movements (incontinence or constipation)
• changes in personality and behaviour
• psychological problems such as anxiety or depression

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 (infections in your lungs)
• contractures (altered position of your hands, feet, arms or legs because of muscle tightness)

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

A stroke happens when the blood supply to your brain is cut off. This can be caused 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
• being overweight or obese
• diabetes
• a family history of stroke or heart disease
• an abnormal heartbeat (often a condition known as atrial fibrillation)
• conditions that cause your blood to close more slowly (for example, haemophilia)
• regularly drinking too much alcohol
• using illegal drugs, such as cocaine

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

You will have your blood pressure measured and 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 will 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.

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

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

If you can’t 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 the nutrients and medicines you need. You may also be given oxygen through a face mask to help you breathe.

You will be helped to sit up and move around as soon as you’re able. If you can’t move, you will regularly be helped to turn in your bed to reduce your risk of getting bed sores and DVT.

The length of time that you need to stay in hospital will vary and depends on how severely you have been affected by your stroke.

Medicines

The medicine you receive will depend on the type of stroke you had. For example, if you had an ischaemic stroke or a TIA, you may be given a medicine called alteplase to break up blood clots and restore blood flow to your brain, or medicines such as aspirin or clopidogrel to prevent further blood clots. You won’t be given these medicines if you had a haemorrhagic stroke 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 and isn't suitable 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

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

Stroke recovery can be difficult to predict. You may find you make most of your recovery in the early weeks and months following the stroke, but recovery can continue after this time and you may carry on improving for years afterwards.

A team of health professionals that may include physiotherapists, speech and language therapists, occupational therapists, dietitians, ophthalmologists and psychologists, as well as doctors and nurses will work out a rehabilitation programme for you. This will be designed around your particular needs and will aim to help you in the long term so that you can stay as independent as possible.

For more information about the recovery after stroke, see our frequently asked questions.

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 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 some 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.

• 1. 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 and 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. So if you have a stroke that affects the blood supply to the left-hand side of your brain, this will cause symptoms such as weakness and loss of feeling 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).

  2. 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. By getting help as soon as possible you 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. FAST stands for the following.

  • Facial weakness. Look at the person's face to see whether the muscles at the corner of his or her eyes or mouth have drooped. Ask the person to smile so you can see if there is any weakness in his or her facial muscles.
  • Arm weakness. Take hold of the person's hands and raise his or her arms up until they are stretched out in front. Then ask the person to keep their arms raised as you let go of his or her hands. Look to see whether there is any weakness in one arm or whether either arm drops back.
  • Speech problems. Ask the person to speak to you – for example, ask their name and where they live. Check whether the person's speech is slurred, whether he or she has trouble understanding you or if you have difficulty understanding them.
  • Time to call 999. If the person has one or more of these symptoms, call for emergency help straight away and ask for an ambulance.

    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.

    3. 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 you recover.

  • 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.
  • Try to understand why you have been asked to do certain exercises and tasks – it will help you to stay motivated.
  • Keep in mind that your recovery may be gradual, so you need to be persistent.
  • 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.

4. Will I be able to drive after having a stroke?

Answer

You won't be allowed to drive for one month after you have had a stroke. After one month, you will 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, co-ordination, concentration and the way that you move. For these reasons, it may not be safe for you to drive. You won't be allowed to drive for one month after you have had a stroke or a transient ischaemic attack (TIA). After this time, you may be able to start driving again provided that your doctor believes that your symptoms have improved enough to make it safe for you to start driving again.

If your symptoms have lasted for over a month, your doctor may decide that it's still unsafe for you to drive.

5. 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.

It’s possible that you will get back much of the function 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 stroke.

The rehabilitation programme put together for you 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 making use of new adaptations.

• The British Heart Foundation
  0300 330 3311
  www.bhf.org.uk

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