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Stroke

A stroke is a serious and life-threatening medical condition that occurs when the blood supply to part of the brain is cut off.

A stroke is a serious, life-threatening medical condition that occurs when the blood supply to part of the brain is cut off.

Strokes are a medical emergency and urgent treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen.

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

Signs and symptoms

The main symptoms of stroke 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 dropped.
  • Arms  the person with suspected stroke may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm.
  • 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.

Read more about the symptoms of a stroke.

Why do strokes happen?

Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain injury, disability and possibly death.

There are two main causes of strokes:

  • ischaemic  where the blood supply is stopped due to a blood clot (this accounts for 85% of all cases)
  • haemorrhagic  where a weakened blood vessel supplying the brain bursts

There is also a related condition known as a transient ischaemic attack (TIA), where the supply of blood to the brain is temporarily interrupted, causing a 'mini-stroke' often lasting between 30 minutes and several hours. TIAs should be treated seriously as they are often a warning sign that you are at risk of having a full stroke in the near future.

Read more about the causes of strokes.

Who is at risk?

In the UK, strokes are a major health problem. Every year, around 110,000 people have a stroke in England and it is the third largest cause of death, after heart disease and cancer. The brain injuries caused by strokes are a major cause of adult disability in the UK.

Older people are most at risk of having strokes, although they can happen at any age – including in children.

If you are south Asian, African or Caribbean, your risk of stroke is higher. This is partly because of a predisposition (a natural tendency) to developing high blood pressure (hypertension), which can lead to strokes.

Smoking, being overweight, lack of exercise and a poor diet are also risk factors for stroke, as are high cholesterol, atrial fibrillation and diabetes.

How strokes are treated

Treatment depends on the type of stroke you have, including which part of the brain was affected and what caused it.

Most often, strokes are treated with medication. This generally includes medicines to prevent and remove blood clots, reduce blood pressure and reduce cholesterol levels.

In some cases, surgery may be required to treat brain swelling and reduce the risk of further bleeding in cases of haemorrhagic strokes.

Read more about diagnosing strokes and treating strokes.

Life after a stroke

Around one in every four people who has a stroke will die, and those who do survive are often left with long-term problems resulting from the injury to their brain.

Some people need to have a long period of rehabilitation before they can recover their former independence, while many will never fully recover and will need support adjusting to living with the effects of their stroke.

Around half the people who have a stroke will be dependent on some form of care for help with their daily activities.

The process of rehabilitation will be specific to you, and will depend on your symptoms and how severe they are. A team of specialists are available to help, including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors.

Read more about recovering from a stroke.

Can strokes be prevented?

You can significantly reduce your risk of having a stroke through a healthy lifestyle, such as eating a healthy diet, taking regular exercise, drinking alcohol in moderation and not smoking.

Lowering high blood pressure and cholesterol levels with medication also lowers the risk of stroke substantially, as does taking anticoagulant medication if you have an irregular heartbeat due to a condition called atrial fibrillation.

If you have had a stroke or TIA in the past, these measures are particularly important because your risk of having another stroke in the future is greatly increased.

Read more about preventing strokes.


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Stroke

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 quickly (and in less than 24 hours) may mean you have had a transient ischaemic attack (TIA) and you could be at risk of having a full stroke in the near future.

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 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 on 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 both arms and keep them there because of arm weakness or numbness in one arm.
  • 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 notice 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.

Other possible symptoms

Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause different symptoms.

Other symptoms and signs may include:

  • complete paralysis of one side of the body
  • sudden loss or blurring of vision 
  • dizziness
  • confusion
  • difficulty understanding what others are saying
  • problems with balance and co-ordination 
  • difficulty swallowing (dysphagia)
  • a sudden and very severe headache resulting in a blinding pain unlike anything experienced before
  • loss of consciousness

However, there are usually other causes for these symptoms.

