Stroke

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

Stroke is a medical emergency, so you need treatment urgently. The sooner you get it, the less damage the brain is likely to suffer.

• you think you or someone you know is having a stroke

Do not drive if you think you've had a stroke or TIA (transient ischaemic attack).

Even if the symptoms of a stroke go away, you still need to go to hospital for an urgent assessment. If your doctor can see you the same day, they may be able to do an urgent assessment. If the doctor's chamber is closed, phone a doctor or the 16263 health line.

The main symptoms of stroke can come on suddenly. They affect the:

• face: one side of your face might drop, you might not be able to smile, your mouth may have dropped, and your eyelid may droop
• arms: you may not be able to lift both arms and keep them there, because of arm weakness or numbness in 1 arm or leg
• speech: your speech might be slurred, garbled or make no sense, or you might not be able to talk at all even though you seem to be awake

You can remember the main symptoms of stroke with the word FAST. It stands for:

• face
• arms
• speech
• time to call 999

If you're having a stroke, you might not have all of these symptoms. If you notice any of them, think about whether you could be having a stroke.

Not everyone who has a stroke shows the FAST symptoms. Some people have other signs, and these can come on suddenly:

• complete paralysis of 1 side of the body
• blurred vision or loss of sight in 1 or both eyes
• difficulty understanding what others are saying
• finding it difficult to speak or think of words
• problems with balance and co-ordination
• very severe headache
• a feeling that the world is spinning around (vertigo)
• loss of feeling in one side of the body

Sometimes these symptoms have other causes.

A TIA, or transient ischaemic attack (some people call it a "mini-stroke"), brings the same symptoms as a stroke. The difference is that they last only a few minutes to a few hours, and then disappear completely.

The symptoms do get better, but never ignore a TIA. It's a serious warning sign that there's a problem with the blood supply to your brain. That means you're at an increased risk of having a stroke in the near future.

• you've had, or think you've had, a TIA

If your doctor's chamber is closed, call a doctor or the 16263 health line.

Your brain, like every organ, needs the oxygen and nutrients that blood carries to it. When that blood supply is restricted or stopped, brain cells begin to die. This can lead to brain injury, disability and possibly death. That is what happens in a stroke.

There are 2 main causes of strokes:

• ischaemic: the blood supply stops because of a blood clot (this is the cause of a stroke in most cases)
• haemorrhagic: a weakened blood vessel supplying the brain bursts

Some things make you more likely to have a stroke or TIA. These include:

• poor diet
• lack of exercise
• obesity
• smoking
• drinking too much alcohol
• high cholesterol
• high blood pressure (hypertension)
• diabetes
• atrial fibrillation

Lifestyle changes can help you control some of these risk factors. You may also need to take medicine regularly.

If your heartbeat is irregular because of atrial fibrillation, anticoagulant medicine will help lower your risk of stroke.

In most cases, you can bring down your risk of having a stroke quite a lot by changing some everyday habits:

• eating a healthy diet, which means low in fat, low in salt and high in fibre, with plenty of fresh fruit, vegetables and whole grains
• exercising regularly, because this can help lower your cholesterol level and keep your blood pressure at a healthy level
• stopping smoking, if you smoke
• cutting down on the amount of alcohol you drink

If you've had a stroke or TIA, you should try to improve these risk factors, because you're at a higher risk of having another stroke.

Some risk factors you can't change:

• 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

A stroke is usually diagnosed with physical tests and by studying scans of the brain.

Some other tests can help confirm the diagnosis and find the cause of the stroke. These may include:

• checking your pulse for an irregular heartbeat
• measuring your blood pressure
• blood tests to check your cholesterol and blood sugar levels

Even when the signs of a stroke are plain to see, you should still have a brain scan. It tells the doctors three things:

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

Anyone who may have had a stroke should get a brain scan as soon as possible after reaching hospital. It matters even more for people who:

• might benefit from treatments to unblock arteries, such as clot-busting drugs (thrombolysis) or a procedure to unblock blood vessels (thrombectomy)
• are on anticoagulant (blood thinning) treatment
• have a lower level of consciousness

The 2 main types of brain scan used after a stroke are:

• computerised tomography (CT) scan
• magnetic resonance imaging (MRI) scan

Which scan you have depends on your symptoms.

Doctors may also use these tests to help diagnose a stroke:

• an electrocardiogram (ECG), to measure your heart's electrical activity
• an echocardiogram scan, to produce images of your heart
• heart monitoring, to look for abnormal heart rhythms like atrial fibrillation
• a carotid ultrasound scan, to check if there's any narrowing or blockages in the neck arteries leading to your brain

You can read about treatments for stroke and life after a stroke.