If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.
If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.
Even if the symptoms of a stroke disappear while you are waiting for the ambulance to arrive, you or the person having the stroke should still go to hospital for an assessment. Symptoms that disappear may mean you have had a transient ischaemic attack (TIA) and you could be at risk of having a full stroke at a later stage.
After an initial assessment, you may need to be admitted to hospital to receive a more in-depth assessment and, if necessary, for specialist treatment to begin.
Recognising the signs and symptoms of a stroke
The signs and symptoms of a stroke vary from person to person but usually begin suddenly. As different parts of your brain control different parts of your body, your symptoms will depend upon the part of your brain affected and the extent of the damage.
The main stroke symptoms can be remembered with the word FAST: Face-Arms-Speech-Time.
- Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
- Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
- Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
- Time – it is time to dial 999 immediately if you see any of these signs or symptoms
It is important for everyone to be aware of these signs and symptoms. If you live with or care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure, being aware of the symptoms is even more important.
Symptoms in the FAST test identify about nine out of 10 strokes.
Other signs and symptoms may include:
- numbness or weakness resulting in complete paralysis of one side of the body
- sudden loss of vision
- communication problems, difficulty talking and understanding what others are saying
- problems with balance and coordination
- difficulty swallowing
- sudden and severe headache, unlike any the person has had before, especially if associated with neck stiffness
- blacking out (in severe cases)
'Mini-stroke' or transient ischaemic attack (TIA)
The symptoms of a transient ischaemic attack (TIA) are the same as a stroke, last from between a few minutes to a few hours, then completely disappear. However, never ignore a TIA as it is a serious warning sign there is a problem with the blood supply to your brain.
There is about a one in 10 chance those who have a TIA will experience a full stroke during the four weeks following the TIA. If you have had a TIA, you should contact your GP, local hospital or out-of-hours service, as soon as possible.
Read more about types of stroke at The Stroke Association.
Stroke is a largely preventable condition. Many of the risks can be reduced by making lifestyle changes.
Stroke is a largely preventable condition. Many risks can be reduced by making lifestyle changes.
However, some things that increase the risk of stroke cannot be changed, including:
- age – you are more likely to have a stroke if you are over 65 years old, although about a quarter of strokes happen in younger people
- family history – if a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher
- ethnicity – if you are south Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups
- your medical history – if you have previously had a stroke, TIA or heart attack, your risk of stroke is higher
Ischaemic strokes, the most common type of stroke, occur when blood clots block the flow of blood to the brain. Blood clots typically form in areas where the arteries have been narrowed or blocked by fatty cholesterol-containing deposits known as plaques. This narrowing of the arteries is caused by atherosclerosis.
As we get older our arteries become narrower, but certain things can dangerously accelerate the process. These risks include:
- high blood pressure (hypertension)
- high cholesterol levels (often caused by a high-fat diet, but can result from inherited factors)
- a family history of heart disease or diabetes
- excessive alcohol intake (which can also make obesity and high blood pressure worse, as well as causing heart damage and an irregular heartbeat)
Diabetes is also a risk factor, particularly if poorly controlled, as the excess glucose in the blood can damage the arteries.
Another possible cause of ischaemic stroke is an irregular heartbeat (atrial fibrillation), which can cause blood clots that become lodged in the brain. Atrial fibrillation can be caused by:
- high blood pressure
- coronary artery disease
- mitral valve disease (disease of the heart valve)
- cardiomyopathy (wasting of the heart muscle)
- pericarditis (inflammation of the bag surrounding the heart)
- hyperthyroidism (overactive thyroid gland)
- excessive alcohol intake
- drinking lots of caffeine; for example, tea, coffee and energy drinks
Haemorrhagic strokes (also known as cerebral haemorrhages or intracranial haemorrhages) usually occur when a blood vessel in the brain bursts and bleeds into the brain (intracerebral haemorrhage). In about 5% of cases, the bleeding occurs on the surface of the brain (subarachnoid haemorrhage).
The main cause of haemorrhagic stroke is high blood pressure (hypertension), which can weaken the arteries in the brain and make them prone to split or rupture.
Things that increase the risk of high blood pressure include:
- being overweight or obese
- drinking excessive amounts of alcohol
- a lack of exercise
- stress, which may cause a temporary rise in blood pressure
Another important risk of haemorrhagic stroke is treatment with medicines given to prevent blood clots, such as warfarin.
Haemorrhagic stroke can also occur from the rupture of a balloon-like expansion of a blood vessel (aneurysm) and badly-formed blood vessels in the brain.
A traumatic head injury can also cause bleeding into the brain. In most cases, the cause is obvious, but bleeding into the lining of the brain (subdural haematoma) can occur without any obvious signs of trauma, especially in the elderly. The symptoms and signs can then mimic a stroke.