'Mini-stroke' or transient ischaemic attack (TIA)

The symptoms of a TIA are the same as a stroke, but they tend to only last between a few minutes and a few hours before disappearing completely.

Although the symptoms do improve, a TIA should never be ignored as it is a serious warning sign there is a problem with the blood supply to your brain and means you are at an increased risk of having a stroke in the near future.

If you have had a TIA, you should contact your GP, local hospital or out-of-hours service, as soon as possible.


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Stroke

There are two main types of stroke - ischaemic strokes and haemorrhagic strokes - which affect the brain in different ways and can have different causes.

There are two main types of stroke – ischaemic strokes and haemorrhagic strokes – which affect the brain in different ways and can have different causes. 

Ischaemic strokes

Ischaemic strokes are the most common type of stroke. They occur when a blood clot blocks the flow of blood and oxygen to the brain.

These blood clots typically form in areas where the arteries have been narrowed or blocked over time by fatty deposits known as plaques. This process is known as atherosclerosis.

As you get older, the arteries can naturally narrow, but certain things can dangerously accelerate the process. These include:

Another possible cause of ischaemic stroke is a type of irregular heartbeat called atrial fibrillation, which can cause blood clots in the heart that break up and escape from the heart and become lodged in the blood vessels supplying the brain.

Atrial fibrillation can have a number of different causes, including lung disease, heart valve disease, excessive alcohol intake, coronary heart disease, and an overactive thyroid gland  (hyperthyroidism). Read more about the causes of atrial fibrillation.

Haemorrhagic strokes

Haemorrhagic strokes (also known as cerebral haemorrhages or intracranial haemorrhages) are less common than ischaemic strokes. They occur when a blood vessel within the skull bursts and bleeds into and around the brain.

The main cause of haemorrhagic stroke is high blood pressure, 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 
  • smoking
  • a lack of exercise 
  • stress, which may cause a temporary rise in blood pressure

Haemorrhagic strokes can also occur as the result of the rupture of a balloon-like expansion of a blood vessel (brain aneurysm) and badly-formed blood vessels in the brain.

Can I reduce my risk?

It's not possible to completely prevent strokes because some things that increase your risk of the condition 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, transient ischaemic attack (TIA) or heart attack, your risk of stroke is higher

However, in most cases it is possible to significantly reduce your risk of having a stroke by making lifestyle changes to avoid problems such as atherosclerosis and high blood pressure. This includes things such as having a healthy diet, exercising regularly, stopping smoking if you smoke and cutting down on the amount of alcohol you drink.

As atrial fibrillation can also significantly increase your risk of having a stroke, it is also important to seek medical advice if you think you may have an irregular heartbeat. If you are diagnosed with the condition, you should talk to your doctor about the option of taking anticoagulant medications to lower your stroke risk.

Read more about preventing strokes.


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Stroke

Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan.

Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan.

When you first arrive at hospital with a suspected stroke, a doctor will usually want to find out as much as they can about your symptoms.

A number of tests can then be carried out to help confirm the diagnosis and determine the cause of the stroke.

This may include blood tests to determine your cholesterol and blood sugar levels, checking your pulse for an irregular heartbeat and taking a blood pressure measurement.

Brain scans

Even if the physical symptoms of a stroke are obvious, brain scans should also be carried out to determine:

  • if the stroke has been caused by a blocked artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke)
  • which part of the brain has been affected
  • how severe the stroke is

Different treatment is required for the different types of stroke, so a rapid diagnosis will make treatment more straightforward.

Everyone with suspected stroke should receive a brain scan within 24 hours and some people should be scanned within an hour of the onset of symptoms, especially those who:

  • might benefit from clot-busting drugs (thrombolysis) such as alteplase or early anticoagulant treatment
  • are already on anticoagulant treatments
  • have a lower level of consciousness

This is why a stroke is a medical emergency and why 999 should be dialled when a stroke is suspected – there isn’t time to wait for a GP appointment.

