What is a stroke?

Stroke is a medical emergency and the third leading cause of death in the UK. It occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops. Without treatment, cells in the brain quickly begin to die. The result can be serious disability or death. If a loved one is having stroke symptoms, seek emergency medical attention without delay.

Stroke symptoms

Signs of a stroke may include:

• Face drooping on one side, unable to smile , eye or mouth drooping on one side
• Numbness or weakness of the body, especially on one side Inability to lift one or both arms and keep them lifted
• Difficulty speaking (slurred or garbled or unable to talk at all) or difficulty understanding others
• Sudden vision changes in one or both eyes
• Sudden, severe headache with unknown cause
• Problems with dizziness, walking, balance or coordination
• Difficulty swallowing
• Confusion

Call 999 immediately if you notice any of these symptoms.

Stroke test: talk, wave, smile

The F.A.S.T. test helps spot symptoms. It stands for:

Face. Ask for a smile. Does one side droop?

Arms. When raised, does one side drift down?

Speech. Can the person repeat a simple sentence? Does he or she have trouble or slur words?

Time. Time is critical. Call 999 immediately if any symptoms are present.

Stroke: Time = Brain damage

Every second counts when seeking treatment for a stroke. When deprived of oxygen, brain cells begin dying within minutes. There are clot-busting drugs that can curb brain damage, but they have to be used within four and a half hours of the initial stroke symptoms. Once brain tissue has died, the body parts controlled by that area won’t work properly. This is why stroke is the largest cause of adult disability in the UK.

Diagnosing a stroke

When someone with stroke symptoms arrives in A&E, the first step is to determine which type of stroke is occurring. There are two main types, and they are not treated the same way. A CT scan can help doctors determine whether the symptoms are coming from a blocked blood vessel or a bleeding one. Additional tests may also be used to find the location of a blood clot or bleeding within the brain.

Ischaemic Stroke

The most common type of stroke is known as an ischaemic stroke. Over 80% of strokes fall into this category. The culprit is a blood clot that obstructs a blood vessel inside the brain. The clot may develop on the spot or travel through the blood from elsewhere in the body.

Haemorrhagic stroke

Haemorrhagic strokes are less common but far more likely to be fatal. They occur when a weakened blood vessel in the brain bursts. The result is bleeding inside the brain that can be difficult to stop.

Transient ischaemic attack (TIA)

A transient ischaemic attack (TIA), often called a 'mini-stroke', is more like a close call. Blood flow is temporarily impaired to part of the brain, causing symptoms similar to an actual stroke. When the blood flows again, the symptoms disappear. A TIA is a warning sign that a stroke may happen soon. It's critical to seek medical attention if you think you've had a TIA. There are therapies to reduce the risk of stroke.

What causes a stroke

A common cause of stroke is atherosclerosis – narrowing of the arteries. Plaque made of fat, cholesterol, calcium and other substances builds up in the arteries, leaving less space for blood to flow through. A blood clot may lodge in this narrow space and cause an ischaemic stroke. Atherosclerosis also makes it easier for a clot to form. Haemorrhagic strokes often result from uncontrolled high blood pressure that causes a weakened artery to burst.

Risk factors: Chronic conditions

Certain chronic conditions increase your risk of stroke. These include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity

Taking steps to control these conditions may reduce your risk.

Risk Factors: Behaviours

Certain behaviours also increase the risk of stroke:

• Smoking
• Not enough exercise
• Excess alcohol consumption

Risk factors: Diet

An unhealthy diet may increase the risk for stroke in a few significant ways. Eating too much fat and cholesterol can lead to arteries that are narrowed by plaque. Too much salt may contribute to high blood pressure. And too many calories can lead to obesity. A diet high in fruit, vegetables, whole grains and fish may help lower stroke risk.

Risk factors you can’t control

Some stroke risk factors are beyond your control, such as getting older or having a family history of strokes. Gender plays a role, too, with men being more likely to have a stroke. However, more stroke deaths occur in women. Finally, race is an important risk factor. South Asian, African or Caribbean people are at greater risk compared to people of other ethnicities.

Stroke: Emergency treatment

For an ischaemic stroke, emergency treatment focuses on medicine to restore blood flow. A clot-busting medication is highly effective at dissolving clots and minimising long-term damage, but it must be given within four and a half hours of the onset of symptoms. Haemorrhagic strokes are more difficult to manage. Treatment usually involves attempting to control high blood pressure, bleeding and brain swelling.

Stroke: Long-term damage

Whether a stroke causes long-term damage depends on its severity and how quickly treatment stabilises the brain. The type of damage depends on where in the brain the stroke occurs. Common problems after a stroke include numbness in the arms or legs, difficulty walking, vision problems, trouble swallowing and problems with speech and comprehension. These problems can be permanent, but people often regain their abilities to varying degrees.

Stroke rehab: Speech therapy

Rehabilitation is the centrepiece of the stroke recovery process. It helps patients regain lost skills and learn to compensate for damage that can't be undone. The goal is to help restore as much independence as possible. For people who have trouble speaking, speech and language therapy is essential. A speech therapist can also help patients who have trouble swallowing.

Stroke rehab: Physiotherapy

Muscle weakness, as well as balance problems, are very common after a stroke. This can interfere with walking and other daily activities. Physiotherapy is an effective way to regain strength, balance and coordination. For fine motor skills, such as using a knife and fork, writing and buttoning a shirt, occupational therapy can help.

Stroke rehab: Talk therapy

It's common for stroke survivors and their loved ones to experience a wide range of intense emotions, such as fear, anger, worry and grief. A psychologist or mental health counsellor can provide strategies for coping with these emotions. A therapist can also watch for signs of depression, which frequently strikes people who are recovering from a stroke.

Stroke prevention: Lifestyle

People who have had a stroke or TIA can take steps to prevent a recurrence:

• Quit smoking
• Exercise and maintain a healthy weight
• Limit alcohol and salt intake
• Eat a healthy diet with plenty of vegetables, fish and whole grains

Stroke prevention: Medication

For people with a high risk of stroke, doctors often recommend medication to lower this risk. Anti-platelet medicines, including aspirin, keep platelets in the blood from sticking together and forming clots. Anti-clotting drugs, such as warfarin, may be needed to help ward off stroke in some patients.  Finally, if you have high blood pressure or high cholesterol, your doctor will prescribe medication to lower it.

Stroke prevention: Surgery

In some cases, a stroke results from a narrowed carotid artery – the blood vessel that travels up each side of the neck to bring blood to the brain. People who have had a mild stroke or a TIA due to this problem may benefit from surgery known as carotid endarterectomy. This procedure removes plaque from the lining of the carotid arteries and can prevent further strokes.

Stroke prevention: Balloon and stent

Doctors can also treat a clogged carotid artery without major surgery in some cases. The procedure, called angioplasty, involves temporarily inserting a catheter into the artery and inflating a tiny balloon to widen the area that is narrowed by plaque. A metal tube, called a stent, can be inserted and left in place to keep the artery open.

Life after a stroke

A third of people will make an almost full recovery physically after a stroke. Those who get clot-busting drugs soon enough may recover completely. Those who experience disability can often learn to function independently through therapy. While the risk of a second stroke is higher at first, this risk drops off over time.

Related Reading