Effective treatment of stroke has been found to prevent long-term disability and save lives.
Ischaemic strokes can be treated using a 'clot-busting' medicine called alteplase, which dissolves blood clots (thrombolysis). However, alteplase is only effective if started during the first four and a half hours after the onset of the stroke. After that time, the medicine has not been shown to have beneficial effects. Even within this narrow time frame, the quicker alteplase can be started the better the chance of recovery. However, not all patients are suitable for thrombolysis treatment.
You will also be given a regular dose of aspirin (an anti-platelet medication), as this makes the cells in your blood, known as platelets, less sticky, reducing the chances of further blood clots occurring. If you are allergic to aspirin, other anti-platelet medicines are available.
You may also be given an additional medication called an anticoagulant. Like aspirin, anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Heparin, warfarin and more recently rivaroxaban are examples of anticoagulants.
Anticoagulants are often prescribed for people who have an irregular heartbeat that can cause blood clots.
If your blood pressure is too high, you may be given medicines to lower it. Medicines that are commonly used include:
- thiazide diuretics
- angiotensin converting enzyme (ACE) inhibitors
- calcium channel blockers
Read more about treating high blood pressure.
If the level of cholesterol in your blood is too high, you will be given a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.
Some ischaemic strokes are caused by a narrowing in the carotid artery, which is an artery in the neck, which takes blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.
If the carotid stenosis is particularly bad, surgery may be used to unblock the artery. This is done using a surgical technique called a carotid endarterectomy. It involves the surgeon making an incision in your neck in order to open up the carotid artery and remove the fatty deposits.
Emergency surgery is often needed to treat haemorrhagic strokes to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.
During a craniotomy, a small section of the skull is cut away to allow the surgeon access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced.
Following a craniotomy, the patient may have to be placed on a ventilator. A ventilator is a machine that assists someone with their breathing. It gives the body time to recover by taking over its normal responsibilities, such as breathing, and it will help control any swelling in the brain.
The patient will also be given medicines, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring.
Transient ischaemic attack (TIA)
The treatment for a TIA involves addressing the risk factors that may have led to it, to try to prevent a bigger, more serious stroke.
If you have a TIA, the treatment you receive will depend on what caused it, but you will typically be given one of the medicines outlined above or a combination of them. So, if high blood pressure and high cholesterol levels put you at risk of having a stroke, you may be given a combination of statins and ACE inhibitors.
If the risk of a stroke is high due to a build-up of fatty plaques in your carotid artery, a carotid endarterectomy may be required.
The best way to prevent a stroke is to eat a healthy diet, exercise regularly, and avoid smoking and excessive consumption of alcohol.
The best way to prevent a stroke is to eat a healthy diet, exercise regularly and avoid smoking and excessive consumption of alcohol.
A poor diet is a major risk factor for a stroke. High-fat foods can lead to the build-up of fatty plaques in your arteries and being overweight can lead to high blood pressure.
A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (five portions a day) and whole grains. You should limit the amount of salt you eat to no more than 6g (0.2oz) a day because too much salt will increase your blood pressure. Six grams of salt is about one teaspoonful.
There are two types of fat – saturated and unsaturated. You should avoid food containing saturated fats because these will increase your cholesterol levels.
Foods high in saturated fat include:
- meat pies
- sausages and fatty cuts of meat
- ghee – a type of butter often used in Indian cooking
- hard cheese
- cakes and biscuits
- foods that contain coconut or palm oil.
However, a balanced diet should include a small amount of unsaturated fat, which will help reduce your cholesterol levels.
Foods high in unsaturated fat include:
- oily fish
- nuts and seeds
- sunflower, rapeseed, olive and vegetable oils
Combining a healthy diet with regular exercise is the best way to maintain a healthy weight. Having a healthy weight reduces your chances of developing high blood pressure.
Regular exercise will make your heart and blood circulatory system more efficient. It will also lower your cholesterol level and keep your blood pressure at a healthy level.
The recommended level of cholesterol is 5mmol/litre (5 millimoles per litre of blood).
Blood pressure is measured using two figures. One figure represents the pressure of the heart as it contracts to pump blood around the body. This is known as the systolic pressure. The second figure represents the pressure of the heart as it rests, expands and fills with blood, while waiting for the next contraction. This is known as the diastolic pressure.
For most people, an ideal blood pressure is a systolic pressure of 90-120 millimeters of mercury (mmHg) and a diastolic pressure of 60-80mmHg. Or, as blood pressure is normally expressed, a level between 90/60mmHg or 120/80mmHg.
For most people, at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week is recommended.