The two main types of scan used to assess the brain in people who have had a suspected stroke are a computerised tomography (CT) scan and a magnetic resonance imaging (MRI) scan. The type of scan you may have largely depends on your symptoms.

CT scans

A CT scan is like an X-ray, but uses multiple images to build up a more detailed, three-dimensional picture of your brain to help your doctor identify any problem areas.

During the scan, you may be given an injection of a special dye into one of the veins in your arm to help improve the clarity of the CT image and look at the blood vessels that supply the brain.

If it is suspected you are experiencing a major stroke, a CT scan is usually able to show whether you have had an ischaemic stroke or a haemorrhagic stroke. It's generally quicker than an MRI scan and can mean you are able to receive appropriate treatment sooner.

MRI scans

An MRI scan uses a strong magnetic field and radio waves to produce a detailed picture of the inside of your body.

For people with more complex symptoms, where the extent or location of the damage is unknown – and in people who have recovered from a transient ischaemic attack (TIA) – an MRI scan is more appropriate. This will provide greater detail of brain tissue, allowing smaller, or more unusually located areas affected by a stroke to be identified.

As with a CT scan, special dye can be used to improve MRI scan images.

Swallow tests

A swallow test is essential for anybody who has had a stroke, as swallowing ability is commonly affected early after a stroke.

When a person cannot swallow properly, there is a risk that food and drink may get into the windpipe and then into the lungs (called aspiration), which can lead to chest infections such as pneumonia.

The test is simple. The person is given a few teaspoons of water to drink. If they can swallow this without choking and coughing they will be asked to swallow half a glass of water.

If they have any difficulty swallowing, they will be referred to the speech and language therapist for a more detailed assessment.

They will usually not be allowed to eat or drink normally until they have seen the therapist and may therefore need to have fluids or food given directly into an arm vein (intravenously) or through a tube inserted into their stomach via their nose.

Heart and blood vessel tests 

Further tests on the heart and blood vessels might be carried out later to confirm what caused your stroke. Some of the tests that may be carried out are described below.

Carotid ultrasound

A carotid ultrasound scan can help show if there is any narrowing or blockages in the neck arteries leading to your brain.

An ultrasound scan involves using a small probe (transducer) to send high-frequency sound waves into your body. When these sound waves bounce back, they can be used to create an image of the inside of your body.

When carotid ultrasonography is needed, it should happen within 48 hours.

Echocardiography

In some cases another type of ultrasound scan called an echocardiogram may be carried out to produce images of your heart and check for any problem with it that could be related to your stroke.

This will normally involve using an ultrasound probe moved across your chest (transthoracic echocardiogram).

In some cases, an alternative type of echocardiogram called transoesophageal echocardiography (TOE) may also be used.

This involves passing an ultrasound probe down your gullet (oesophagus), usually under sedation. As this allows the probe to be placed directly behind the heart, it produces a clear image of blood clots and other abnormalities that may not get picked up by a transthoracic echocardiogram.


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Stroke

Effective treatment of stroke can prevent long-term disability and save lives.

Treating ischaemic strokes

If you have had an ischaemic stroke, a combination of medications to treat the condition and prevent it from happening again will usually be recommended.

Some of these medications will need to be taken immediately and only for a short time, while others may only be started once the stroke has been treated and may need to be taken in the long-term.

Thrombolysis

Ischaemic strokes can often be treated using injections of a medication called alteplase that dissolves blood clots and restores the flow of blood to the brain. This use of 'clot-busting' medication is known as thrombolysis.

Alteplase is most effective if started as soon as possible after the stroke occurs and is not generally recommended if more than four and a half hours have passed because it's not clear how beneficial it is when used after this time.

However, before alteplase can be used, it is very important that a brain scan to confirm a diagnosis of an ischaemic stroke is carried out because the medication can make the bleeding that occurs in haemorrhagic strokes worse.

