Strokes & TIAs

What is a stroke?

A stroke happens when the blood supply to part of the brain is interrupted. As a result, brain cells get less of the oxygen and nutrients that they need. Some brain cells can become damaged, and other cells can die. This can cause different effects depending on where it happens in your brain.

There are two types of strokes:

• Ischaemic stroke – this type of stroke occurs when a blood clot blocks one of the arteries that carries blood to the brain. About 85 in every 100 strokes are ischaemic.
• Haemorrhagic stroke – this type of stroke occurs as a result of bleeding from a burst blood vessel, in or around the brain. About 15 in every 100 strokes are haemorrhagic.

Stroke is often considered an illness of old age, but many younger people are also affected by stroke. In fact, the number of younger people having a stroke is increasing. About 1 in 4 people who have a stroke are below the age of 65.

What are the signs and symptoms of a stroke or TIA?

A stroke is a medical emergency. Urgent treatment is essential because the sooner a person receives treatment for a stroke, the better the outcome is likely to be.

In the early stages it is not possible to tell whether you are having a stroke or a TIA as the symptoms for both are the same.

If you think that you or someone else is having a stroke or TIA, phone 999 immediately and ask for an ambulance.

The signs and symptoms of strokes and TIAs include:

• Sudden weakness or numbness, especially on one side of the body. It could be the face, arm, leg, or a combination of these.
• Sudden blurred vision or loss of sight in part of the eye, one eye or both eyes.
• Sudden confusion, difficulty speaking or understanding.
• Sudden dizziness, loss of balance or lack of co-ordination.
• Sudden severe headache with no known cause.
• Sudden change to facial expression or inability to smile.

If you have any of these symptoms, even for just a short amount of time, call 999 and ask for an ambulance.

What happens after a stroke?

When you have had a stroke, you should go straight to hospital by emergency ambulance. Usually you will be admitted to a specialist stroke ward, but you may also go to the A&E department or another assessment ward first.

Doctors will begin by performing tests to confirm what type of stroke you have had. This will usually be either a CT scan or MRI scan to help determine if your stroke was caused by a clot or a bleed.

You may also have other tests, including blood pressure checks, blood tests, chest x-rays and electrocardiograms (ECG).

In the first 48 hours after your stroke, an initial assessment will be carried out to find out how the stroke has affected you. This may include:

• A swallowing test to make sure it is safe for you to eat or drink normally without choking
• A mobility assessment to see whether you have difficulties moving your limbs, hands and feet
• A communication and cognitive assessment to check whether your speech or understanding have been affected
• A pressure risk assessment to make sure you are not at risk of pressure sores
• A continence assessment to see if you are having difficulties controlling your bladder or bowels
• A nutrition and hydration assessment in case you need extra fluids or dietary supplements

Your initial treatment will depend on what type of stroke you have had. If your stroke was caused by a bleed (haemorrhagic stroke) you may be considered for surgical treatment.

If your stroke was caused by a clot (ischaemic stroke) you may be offered a clot-busting treatment called Thrombolysis or a specialist procedure called Thrombectomy to remove the clot. Other treatment options include blood-thinning treatment, cholesterol-lowering medicines called statins, carotid endarterectomy (an operation to unblock narrowed arteries in your neck) or decompressive surgery to release pressure on your brain.

Recovery and rehabilitation after stroke

Everyone’s recovery after a stroke is different. You may make a full recovery within weeks, or it may take you much longer. Some people, especially if you have had a severe stroke, never make a full recovery and are left with long-term disabilities.

In the first few days and weeks you may be very tired and emotional. This is normal. Pace yourself and allow plenty of time to rest, as well as time to try various activities and therapies as recommended by your healthcare professionals.

Even in the early days, it is important to try to avoid prolonged time in bed if you can. Moving as much as you can is really important because it:

• Helps prevent limbs becoming stiff and sore
• Helps recover posture, balance and movement
• Can make it easier to eat and drink
• Reduces the risk of blood clots in the legs
• Reduces the risk of developing chest infections

With help and support from your stroke team, you should start to notice improvements in the weeks following your stroke. Remember that recovery can be a long process and everyone is different, so don’t feel disheartened if it takes months or even years to see certain improvements.

Regular practice of physiotherapy, occupational therapy and speech exercises can help to keep you motivated. Your stroke team will help you find exercises, therapy and activities which work for you.

Longer-term, rehabilitation can help you to cope and adapt to your situation. You will be helped to relearn or adapt skills so that you can be as independent as possible after your stroke. This can be done in hospital, in an out-patient clinic or at home with the support of community therapists.

At Chest Heart & Stroke Scotland, we offer a range of stroke rehabilitation services across Scotland to help you recover when you get home from hospital. This can help with everything from communication difficulties to problems with movement, vision, memory or thinking.

Returning home after a stroke

When you leave hospital, you should have a discharge plan from your stroke team. This covers the practical help and support you might need at home.

It can be a daunting time for you and your family, but we’re here to support you as you return home from hospital. Give our Advice Line nurses a call on 0808 801 0899 to find out more about how we can help you, including:

• Providing free, confidential advice over the phone
• Support from our stroke nurses and community support workers
• Referral to your local peer support group to meet other people who understand what you’re going through
• Being matched with one of our Kindness Volunteers for a regular phone call to combat isolation and loneliness

Don’t forget, you can also contact your GP for advice about your health or to get referrals to other healthcare services, and your pharmacist can give you advice and information about any medicines you have to take.

Support to help you manage at home can be arranged through your local council’s social work department (sometimes called social care or social services). Services to help you live as independently as possible include help with washing and dressing, help with housework and shopping, day care services, respite care, advice on transport, housing and equipment and information on benefits.

How a stroke can affect you

A stroke can affect the way your body works as well as how you feel, think and communicate. It affects everyone in different ways.

How you are affected will depend on which part of your brain has been damaged and how severe your stroke is. Specific areas of your brain control specific tasks in your body such as vision, memory, speech or hearing.

Although all strokes are different, there are some common effects that people experience frequently after a stroke. These include:

• Muscle weakness or loss of movement
• Problems with balance and movement
• Communication difficulties
• Swallowing difficulties
• Changes in thinking and behaviour
• Tiredness and fatigue
• Pain including central post-stroke pain (CPSP)
• Loss of bladder and bowel control
• Altered vision

Life after a stroke

For the first few weeks and months, it’s likely you’ll be focused on relearning old skills or learning new ones. It’s important to pace yourself and ask for help when you need it, to make sure you can rebuild your life and get back to doing the things you love.

Daily life is likely to look a little bit different, but we’re here to help you recover well and enjoy life to the full.

Visit our Living with a Stroke Condition section for more information about how to manage your condition at home, how to stay well and reduce your risk of strokes.