If you are recovering from a stroke, you should discuss possible exercise plans with the members of your rehabilitation team. Regular exercise may be impossible in the first weeks or months following a stroke but you should be able to begin exercising once your rehabilitation has progressed.
Read more about health and fitness.
Smoking doubles your risk of having a stroke. This is because it narrows your arteries and makes your blood more likely to clot.
If you stop smoking, you can reduce your risk of having a stroke by up to half. Not smoking will also improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease.
The NHS Smoking Helpline can offer advice and encouragement to help you quit smoking. You can call on 0300 123 1044, or visit NHS Smokefree.
Read more about stopping smoking.
Excessive alcohol consumption can lead to high blood pressure and an irregular heartbeat (atrial fibrillation). Both are major risk factors for stroke.
Because alcoholic drinks are rich in energy (high in calories) they also cause weight gain. Heavy drinking multiplies the risk of stroke by more than three times.
Read more about alcohol.
There are some complications that can arise as a result of a stroke, many of which are potentially life threatening.
There are complications that can arise as a result of a stroke, many of which are potentially life threatening.
The damage caused by a stroke can interrupt your normal swallowing reflex, making it possible for small particles of food to enter your respiratory tract (windpipe).
To prevent any complications from dysphagia, you may be fed using a feeding tube. The tube is usually put into your nose and then passed into your stomach, but it may be directly connected to your stomach during surgery.
How long you will need a feeding tube can vary from a few weeks to a few months, but it is rare to have to use a tube for more than six months.
Hydrocephalus is a condition that occurs when there is too much cerebrospinal fluid in the cavities (ventricles) of the brain. About 10% of people who experience a haemorrhagic stroke will develop hydrocephalus.
Cerebrospinal fluid (CSF) is produced in the brain to protect it and the spinal cord and carry away waste from brain cells. CSF flows continuously through the ventricles and over the surface of the brain and spinal cord. Any excess CSF usually drains away from the brain and is absorbed by the body.
Damage caused by a haemorrhagic stroke can stop the CSF from draining, and an excess of fluid can build up. Symptoms include:
- sickness and vomiting
- loss of balance
However, the condition can be treated by placing a tube into the brain to allow the fluid to drain properly.
Deep vein thrombosis
Around 5% of people who have had a stroke will experience a further blood clot in their leg, known as deep vein thrombosis (DVT).
This normally occurs in people who have lost some or all of the movement in their leg, as immobility will slow the blood flow in their veins, increasing blood pressure and the chances of a blood clot.
Symptoms of DVT include:
- warm skin
- redness, particularly at the back of the leg, below the knee
If you have DVT, prompt treatment is required because there is a chance the clot may move into your lungs, which is known as a pulmonary embolism and can be fatal.
DVT can be treated using anti-clotting medicines. If it is felt that you are at risk of DVT, your stroke team may recommend you wear a compression stocking. This is a specially designed stocking that can reduce the blood pressure in your legs.
Having a stroke on the first day of his summer holiday was the last thing Stephen Harnet expected, especially as he was a healthy 32-year-old at the time
Having a stroke on the first day of his summer holiday was the last thing Stephen Harnet expected, especially as he was a healthy 32-year-old at the time.
”I’d taken my wife and baby boy for a week in Spain. We’d been there less than 12 hours when I collapsed on the street. I was rushed to a hospital in Barcelona and I lay there in a coma for 72 hours.
“It turned out that the stroke was due to a condition I was born with called AVM (arteriovenous malformation), which is a tangle of abnormal blood vessels (arteries and veins), and can affect the brain and lead to a stroke.
“Hospital staff didn’t think I was going to make it during those critical hours. They kept saying to my wife, ‘No good, no good.’ I don’t know how she kept it together.
“Luckily, I did pull through. I had a life-saving operation on my brain and was then air-ambulanced home to the Queen Elizabeth Hospital in Birmingham, where I spent the next three months.
“I don’t remember much about that time, but I do recall a lot of people saying I might not walk or talk again. But those words of doubt spurred me on; I was determined to lead a normal life.
“Every day I faced a new challenge, but as the weeks went by I accomplished so much. The more I succeeded the more I wanted to do. I even shocked medical staff by becoming a dad again, which they had said I wouldn’t be able to do.
“Before the stroke I was a technical manager working 12-hour days, seven days a week. I knew I wouldn’t be able to do that again. I took a computer course and applied for administrative jobs. Now I have a paid part-time job as a medical records assistant at my rehabilitation centre.
“I also do voluntary work with other stroke victims. When I was really poorly it gave me so much hope when I met people who’d had the same experience but had turned their lives around. I wanted to do the same for others. I truly believe that positivity is the best medicine – there’s only so much that medicine can do.
“I’ve been through a hard time, but I really believe that, in some ways, my stroke made me a better person. I now know what’s important in life and try to enjoy every minute.”