Antiplatelets

Most people will also be offered a regular dose of aspirin which – as well as being a painkiller – makes the cells in your blood called platelets less sticky, reducing the chances of another clot forming.

In addition to aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.

Anticoagulants

Some people may also be offered an additional medication called an anticoagulant to help reduce their risk of developing further blood clots in the future.

Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Warfarin, rivaroxaban, dabigatran and apixaban are examples of anticoagulants for long term use. There are also a number of anticoagulants called heparins that can only be given by injection and are used in the short-term.  

Anticoagulants may be offered if you:

  • have a type of irregular heartbeat called atrial fibrillation that can cause blood clots
  • have a history of blood clots
  • are at risk of developing clots in your leg veins – known as deep vein thrombosis (DVT) – because a stroke has left you unable to move one of your legs

Antihypertensives

If your blood pressure is too high, you may be offered medicines to lower it. Medicines that are commonly used include:

  • thiazide diuretics
  • angiotensin-converting enzyme (ACE) inhibitors
  • calcium channel blockers
  • beta-blockers
  • alpha-blockers

Read more about treating high blood pressure.

Statins

If the level of cholesterol in your blood is too high, you will be advised to take 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.

You may be offered a statin even if your cholesterol level is not particularly high, because a statin may help reduce your risk of stroke whatever your cholesterol level is.

Carotid endarterectomy

Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries 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 severe, surgery may be offered 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 to open up the carotid artery and remove the fatty deposits.

Treating haemorrhagic strokes

As with ischaemic strokes, some people who have had a haemorrhagic stroke will also be offered medication, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring.

If you were previously taking anticoagulant medicine before you had your stroke, you may also need treatment to reverse the effects of the medication and reduce your risk of further bleeding.

Surgery

Occasionally, emergency surgery may be needed 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 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, often by an artificial metal plate.

Surgery for hydrocephalus

Surgery can also be carried out to treat a complication of haemorrhagic strokes called hydrocephalus.

This is where damage resulting from a stroke causes cerebrospinal fluid to build up in the cavities (ventricles) of the brain, causing symptoms such as headaches, sickness, vomiting and loss of balance.

Hydrocephalus can be treated by surgically placing an artificial tube called a shunt into the brain to allow the fluid to drain properly.

Read more about treating hydrocephalus.

Supportive treatments

In addition to the treatments mentioned above, you may also need further short-term treatment to help manage some of the problems that can affect people who have had a stroke.

For example, you may require:

  • a feeding tube inserted into your stomach through your nose (nasogastric tube) to provide nutrition if you have difficulty swallowing (dysphagia)
  • nutritional supplements if you are malnourished
  • fluids given directly into a vein (intravenously) if you are at risk of dehydration
  • oxygen through a nasal tube or face mask if you have low levels of oxygen in your blood

For more information about the supportive treatments you may need in the long-term to help you manage the lasting effect of a stroke, see recovering from a stroke.

What is good stroke care?

The National Stroke Strategy, published in December 2007, provides a guide to high quality health and social care for those affected by stroke. Stroke experts have set out standards which define good stroke care, including:

  • a rapid response to a 999 call for suspected stroke
  • prompt transfer to a hospital providing specialist care
  • an urgent brain scan – for example, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan undertaken as soon as possible
  • immediate access to a high quality stroke unit
  • early multidisciplinary assessment, including swallowing screening
  • stroke specialised rehabilitation
  • planned transfer of care from hospital to community and longer term support

The National Institute for Health and Care Excellence (NICE) has also produced guidelines on the diagnosis and management of stroke and a quality standard for stroke that describes the level of care the NHS is working towards.

If you are concerned about the standard of care provided, speak to your stroke specialist or a member of the stroke team.












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Stroke

The injury to the brain caused by a stroke can lead to widespread and long-lasting problems.

