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Stroke
Published by Bupa's Health Information Team, February 2010.
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
Symptoms of stroke
Complications of stroke
Causes of stroke
Diagnosis of stroke
Treatment of stroke
Prevention of stroke
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 stroke 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 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, 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. Regular activity (30 minutes a day for five days a week) can help to lower your blood pressure and regulate the fat levels in your body.
Published by Bupa's Health Information Team, February 2010.
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
Why does a stroke usually only affect one side of the body?
If I think someone is having a stroke what should I do?
Is there anything I can do to help my recovery after a stroke?
Will I be able to drive after having a stroke?
After a stroke, will I recover and be able to get back to my normal life?
Why does a stroke usually only affect one side of the body?
Because each side of your brain controls the opposite side of your body, damage to an area in your brain usually affects only one 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 on the right side of your body.
Common symptoms of a stroke are weakness or paralysis. When someone has a stroke, it’s common for just one side of their body to be affected, but it can affect both sides.
If I think someone is having a stroke what should I do?
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, you should call for an ambulance straight away. To help you recognise the symptoms of stroke, use the FAST test. FAST stands for:
• Facial weakness. Have a 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 whether there is any weakness in his or her face muscles.
• Arm weakness. Take hold of the person's hands and raise his or her arms up until they are stretched out in front of them. 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 down to his or her side.
• Speech problems. Ask the person to speak to you, ask their name, for example, and where they live. Check whether the person's speech is slurred, whether he or she has trouble understanding you or you have difficulty understanding them.
• Time to call 999. Look for all of these symptoms and if the person fails one or more of these tests, call for emergency help straight away and ask for an ambulance.
The right treatment early on helps to prevent the 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.
Is there anything I can do to help my recovery after a stroke?
Yes, there are a number of things you can do to help your recovery. While it’s important 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.
• Practise the exercises and the tasks you have been given, but don't overdo it – a few short periods of exercise each day are better than one long one.
• 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 like they are taking forever, but the more you can do on your own, the more independent you will become.
• Be realistic about your goals and what you think you can achieve.
H2 Will I be able to drive after having a stroke?
You won't be allowed to drive for one month after you have had a stroke. After one month, your doctor will decide whether or not it's safe for you to start driving again.
Explanation
Having a stroke can affect your vision, coordination, 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 one month, your doctor will decide whether 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. If this is the case, then you will need to inform the Driver and Vehicle Licensing Agency (DVLA). The DVLA will make a final decision as to whether or not it's safe for you to start driving again. You will usually be asked to fill in a questionnaire and your doctor may be asked for further information about your condition.
The DVLA may take several months to make a decision. If they decide that it's unsafe for you to drive, you may still be allowed to start again sometime in the future. If your condition improves then you can re-apply for your licence, but you shouldn't begin driving again until your licence has been re-issued.
You must always inform your insurance company of your condition and let them know of the decision that the DVLA has made.
After a stroke, will I recover and be able to get back to my normal life?
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 can depend on many things, including which part of your brain was affected and what kind of stroke you had.
Many people get back much of the function and abilities that they lost during their stroke within the first weeks and months but, for other people, this process can take much longer. Some people may never get back all of the functions they have lost.
The rehabilitation programme put together for you by the stroke team at the hospital will be designed to help your recovery. This may involve re-learning skills that have been affected by the stroke and adapting to life within your capabilities.
Further information
The Stroke Association
0303 3033 100
www.stroke.org.uk
Sources
• Stroke information. The Stroke Association. www.stroke.org.uk, accessed 17 November 2010
• Stroke and TIA. Clinical Knowledge Summaries. www.cks.nhs.uk, published February 2009
• Stroke, Ischemic. eMedicine. http://emedicine.medscape.com, published 4 June 2010
• Transient Ischemic Attack. eMedicine. http://emedicine.medscape.com, published 19 July 2010
• Dissection, Carotid Artery. eMedicine. http://emedicine.medscape.com, published 29 October 2009
• Stroke (CVA). The Merck Manuals. www.merck.com/mmhe, published November 2007
• Stroke: Act F.A.S.T Awareness Campaign. Department of Health. www.dh.gov.uk, published 9 February 2009
• Personal communication, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician, Spire Leeds Hospital, 5 January 2011
• Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010:570–1
• Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). National Institute for Health and Clinical Excellence (NICE), 2008 www.nice.org.uk
• Stroke - National clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians, 2008:1-123
• Stroke rehabilitation. The Merck Manuals. www.merck.com/mmhe, published February 2009
• Joint Formulary Committee, British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2010
• Factsheet 19: Smoking and stroke. The Stroke Association. www.stroke.org.uk, published April 2009
• Factsheet 13: Alcohol and stroke. The Stroke Association. www.stroke.org.uk, published April 2009
• Factsheet 8: Healthy eating and stroke. The Stroke Association. www.stroke.org.uk, published December 2010
• Stroke. Brain Foundation. http://brainfoundation.org.au, accessed 22 November 2010
• National Stroke Strategy. Department of Health. www.dh.gov.uk, published 5 December 2007
• Stroke information. Chest Heart & Stroke Scotland. www.chss.org.uk, published September 2010
• Factsheet 2: Driving after stroke. The Stroke Association. www.stroke.org.uk, published March 2010
• Stroke and driving. Directgov. www.direct.gov.uk, accessed 19 November 2010
Related topics
• Cervical artery dissection
• Haemorrhagic stroke
• Ischaemic stroke
• Transient ischaemic attack (TIA)
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