Stroke

A stroke is a serious, life-threatening medical condition that happens when the blood supply to part of the brain is cut off.

Strokes are a medical emergency and urgent treatment is essential. The sooner a person receives treatment for a stroke, the less damage to the brain is likely to occur.

Even if the symptoms of a stroke go away, you or the person having a stroke should still go to hospital for an assessment.

Signs and symptoms

The main symptoms of stroke can be remembered with the word FAST. FAST stands for:

• Face – the face might drop on one side, the person may not be able to smile or their mouth may have dropped, and their eyelid may droop
• Arms – the person may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm
• Speech – they might slur their speech or it might be garbled, or the person may not be able to talk at all despite appearing to be awake
• Time – it’s time to phone 999 immediately if you see any of these signs or symptoms

Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause different symptoms which might include:

• complete paralysis of one side of the body
• sudden loss or blurring of vision
• difficulty understanding what others are saying
• problems with balance and co-ordination
• a sudden and very severe headache
• loss of feeling in one side of the body

However, there are sometimes other causes for these symptoms.

Why do strokes happen?

Like all organs, the brain needs the oxygen and nutrients provided by blood to function. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain injury, disability and possibly death.

There are 2 main causes of strokes:

• ischaemic – where the blood supply is stopped due to a blood clot (this accounts for 85% of all cases)
• haemorrhagic – where a weakened blood vessel supplying the brain bursts

There’s also a related condition known as a transient ischaemic attack (TIA).

‘Mini-stroke’ or transient ischaemic attack (TIA)

The symptoms of a TIA are the same as a stroke, but they only last between a few minutes and a few hours before disappearing completely.

Although the symptoms do improve, you should never ignore a TIA. A TIA is a serious warning sign there’s a problem with the blood supply to your brain. This means you’re at an increased risk of having a stroke in the near future.

Who is at risk?

There are some things that can make you more likely to have a stroke or TIA:

• poor diet
• lack of exercise
• obesity
• smoking
• drinking too much alcohol
• high cholesterol
• high blood pressure (hypertension)
• diabetes
• atrial fibrillation

Lifestyle changes can help control some of these risk factors. You may also need to take regular medication. Taking anticoagulant medication if you have an irregular heartbeat due to atrial fibrillation will help reduce the risk of stroke.

If you’ve had a stroke or TIA, these measures are very important because you’re at a higher risk of having another stroke.

How can I reduce my risk of stroke?

In most cases it’s possible to significantly reduce your risk of having a stroke by making lifestyle changes like

• eating a healthy diet – a low-fat, low-salt, high-fibre diet is usually recommended, with plenty of fresh fruit, vegetables and whole grains
• exercising regularly – this can help lower your cholesterol level and keep your blood pressure at a healthy level
• stopping smoking if you smoke
• cutting down on the amount of alcohol you drink

There are some risk factors you can’t change like:

• age – people over 65 are most at risk of having strokes, although they can happen at any age – including in children
• family history – if a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher
• ethnicity – if you’re south Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups
• your medical history – if you’ve had a stroke, transient ischaemic attack (TIA) or heart attack, your risk of stroke is higher

Diagnosing a stroke

Strokes are usually diagnosed by physical tests and studying scans of the brain.

Some tests can help confirm the diagnosis and determine the cause of the stroke. This may include:

• checking your pulse for an irregular heartbeat
• measuring your blood pressure
• blood tests to check your cholesterol and blood sugar levels

How strokes are treated

Effective treatment of stroke can reduce the risk of long-term disability and save lives.

The specific treatments recommended depend on whether a stroke is caused by:

• a blood clot obstructing the flow of blood to the brain (ischaemic stroke)
• a burst blood vessel bleeding in or around the brain (haemorrhagic stroke)

Treatment usually involves taking one or more different medications. Some people may also need surgery. It’s important to seek treatment as soon as possible to improve the chances of a good recovery.

Life after a stroke

The brain injury caused by a stroke can lead to long-lasting problems.

Some people who’ve had a stroke need long-term rehabilitation to help them regain as much independence as possible.

Rehabilitation often starts in hospital, at a local clinic and might continue at home. A team of specialists are available to help with your rehabilitation, including:

• physiotherapists
• speech and language therapists
• occupational therapists
• dietitians
• psychologists
• specialist nurses and doctors

These specialists might help you with:

Caring for someone who’s had a stroke

Around half the people who have a stroke will need some form of care or help with their daily activities. For example, a care worker could come to the person’s home to help with household tasks, or to provide companionship.

There are lots of ways you can support a friend or relative who’s had a stroke to speed up their rehabilitation.