Psychological impact

Two of the most common psychological problems that can affect people after a stroke are:

  • depression – many people experience intense bouts of crying and feel hopeless and withdrawn from social activities 
  • anxiety where people experience general feelings of fear and anxiety, sometimes punctuated by intense, uncontrolled feelings of anxiety (anxiety attacks)

Feelings of anger, frustration and bewilderment are also common.

You will receive a psychological assessment from a member of your healthcare team soon after your stroke to check if you are experiencing any emotional problems.

Advice should be given to help deal with the psychological impact of stroke. This includes the impact on relationships with other family members and any sexual relationship. There should also be a regular review of any problems of depression and anxiety, and psychological and emotional symptoms generally.

These problems may settle down over time but if they are severe or last a long time, GPs can refer people for expert healthcare from a psychiatrist or clinical psychologist.

For some people, medicines and psychological therapies, such as counselling or cognitive behavioural therapy (CBT) can help. CBT is a therapy that aims to change the way you think about things to produce a more positive state of mind.

Want to know more?

Cognitive impact

'Cognitive' is a term used by scientists to refer to the many processes and functions our brain uses to process information.

One or more cognitive functions can be disrupted by a stroke, including:

  • communication  both verbal and written 
  • spatial awareness  having a natural awareness of where your body is in relation to your immediate environment 
  • memory 
  • concentration 
  • executive function  the ability to plan, solve problems and reason about situations 
  • praxis  the ability to carry out skilled physical activities, such as getting dressed or making a cup of tea

As part of your treatment, each one of your cognitive functions will be assessed and a treatment and rehabilitation plan will be created.

You can be taught a wide range of techniques that can help you re-learn disrupted cognitive functions, such as recovering communication skills through speech therapy (see below).

There are also many methods to compensate for any loss of cognitive function, such as using memory aids, diaries and routines to help plan daily tasks.

Most cognitive functions will return after time and rehabilitation but you may find that they do not return to their former levels.

The damage that a stroke causes to your brain also increases the risk of developing vascular dementia. The dementia may happen immediately after a stroke or may develop some time after the stroke occurred.

Want to know more?

Movement problems

Strokes can cause weakness or paralysis in one side of the body and can result in problems with co-ordination and balance.

Many people also experience extreme tiredness (fatigue) in the first few weeks after a stroke, and may also have difficulty sleeping, making them even more tired.

As part of your rehabilitation you should be seen by a physiotherapist, who will assess the extent of any physical disability before drawing up a treatment plan.

Physiotherapy will often involve several sessions a week, focusing on areas such as exercises to improve your muscle strength and overcome any walking difficulties.

The physiotherapist will work with you by setting goals. At first, these may be simple goals such as picking up an object. As your condition improves, more demanding long-term goals, such as standing or walking, will be set.

A careworker or carer, such as a member of your family, will be encouraged to become involved in your physiotherapy. The physiotherapist can teach you both simple exercises you can carry out at home.

If you have problems with movement, you may also receive help from an occupational therapist, who can assess your ability to carry out everyday tasks and help find ways to manage any difficulties.

Occupational therapy may involve adapting your home or using equipment to make everyday activities easier, as well as trying to find alternative ways of carrying out tasks you have problems with.

Want to know more?

Communication problems

After having a stroke, many people experience problems with speaking and understanding, as well as with reading and writing.

This is called aphasia, or dysphasia, when it is caused by injury to the parts of the brain responsible for language. If the problems are caused by muscles involved in speech being affected, this is known as dysarthria.

You should see a speech and language therapist as soon as possible for an assessment, and to start therapy to help you with communication skills.

This may involve exercises to improve your control over your speech muscles, as well as using communication aids (such as letter charts and electronic aids) and alternative methods of communication (such as gestures or writing).

Read more about treating aphasia.

Want to know more?

Swallowing problems

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).

Problems with swallowing are known as dysphagia. Dysphagia can lead to damage to your lungs, which can trigger a lung infection (pneumonia).

