A stroke is a serious, life-threatening medical condition that happens when the blood supply to part of the brain is cut off.
Strokes are a medical emergency and urgent treatment is essential. The sooner a person receives treatment for a stroke, the less damage to the brain is likely to occur.
Even if the symptoms of a stroke go away, you or the person having a stroke should still go to hospital for an assessment.
Signs and symptoms
The main symptoms of stroke can be remembered with the word FAST. FAST stands for:
- Face – the face might drop on one side, the person may not be able to smile or their mouth may have dropped, and their eyelid may droop
- Arms – the person may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm
- Speech – they might slur their speech or it might be garbled, or the person may not be able to talk at all despite appearing to be awake
- Time – it’s time to phone 999 immediately if you see any of these signs or symptoms
Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause different symptoms which might include:
- complete paralysis of one side of the body
- sudden loss or blurring of vision
- difficulty understanding what others are saying
- problems with balance and co-ordination
- a sudden and very severe headache
- loss of feeling in one side of the body
However, there are sometimes other causes for these symptoms.
Why do strokes happen?
Like all organs, the brain needs the oxygen and nutrients provided by blood to function. 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 2 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’s also a related condition known as a transient ischaemic attack (TIA).
'Mini-stroke' or transient ischaemic attack (TIA)
The symptoms of a TIA are the same as a stroke, but they only last between a few minutes and a few hours before disappearing completely.
Although the symptoms do improve, you should never ignore a TIA. A TIA is a serious warning sign there's a problem with the blood supply to your brain. This means you're at an increased risk of having a stroke in the near future.
Read more about TIA
Phone your GP urgently if:
- you've had, or think you've had a TIA
If your GP practice is closed, phone 111.
Who is at risk?
There are some things that can make you more likely to have a stroke or TIA:
Lifestyle changes can help control some of these risk factors. You may also need to take regular medication. Taking anticoagulant medication if you have an irregular heartbeat due to atrial fibrillation will help reduce the risk of stroke.
If you've had a stroke or TIA, these measures are very important because you're at a higher risk of having another stroke.
How can I reduce my risk of stroke?
In most cases it's possible to significantly reduce your risk of having a stroke by making lifestyle changes like
There are some risk factors you can't change like:
- age – people over 65 are most at risk of having strokes, although they can happen at any age – including in children
- 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're 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’ve had a stroke, transient ischaemic attack (TIA) or heart attack, your risk of stroke is higher
Diagnosing a stroke
Strokes are usually diagnosed by physical tests and studying scans of the brain.
Some tests can help confirm the diagnosis and determine the cause of the stroke. This may include:
- checking your pulse for an irregular heartbeat
- measuring your blood pressure
- blood tests to check your cholesterol and blood sugar levels
Even if the physical symptoms of a stroke are obvious, you should have a brain scan to determine:
- if a blocked artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke) caused the stroke
- which part of the brain is affected
- how severe the stroke is
Everyone with suspected stroke should receive a brain scan as soon as possible when they attend hospital, especially those who:
- might benefit from treatments to unblock arteries like clot-busting drugs (thrombolysis) such as alteplase or a procedure to unblock blood vessels (thrombectomy)
- are on anticoagulant (blood thinning) treatments
- have a lower level of consciousness
This is why a stroke is a medical emergency and you should phone 999 if you think someone is having a stroke.
The 2 main types of scan used to assess the brain in people who have had a suspected stroke are:
The type of scan you may have depends on your symptoms.
Heart and blood vessel tests
There may be further tests on the heart and blood vessels to confirm what caused your stroke.
An electrocardiogram (ECG) measures your heart's electrical activity using electrodes (small, sticky patches) on your skin.
An ECG can detect abnormal heart rhythms, which may be a sign of conditions like atrial fibrillation (where your heart beats irregularly). Atrial fibrillation can increase your risk of stroke and TIAs.
Another type of ultrasound scan called an echocardiogram. This type of scan can produce images of your heart. This involves having an ultrasound probe moved across your chest (transthoracic echocardiogram) or occasionally down your gullet (oesophagus).
While you're in a stroke unit, the team may put a heart monitor on you to look for abnormal heart rhythms such as atrial fibrillation.
This may be done again after you go home by having you wear a small device attached to your skin for at least 3 days.
A carotid ultrasound scan can help show if there's 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 create an image of the inside of your body.
How strokes are treated
Effective treatment of stroke can reduce the risk of long-term disability and save lives.
The specific treatments recommended depend on whether a stroke is caused by:
- a blood clot obstructing the flow of blood to the brain (ischaemic stroke)
- a burst blood vessel bleeding in or around the brain (haemorrhagic stroke)
Treatment usually involves taking one or more different medications. Some people may also need surgery. It’s important to seek treatment as soon as possible to improve the chances of a good recovery.
Treating ischaemic strokes
If you’ve had an ischaemic stroke, you may benefit from emergency treatments, like thrombolysis or thrombectomy, to reduce the amount of brain damage.
After an ischaemic stroke, the aim is to reduce the risk of another stroke especially in the first few days. To do this a combination of treatments is usually recommended. Some of the treatments might include:
Some of these medications need to be taken immediately and only for a short time. Others may only be started once the stroke has been treated and may need to be taken long term.
You might also benefit from a carotid endarterectomy which is a surgical procedure to remove a narrowing in a blood vessel in the neck. This is to reduce the risk of a future stroke.
Treating haemorrhagic strokes
Some people who've had a haemorrhagic stroke will be offered medication to reduce blood pressure immediately. However, most patients will be offered long-term treatments to lower blood pressure to reduce the risk of another stroke.
If you were 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.
Occasionally, neurosurgery can be considered to treat a haemorrhagic stroke.
