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. This can damage or even kill some of your brain cells, which causes different effects depending on where it happens in your brain.

There are two types of strokes:

• Ischaemic stroke – one or more of the arteries carrying blood to the brain are blocked by a blood clot. About 85 in every 100 strokes are ischaemic.
• Haemorrhagic stroke – one or more blood vessels around the brain bursts, causing bleeding. About 15 in every 100 strokes are haemorrhagic.

Stroke is often associated with 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 now below the age of 65.

What is a TIA?

A transient ischaemic attack (also known as a TIA or mini-stroke) is the same as a stroke, but the blood supply is only disrupted for a short time, and usually not completely. Symptoms usually pass in less than 24 hours.

Although the symptoms do not last long, a TIA should be taken seriously. It is a sign of a deeper problem with your brain circulation. It is important not to ignore the symptoms of a TIA, even if they are mild and pass quickly – you could be at risk of having a more severe stroke in the near future. More than 1 in 12 people will have a full stroke within a week of having a TIA.

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

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.

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 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. You will usually be taken to a specialist stroke ward, but you may need to 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 include either a CT scan or MRI scan, which will help to determine whether 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 difficulty moving your limbs, hands, and feet
• A communication and cognitive assessmentto check whether your speech or understanding have been affected by the stroke
• 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 to repair the damaged blood vessel(s).

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 when their stroke was severe, 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 a normal reaction to what is often a traumatic event. 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 move around as much as you can, even if you cannot get out of bed. This:

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

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’s recovery is different – don’t feel disheartened if it takes months or even years to see a particular improvement.

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

Longer-term, rehabilitation can help you to cope and adapt to your situation. Rehabilitation specialists can help you to relearn or adapt skills, so 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. We 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.

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

• Providing free, confidential advice over the phone
• Support from our stroke nurses and community support workers
• Referral to your local peer support group, where you can 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

Remember, 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
• 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. Stroke symptoms affect 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, some common effects of a stroke 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 is likely you’ll be focused on relearning old skills or learning new ones. It is 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 are here to help you recover 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.