To prevent any complications from dysphagia, you may need to be fed using a feeding tube during the initial phases of your recovery. The tube is usually put into your nose and then passed into your stomach (nasogastric tube), but it may be directly connected to your stomach with a minor surgical procedure carried out using local anaesthetic (a percutaneous endoscopic gastrostomy, or PEG, tube).

In the long-term, you will usually see a speech and language therapist several times a week for treatment to help manage your swallowing problems. This may involve tips to make swallowing easier (such as taking smaller bites of food and advice on posture) and exercises to help improve your control of the muscles involved in swallowing.

Read more about treating dysphagia.

Want to know more?

Visual problems

Stroke can sometimes damage the parts of the brain that receive, process and interpret information sent by the eyes. This can result in losing half of the field of vision – for example only being able to see the left or right hand side of what is in front of you.

Strokes can also affect the control of the movement of the eye muscles. This can cause double vision. 

If you have any problems with your vision after a stroke, you will be referred to an eye specialist called an orthoptist who can assess your vision and suggest possible treatments.

For example, if you have lost part of your field of vision you may be offered eye movement therapy. This involves carrying out exercises to help you learn to look to the side with the reduced vision.

You may also be given advice about particular ways to perform tasks that can be difficult if your vision is reduced on one side, such as getting dressed.

Want to know more?

Bladder and bowel control

Some strokes damage the part of the brain that controls bladder and bowel movements. This can result in urinary incontinence and difficulty with bowel control.

Some people who have had a stroke may regain bladder and bowel control quite quickly, but if you still have problems after leaving hospital, help is available from the hospital, your GP and specialist continence advisors.

Don’t be embarrassed – seek advice if you have a problem as there are lots of treatments that can help. These include bladder retraining exercises, medications, pelvic floor exercises and the use of incontinence products.

Read more about treating urinary incontinence.

Want to know more?

Sex after a stroke

Having sex will not put you at higher risk of having a stroke.

There's no guarantee you won't have another stroke, but there's no reason why it should happen while you are having sex.

Even if you have been left with a severe disability, you can experiment with different positions and find new ways of being intimate with your partner.

Be aware that some medications can reduce your sex drive (libido), so make sure your doctor knows if you have a problem, there may be other medicines which can help.

Some men may experience erectile dysfunction after having a stroke. Speak to your GP or rehabilitation team if this is the case, as there are a number of treatments available that can help.

Read more about good sex and treating erectile dysfunction.

Want to know more?

Driving after a stroke

If you have had a stroke, you cannot drive for one month. Whether you can return to driving depends on what long-term disabilities you may have and the type of vehicle you drive.

It is often not the physical problems that can make driving dangerous (such as pressing the pedals or holding the steering wheel) but the problems with concentration, reaction time and awareness that can develop after a stroke.

Your GP can advise about whether you can start driving again a month after your stroke or whether you need further assessment at a mobility centre.

Want to know more?

Preventing further strokes

If you have had a stroke, your chances of having another one are significantly increased.

Some studies have shown that, without treatment, you have around a 25% chance of having another stroke within five years and a 40% chance of having one within 10 years.

Therefore, you will usually require long-term treatment with medications aimed at improving the underlying risk factors for your stroke.

For example, you may need long-term treatment with medication to help lower your blood pressure, with anticoagulants or antiplatelets to reduce your risk of blood clots, or with statins to lower your cholesterol levels.

You will also be encouraged to make lifestyle changes to improve your general health and lower your stroke risk, such as eating a healthy diet, exercising regularly, stopping smoking if you smoke and cutting down on the amount of alcohol you drink.

Read more about preventing strokes.

Caring for someone who has had a stroke

There are many ways you can provide support to a friend or relative who has had a stroke to speed up their rehabilitation process. These include:

  • helping to practice physiotherapy exercises in between their sessions with the physiotherapist
  • providing emotional support and reassurance their condition will improve with time
  • helping motivate the person to reach their long-term goals
  • adapting to any needs they may have, such as speaking slowly if they have communication problems

Caring for somebody after a stroke can be a frustrating and sometimes a lonely experience. The advice outlined below may help.