Swallow tests following a stroke
A swallow test is essential for anybody who's had any type of stroke, as swallowing ability is often affected after a stroke.
When a person can't swallow properly, food and drink may get into the windpipe and then into the lungs (aspiration). This can lead to chest infections such as pneumonia.
For the test, you'll be given a few teaspoons of water to drink. If you can swallow this without choking and coughing you'll be asked to swallow half a glass of water.
If you have any difficulty swallowing, you'll be referred to the speech and language therapist for an assessment.
You might not be able to eat or drink until you've seen the therapist. This means you may need to have fluids or food given into a vein in your arm (intravenously) or through a feeding tube.
You may need further treatment to help manage some of the problems that can affect people who've had a stroke.
You might need:
- 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're malnourished
- fluids given into a vein (intravenously) if you're at risk of dehydration
- oxygen through a nasal tube or face mask if you have low levels of oxygen in your blood
- compression sleeves (intermittent pneumatic compression) to reduce the risk of blood clots in the leg (deep vein thrombosis)
Life after a stroke
The brain injury caused by a stroke can lead to long-lasting problems.
Some people who've had a stroke need long-term rehabilitation to help them regain as much independence as possible.
Rehabilitation often starts in hospital, at a local clinic and might continue at home. A team of specialists are available to help with your rehabilitation, including:
- speech and language therapists
- occupational therapists
- specialist nurses and doctors
These specialists might help you with:
Strokes can cause weakness or paralysis in one side of the body. This can result in problems with co-ordination and balance.
As part of your rehabilitation, you should see a physiotherapist. They'll assess the extent of any physical disability before deciding on treatment.
Physiotherapy often involves exercises to improve your muscle strength to overcome walking difficulties.
You might also get help from an occupational therapist. They'll assess your ability to carry out everyday tasks. They can help adapt your home or suggest equipment to make tasks easier.
After having a stroke, many people experience problems with language which can affect speaking, understanding, reading, and writing.
This is known as aphasia, or dysphasia, when it's caused by injury to the parts of the brain responsible for language.
If the muscles involved in speech are affected this can cause slurring (dysarthria).
You should see a speech and language therapist for an assessment, and to start therapy for your communication.
Read more about aphasia
The damage caused by a stroke can interrupt your normal swallowing reflex (dysphagia). This makes it possible for small particles of food to enter your windpipe.
Dysphagia can lead to damage to your lungs, which can trigger a lung infection (pneumonia).
You may need to be fed using a feeding tube during the initial phases of your recovery to reduce the risk of any complications from dysphagia.
You'll usually see a speech and language therapist for treatment to manage swallowing problems.
Read more about dysphagia
Strokes can also affect the control of the movement of the eye muscles. This can cause double vision. Strokes which damage the nerves affecting your sight can cause loss of vision in one, or more often, both eyes.
If you have any problems with your vision after a stroke, you'll be referred to an orthoptist (eye specialist). They can assess your vision and suggest possible treatments.
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’ve had a stroke may regain bladder and bowel control quite quickly. If you still have problems after leaving hospital, help is available from your GP and specialist continence advisors.
There are lots of treatments that can help including:
Read more about treating urinary incontinence
A stroke might disrupt the way your brain works (cognitive functions) like:
- communication – both speaking and written
- spatial awareness – having an awareness of where your body is in relation to what's around you
- executive function – the ability to plan, solve problems, and reason about situations
- praxis – the ability to do physical activities, like getting dressed or making a cup of tea
Most cognitive functions will improve after time and rehabilitation, but you might find they do not return to how they were before.
The damage that a stroke causes to your brain also increases the risk of developing vascular dementia.
You might experience extreme tiredness (fatigue) after a stroke. This can last months or even years. You might have difficulty sleeping, making you even more tired.
Two common psychological problems that can affect people after a stroke are depression and anxiety. Feelings of anger, frustration and bewilderment are also common. Some people experience periods of laughter or crying which is difficult to control.
You’ll receive a psychological assessment from a member of your healthcare team.
For some people, medicines and psychological therapies, such as counselling or cognitive behavioural therapy (CBT) can help.
Sex after a stroke
Having sex will not put you at a higher risk of having a stroke. Even if you have a severe disability, you can find new ways of being intimate with your partner.
Some medications can reduce your sex drive (libido). Tell your doctor if you have a problem, as there may be other medicines that can help.
Some men may experience erectile dysfunction. Speak to your GP or rehabilitation team if this is the case, as there are treatments available that can help.
Read more about treating erectile dysfunction
Driving after a stroke
If you've had a stroke or TIA, you can't drive for one month. Whether you can return to driving depends on what long-term disabilities you have and the type of vehicle you drive.
Your GP can tell you whether you can start driving again a month after your stroke or if you need a specialist assessment.
Caring for someone who’s had a stroke
Around half the people who have a stroke will need some form of care or help with their daily activities. For example, a care worker could come to the person's home to help with household tasks, or to provide companionship.
There are lots of ways you can support a friend or relative who's had a stroke to speed up their rehabilitation.
help practice physiotherapy exercises
provide emotional support and reassurance
help motivate the person to reach their long-term goals
adapt 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 lonely experience. Be prepared for changed behaviour. Someone who’s had a stroke can often seem as though they’ve had a change in personality and appear to act irrationally because of the psychological and cognitive impact of a stroke.
Try to remain patient and positive. Rehabilitation can be a slow and frustrating process. Encouraging and praising any progress, can help motivate someone who has had a stroke to achieve their long-term goals.
Make time for yourself. If you're caring for someone who has had a stroke, it's important not to neglect your own physical and psychological wellbeing.
Ask for help. There are a wide range of support services and resources available for people recovering from strokes, and their families and carers.
Read more about care services in your home on Care Information Scotland.