David Diston, 61, runs a Salvation Army hostel in Swindon. He had a major stroke that left him paralysed down his right side and unable
David Diston, 61, runs a Salvation Army hostel in Swindon. He had a major stroke that left him paralysed down his right side and unable to speak. Now he has made a near total recovery, and has even run a marathon
When David crossed the finishing line of the London Marathon, after a gruelling eight hours, 23 minutes and 15 seconds, he was entitled to feel proud. It was just two-and-a-half years since he had suffered a major stroke.
“I’m sure the doctors thought I wouldn’t get better, let alone run a marathon,” says David.
David was overweight, had high blood pressure and had begun to have symptoms of stroke, such as episodes of blurred vision, as long as 10 years earlier. His daughter, cousin, father and aunt have all had strokes, yet he was never diagnosed as being at high risk. Indeed, he was feeling well when he suddenly dropped to the floor in what must have looked like a dead faint.
He woke up in an assessment ward at Swindon’s Princess Margaret Hospital. He had no feeling or movement down his right side, and he couldn’t speak.
“I wanted to ask for a coffee and I could read the word on the hospital menu, but I couldn’t say it. I couldn’t walk, I couldn’t go to the loo on my own, or even do up my trousers. Worst of all, I couldn’t tell anyone how embarrassed I felt.
“After a few days, I was moved to a specialist stroke unit where the doctors explained that I would have to learn to speak, write and walk again from scratch. The lessons began quickly, and I was soon having daily physiotherapy to strengthen my right arm and leg. I also had speech therapy a few times a week.”
After four weeks, David was allowed home. “I had to make a cup of tea, walk up four stairs and do some clearing up, otherwise they wouldn’t have let me leave.
"Although I still couldn’t write more than two or three letters of the alphabet, I could read, and this helped me re-learn how to write letters and numbers. A speech therapist and physiotherapist came to the house two or three times a week for three months. After that, I continued to go to the hospital for physio and speech therapy.
“The doctors explained that my family history of strokes and being so overweight meant I had to change my diet and start exercising. I was 127kg (20st) and only 1.73m (5ft 8in). I follow a low-fat diet and eat far more fruit and veg and have lost five stone. I run up to 10 miles several times a week. I also go to the gym and use weight machines to carry on strengthening my right arm and leg.
“Now, no one knows I’ve had a stroke, unless I choose to tell them."
stroke victim's own story, ischaemic, physiotherapy,smoker
Before June 17 2000, Jane Stokes CBE was a successful lawyer with a 25-year career in the civil service.
She was highly driven and passionate, working up to 15 hours a day as a legal advisor in the Treasury Solicitor’s Department. That stopped suddenly one Monday morning.
Jane, 52 at the time, was getting ready for work when she collapsed in her bathroom in Dulwich, south London.
She might not have been here today if two concerned colleagues hadn't travelled to her house when she didn't turn up for work.
“I was on the bathroom floor, going in and out of consciousness and unable to move,” she says. “I lived alone so there was no one I could call out to for help.”
By the time Jane reached King’s College Hospital, it had been more than three hours since the stroke, a delay which may have increased the brain damage.
Jane had had an ischaemic stroke (a blood clot in the brain) and she was given statins and aspirin to thin the blood. Once her condition was stable, she began rehabilitation and spent seven months in hospital.
“I was devastated,” she says. “I thought, 'The career is finished.’ But I tried to remain positive and take one day at a time.”
Her parents, who lived in Bournemouth, came up to visit her three days a week. Jane says the support from her family and close friends was vital for helping her recovery. “They were fantastic,” she says.
In hospital, Jane received physiotherapy, occupational therapy (including relearning everyday tasks in the home) and speech and language therapy.
She had lost the movement down her right side and had a severe speech disability.
“Doctors said I had had a massive stroke,” says Jane. “I was almost dead. It was more than three hours before I received any treatment.”
'I don’t know what keeps me going, but I just think it’s good to be here.'
She says her lifestyle may have raised her risk of a stroke. As a smoker, she had developed a two-pack-a-day habit. She drank moderately and neglected her fitness when her career began to take over.
“I was working up to 15 hours a day, seven days a week,” she says. “I was driven and I enjoyed the challenge.”
Recovery is a long process. Jane's speech was severely affected and she found it frustrating when she could not find the words to express what she was thinking.
Jane now dedicates her time to volunteering for Connect, a charity that provides support services and information for people recovering from a stroke. “I’ve stopped smoking. “That was no problem. I drink moderately and keep fit, mainly through walking."
Keeping her spirits up isn’t always easy. “I try to stay positive but sometimes I feel down in the dumps,” she says.
"I don’t know what keeps me going, but I just think it’s good to be here.”