Be prepared for changed behaviour

Someone who has had a stroke can often seem as though they have had a change in personality and appear to act irrationally at times. This is due to the psychological and cognitive impact of a stroke. They may become angry or resentful towards you. Upsetting as it may be, try not to take it personally.

It is important to remember that a person will often start to return to their old self as their rehabilitation and recovery progresses.

Try to remain patient and positive

Rehabilitation can be a slow and frustrating process, and there will be periods of time when it appears little progress has been made.

Encouraging and praising any progress, no matter how small it may appear, can help motivate someone who has had a stroke to achieve their long-term goals.

Make time for yourself

If you are caring for someone who has had a stroke, it is important not to neglect your own physical and psychological wellbeing. Socialising with friends or pursuing leisure interests will help you cope better with the situation.

Ask for help

There are a wide range of support services and resources available for people recovering from strokes, and their families and carers. This ranges from equipment that can help with mobility, to psychological support for carers and families.

The hospital staff involved with the rehabilitation process can provide advice and relevant contact information.

Want to know more?





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Stroke

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 help prevent a stroke is to eat a healthy diet, exercise regularly and avoid smoking and drinking too much alcohol.

These lifestyle changes can reduce your risk of problems such as atherosclerosis (where arteries become clogged up by fatty substances), high blood pressure and high cholesterol levels, all of which are important risk factors for strokes.

If you have already had a stroke, making these changes can help reduce your risk of having another one in the future.

Diet

An unhealthy diet can increase your chances of having a stroke because it may lead to an increase in your blood pressure and cholesterol levels.

Therefore, a low-fat, high-fibre diet is usually recommended, including plenty of fresh fruit and vegetables (five portions a day) and whole grains.

Ensuring a balance in your diet is important. Don’t eat too much of any single food – particularly foods that are high in salt and processed foods.

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.

Read more about healthy eating and losing weight.

Exercise

Combining a healthy diet with regular exercise is the best way to maintain a healthy weight, and regular exercise can also help lower your cholesterol level and keep your blood pressure at a healthy level.

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 not be possible 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.

Stop smoking

Smoking significantly increases 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. 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.

Cut down on alcohol

Excessive alcohol consumption can lead to high blood pressure and trigger irregular heartbeat (atrial fibrillation), both of which can increase your risk of having a stroke.

Because alcoholic drinks are high in calories they also cause weight gain. Heavy drinking multiplies the risk of stroke by more than three times.

If you choose to drink alcohol and have fully recovered, you should aim not to exceed the recommended limits. These are:

  • men should not regularly drink more than 3-4 units of alcohol a day
  • women should not regularly drink more than 2-3 units a day

If you have not fully recovered from your stroke, you may find that you will have become particularly sensitive to alcohol and even the recommended safe limits as above for the general population may be too much for you. 

Read more about drinking and alcohol.

Managing underlying conditions

If you have been diagnosed with a condition known to increase your risk of stroke – such as high cholesterol, high blood pressure, atrial fibrillation, diabetes or a transient ischaemic attack (TIA) – ensuring the condition is well controlled is also important in helping prevent strokes.

The lifestyle changes mentioned above can help control these conditions to a large degree, but you may also need to take regular medication.

For more information, see:


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Stroke

Jim Whyte was forced to give up work after suffering a stroke 10 years ago, but he’s proved that there is life after stroke.

Jim Whyte was forced to give up work after having a stroke, but he’s proved that there is life after stroke.

Jim was getting out of a van when he suddenly felt his left leg turn to jelly. “I fell down, and my workmates got me a chair,” he says. “They brought me a cup of tea, but I couldn’t work out where the handle was to grasp it. Somehow I knew I’d had a stroke and asked them to take me to hospital.

“By the time I got there, I didn’t have any feeling in the left side of me. I felt like a lump of meat. I could hardly get out of the car.”

