Stroke

When the blood supply to a part of your brain is reduced, brain cells begin to die, leading to brain injury, disability and possibly death.

Stroke is the fourth biggest cause of death in the UK. It’s also the largest cause of disability, as it can lead to:

• Neurological problems – such as difficulty concentrating, remembering things or learning new things
• Depression and anxiety
• Difficulty with speech and communication
• Difficulty with daily activities

Strokes are usually treated with medication, although treatment depends on what part of the brain has been affected and what caused it.

The main signs of a stroke can be remembered using the FAST test:

• Facial weakness – your face may be dropped to one side or you’re unable to smile
• Arm weakness – you can’t lift your arms and hold them there or have numbness
• Speech – you may have slurred speech or be unable to speak or understand what someone's saying
• Time – it’s time to dial 999 immediately if you think you or someone you know is having a stroke

Other stroke symptoms include:

• Nausea and vomiting
• Headache
• Confusion
• Visual problems
• Neck or facial pain

If someone is suspected of having a stroke, the doctor will discuss their symptoms with them and preferably someone who was with them when they experienced their symptoms. They’ll also ask questions about:

• Possible family history of stroke
• Risk factors including other conditions (such as diabetes or heart failure), smoking, pregnancy, drug abuse and recent injury
• Any past history of thrombosis
• Current medication such as anticoagulants

They may also carry out:

• Blood tests
• Blood pressure measurement
• An electrocardiogram to check for an irregular heartbeat

These tests can help rule out or identify other conditions that may be causing the symptoms.

If a stroke is suspected, a brain scan, such as an MRI scan or CT scan, will be used to help determine:

• The cause of the stroke
• What part of the brain is affected
• How serious the stroke is

Other tests to help diagnose and assess a stroke include:

• The swallow test – your ability to swallow is commonly affected by a stroke so this must be checked to avoid further complications
• Heart and blood vessel tests using ultrasound scans – may be carried out later to find out what caused your stroke

Blood supply in your brain may be reduced during a stroke due to:

• Ischaemia – the blood supply is restricted due to a blood clot in a blood vessel, the cause of 85% of strokes
• A transient ischaemic attack (a TIA, also called a mini stroke) – this is the same as an ischaemic stroke except it only lasts for a short time because the blockage is only temporary
• Haemorrhage – a blood vessel in your brain bursts

A TIA is still a medical emergency because it may be a sign that you’re at risk of a stroke in the future.

You’re more at risk of having a stroke if you have:

• High blood pressure
• High cholesterol
• Atrial fibrillation – an irregular heartbeat (a type of arrhythmia)
• Diabetes

Treatment will depend on:

• The cause of the stroke
• How severe the stroke is
• The affects it has caused
• Other conditions you may have

Ischaemic stroke treatment

• Clot-busting medicine - to dissolve the clot that caused your stroke to help restore blood flow to the affected brain cells
• Antiplatelet or anticoagulant medication – these types of drugs reduce your chances of another clot forming by changing how well your blood clots
• Medication to reduce your blood pressure if it’s too high
• Statins to lower your cholesterol level if it’s too high
• Surgery (carotid endarterectomy) – if your stroke was caused by a build-up of fatty deposits in an artery causing it to narrow and become blocked, surgery can help to unblock it

Haemorrhagic stroke treatment

• Medication to prevent further strokes and reduce blood pressure or cholesterol levels if required ­– the same as with ischaemic strokes
• Surgery (craniotomy) – to remove blood and repair damaged vessels
• Surgery to treat Hydrocephalus – a complication of haemorrhagic stroke where fluid builds up in the cavities of your brain

Rehabilitation

Rehabilitation can help alleviate long term problems. This can include:

• Physiotherapy
• Occupational therapy
• Dietitians
• Speech and language therapy

You can help prevent strokes by following a healthy lifestyle, screening for and treating risk factors (such as high cholesterol or blood pressure) and having any TIAs checked and treated.