Stroke

What is a stroke?

When the blood supply to the brain is cut off, brain cells aren’t receiving the oxygen they need to function well, and they get damaged or die.
Depending on which part of the brain is affected, a stroke can have different long-term effects on your body and mind. For example, you may experience mobility problems or difficulties with speech, language or memory.

Signs of a stroke

A stroke is a medical emergency, so it’s important to understand the signs of a stroke and to get help as soon as possible, even if the signs go while you’re waiting for an ambulance.

The sooner you receive treatment for a stroke, the better your chances of recovery. Learn the FAST acronym to remember how to spot the signs of a stroke and act on them:

• Face – One side of the face may droop, or smiling might be difficult

• Arms – The arms may feel weak or numb, or it might be challenging to keep them both lifted

• Speech – Speech can become slurred or might go altogether

• Time – If you notice any of these symptoms, it’s time to call 999 straight away

Other stroke symptoms

The FAST test outlines the most important symptoms to recognise, but sometimes a stroke may cause other symptoms, including:

• Sudden vision loss

• No movement (paralysis) on one side of the body

• Problems understanding others

• Balance and coordination problems

• Feeling dizzy or confused

• Sudden headaches causing intense pain

• Losing consciousness

What causes a stroke?

There are two main types of stroke, and these can be caused in different ways:

Ischaemic stroke

schaemic stroke is the most common type of stroke, caused by a blood clot cutting off blood and oxygen supply to the brain.

This is usually a result of atherosclerosis, where fatty deposits build up in the arteries, making them narrower. This process happens naturally as you get older, but certain factors can speed it up. For example:

• Hypertension (high blood pressure)

• Smoking

• Being overweight/obese

• High cholesterol

• Diabetes

• Drinking too much alcohol

A condition called atrial fibrillation can also cause blood clots that end up in the arteries and can lead to an ischaemic stroke.

Haemorrhagic stroke

This type of stroke is caused by a blood vessel bursting and bleeding in or around the brain. As a result, brain cells receive less blood and become damaged or die.

Possible causes of haemorrhagic stroke include:

• High blood pressure

• Aneurysm (a bulge in a blood vessel caused by weakness in the blood vessel wall)

• Blood-thinning medication, called anticoagulants

• Cerebral amyloid angiopathy, a condition where a protein builds up in the blood vessels in the brain, making them more likely to tear

• Illegal drugs

Mini stroke

A mini stroke, also known as a transient ischaemic attack or TIA, also causes an interruption in blood flow to part of the brain, but only for a short time - the symptoms resolve fully within 24hours. It’s still important to get medical attention, as a TIA can be a warning sign that you’re at greater risk of having a full stroke in the near future.

Risk factors for a stroke

Factors that increase your risk of having a stroke that you can’t change include:

• Older age

• Family history of stroke

• Ethnicity

• If you’ve previously had a stroke, TIA or heart attack

Preventing a stroke

There are some changes you can make to your lifestyle to help reduce your risk of having a stroke:

• Eat a healthy diet

• Take regular exercise

• Stop smoking

• Don’t drink too much alcohol

• If you have an underlying condition that can increase your risk of stroke, like diabetes, high cholesterol, high blood pressure or atrial fibrillation, it’s important to keep these well-managed

How a stroke is diagnosed

When you arrive at the hospital you may have a range of tests to diagnose a stroke:

• Blood tests to check your cholesterol, blood count and coagulation status

• Checking your pulse and blood pressure

• A brain scan should be taken within an hour of your arrival at the hospital. This helps to determine if you’ve had a stroke, what type you’ve experienced, what area of the brain’s affected and how severe the damage is

Treatment for a stroke

The treatment you have will depend on the type of stroke and how severe it was.

Treatment for ischaemic stroke

Medication for ischaemic stroke includes:

• Antiplatelet drugs – To help stop further clots forming in your blood

• Thrombolysis – Clot-busting medicine to dissolve blood clots and restore blood flow to the brain

• Anticoagulants – Another type of medication that reduces further blood clots forming

• Medication to lower your blood pressure – Like beta blockers or calcium channel blockers

• Statins – To help reduce the levels of cholesterol in your blood, as cholesterol deposits can damage the inside of your blood vessels making clots more likely

Hospital procedures to treat ischaemic stroke include:

• Thrombectomy – This emergency procedure needs to be done as quickly as possible after a stroke. It uses a catheter (a thin, flexible tube) to remove the blood clot and return blood flow to your brain.

• Carotid endarterectomy – If the cause of the stroke is a narrow artery in your neck (called the carotid artery), an incision can be made in the neck to open the artery and remove the fatty deposits.

Treatment for haemorrhagic stroke

If you’ve had a haemorrhagic stroke you may be given medication to lower your blood pressure to reduce your risk of further strokes.

Hospital procedures to treat haemorrhagic stroke include a craniotomy, which is surgery to the brain where any blood in the brain is removed and damaged blood vessels are repaired.

Long-term effects of a stroke

While some people recover quickly from a stroke, for others, it can be a long process.

Some of the most common long-term effects of a stroke include:

• Mental health issues, like depression and anxiety

• Cognitive problems, where memory or concentration may be affected, or you find it hard to solve problems or apply reason to situations

• Problems with movement, where coordination and balance are affected or you experience weakness or paralysis

• Communication problems that affect your speech and understanding and sometimes reading and writing

• Difficulties swallowing

• Vision problems

• Bladder and bowel control problems

Rehabilitation is different for everyone, but it often involves a multidisciplinary care team of healthcare professionals, including physiotherapists, occupational therapists, speech and language therapists, psychologists, dietitians, specialist nurses and doctors.