Doctors confirmed that Jim was right; he'd had a stroke. He spent the next 27 weeks in hospital undergoing rehabilitation and physiotherapy. “Luckily, my speech was still all right, though I’m sure my kids and grandchildren sometimes wish I’d be quiet!” he says. “During my time in hospital I regained around 85% use of my hand and arm. I’m actually very lucky.”

Jim had high blood pressure and was diabetic, which are both risk factors for stroke. However, he had never smoked and, due to his diabetes, was already following the healthy diet recommended for stroke survivors.

“My wife was a chef and she made sure we ate properly,” he says. He was put on tablets for high blood pressure and now has regular checks. “When I had the stroke, I had no idea I had high blood pressure,” he says.

Jim had his stroke 10 years ago. Although it forced him to give up work, he makes a point of leading an active, healthy lifestyle. He attends his local stroke survivors club every week, which includes exercise sessions, talks from experts and a blood-pressure check.

“It’s also a great place to share advice and make friends,” says Jim. “It’s good to talk about any problems you’re having with people who have been through the same thing. I’d recommend any stroke survivors to contact the Stroke Association to get information on their nearest club.” He also visits stroke survivors in hospital.

Jim believes there is life after stroke. “We call ourselves stroke survivors, not patients; that’s very important. When you’ve had a stroke, the most important thing to do is accept it. Unless you do that, it’s difficult to move forward. But once you do, you’ll realise that you can live a very happy, active life. I certainly do!”

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Stroke

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.”

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Stroke

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."

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Stroke

Manjit Bains was just 26 when he had a stroke. Determination, support from his family and friends and rehabilitation helped him get his life

Manjit Bains was just 26 when he had a stroke. Determination, support from his family and friends and rehabilitation helped him get his life back 

"'I've had a stroke'. This may be quite a common thing to hear. But not for me. I was just 26 and had my whole life ahead of me. I also worked as a senior staff nurse in a hospital and remember asking the rehabilitation nurse where my emboli, thrombosis or even my haemorrhage was!

"I had heart problems from birth and developed complications as I got older, which led to my stroke. Apparently, I had had a respiratory arrest and ended up in intensive care. But I guess luck was on my side, even though my life changed as a result. I had to battle to overcome a speech problem and gain control of my right hand, but thankfully the rest of me was in working order.

"Depression soon followed. I couldn’t believe that I had suffered a stroke at such a young age, and I suppose I went through a kind of grieving process of anger, bitterness and finally acceptance. Although I was improving every week (my speech was getting clearer and my hand much stronger) I discovered that patience was not one of my strongest points. I was determined to go back to my nursing career and I had to learn to write left-handed.

"With a lot of support from my family and my rehabilitation and occupational health team, I had an assessment at work and was given a staff nurse post on a medical ward. As the years have gone by I've become more confident and my speech and manual dexterity have improved. I’ve also nursed elderly and physically disabled clients.

"This hasn't been a solo journey. I've had a lot of support, including psychologists and counselling. 

"After intensive care I was nursed on a medical ward at the hospital where I had been working. I remember asking my consultant how long it would take for me to get better. I had no idea I had been at death’s door.

"I was walking a lot, and my speech therapist assessed my swallowing ability and said I could have soft food. My hand was slowly improving but still weak, and I couldn’t comb my hair or tie it up – thankfully hair bands had come into fashion! My colleague from work tied my shoelaces for me, but I was determined to get back to normal.

"I was finally discharged from hospital and referred to a rehabilitation team. For one week I was assessed on my ability to cope with daily activities. At home I started to practise manual dexterity skills, from opening cans to striking matches. My speech was improving, my slur had completely gone, and all the while I had fantastic support from my extended family.

"Eventually, I began attending the rehabilitation centre on an outpatient basis. And every day I get stronger and stronger."

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Stroke

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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.'

Raised risk

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.”

 

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Stroke

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