The impact of a stroke on a person’s mobility, strength and dexterity can vary dramatically – unfortunately however, a stroke leaves many struggling to dress independently.

If you suspect that you or someone else is having a stroke, you must 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 they) should still go to hospital for an assessment because there is a risk that you may be about to have a full stroke.

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 they 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 that has been 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 fallen 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 raise both arms and keep them there because of arm weakness or numbness.
• Speech. There may be slurred speech.
• Time. It is time to dial 999 immediately if you see any of these signs or 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 them is even more important.

Symptoms in the FAST test identify about nine out of 10 strokes.

Other signs and symptoms may include:

• dizziness,
• communication problems, difficulty talking and understanding what others are saying,
• problems with balance and coordination,
• difficulty swallowing,
• severe headaches,
• numbness/weakness resulting in complete paralysis of one side of the body, and
• loss of consciousness (in severe cases).

Recognising a stroke in other people

One of the problems with strokes is that people who are affected by them often have problems communicating with others. They therefore may not be able to raise an alarm or alert others to the fact that something is wrong.

Prompt emergency treatment for strokes is important because, typically, 1.9 million brain cells are lost during every minute a stroke goes untreated.

Also, one of the treatments for strokes called thrombolysis (where medicines are used to dissolve blood clots) must be given within three hours of the stroke happening.

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

The symptoms of a transient ischaemic attack (TIA) are the same as for a stroke, but they only 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 that there is a problem with the blood supply to your brain.

There is about a one in five chance that 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 immediately, to arrange for a specialist assessment.

The Department of Health recommends that anyone who experiences a TIA receives a specialist assessment within seven days of the TIA. Some people have a higher risk of  stroke after a TIA. This includes people:

• with diabetes,
• aged 60 or above,
• with high blood pressure (hypertension),
• who had TIA symptoms that lasted for more than an hour, and
• who had both weakness in the body and problems with speech during a TIA.

The Department of Health recommends that anyone in those groups should receive a specialist assessment within 24 hours of having a TIA.

Strokes are usually diagnosed by studying images of the brain (brain imaging). This can also be helpful in determining the risk of a transient ischaemic attack (TIA).

Even if the physical symptoms of a stroke are obvious, brain imaging should be carried out in order to determine whether an ischaemic stroke or a haemorrhagic stroke has occurred.

This is important because different treatment is required for each condition, and treating a haemorrhagic stroke with the methods used for an ischaemic stroke will make the condition worse.

CT and MRI scans

Two common methods that are used for brain imaging are a computer tomography (CT) scan and a magnetic resonance imaging (MRI) scan.

A CT scan is like an X-ray, but it uses multiple images to build up a more detailed, three-dimensional (3-D) picture of your brain. An MRI scan uses a strong magnetic field and radio waves to produce a detailed picture of the inside of your body.

Other tests

A number of other tests will also be carried out to try and identify the cause of the stroke. These include:

• a blood pressure test,
• blood tests to measure factors such as your cholesterol level or, if you are diabetic, your glucose level, and
• an echocardiogram, which is an image of your heart that is produced using sound waves.

Glossary

ECG

An ECG (electrocardiogram) is a test that measures electrical activity in the heart, and is used to identify heart problems. 

Brain

The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.

Arteries

Arteries are blood vessels that carry blood from the heart to the rest of the body.

Ultrasound

Ultrasound scans are a way of producing pictures of inside the body using sound waves.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Heart

The heart is a muscular organ that pumps blood around the body.

MRI

MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.

Lung

Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

Ischaemic strokes

Ischaemic strokes can be treated using a 'clot-busting' medicine called alteplase, which dissolves blood clots. However, alteplase is only effective if used during the first three hours after a stroke has taken place. After that time, the medicine has no beneficial effects.

You will also be given a regular dose of aspirin, 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.

Anticoagulants:
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 and warfarin are two anticoagulants that are commonly used.

Anticoagulants are often prescribed for people who have an irregular heartbeat that can cause blood clots.

Blood pressure:
If your blood pressure is too high, you may be given medicines to lower it. Two medicines that are commonly used are:

• thiazide diuretic - this reduces the amount of water in your body and widens the blood vessels, which decreases blood pressure, and
• angiotensin converting enzyme (ACE) inhibitors, which widen the blood vessels and reduce blood pressure.

Statins:
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.

Carotid stenosis:
Some ischaemic strokes are caused by a blockage in the carotid artery, which is an artery in the neck. The blockage, 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 can be done using a surgical technique called a carotid endarterectomy, which involves the surgeon making an incision in your neck in order to open up the carotid artery and remove the fatty deposits.

Haemorrhagic strokes

Emergency surgery is often required to treat haemorrhagic strokes in order 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 your skull is cut away to allow the surgeon to gain access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and will ensure that there are no blood clots present that may restrict the blood flow to your brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced.

Following a craniotomy, you may have to be placed on a ventilator. A ventilator is a machine that assists you with breathing. It gives your body time to recover by taking over its normal responsibilities, such as breathing, and it will also help control any swelling that you have in your brain.

You will also be given medicines, such as ACE inhibitors, to lower your blood pressure and prevent further strokes from occurring.

Transient ischaemic attack (TIA)

The treatment for a transient ischaemic attack involves addressing the conditions that led to it, while trying to prevent those conditions causing a bigger, more serious stroke.

If you have a TIA, the treatment that 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 very high due to a build-up of fatty plaques in your carotid artery, a carotid endarterectomy may be required.

Glossary

Physiotherapy

Physiotherapy is a treatment that uses physical movements, massage and exercise to relieve illness or injury.

Heart

The heart is a muscular organ that pumps blood around the body.

Cholesterol

Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Dose

Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.

Platelets

Platelets are cells in the blood that control bleeding by plugging the broken blood vessel and helping the blood to clot.

The best way to prevent a stroke is to eat a healthy diet, exercise regularly, and avoid smoking and excessive consumption of alcohol.

Diet

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 that you eat to no more than 6g (0.2oz) a day because too much salt will increase your blood pressure. 6g 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,
• butter,
• ghee - a type of butter that is often used in Indian cooking,
• lard,
• cream,
• hard cheese,
• cakes and biscuits, and
• foods that contain coconut, or palm oil.

However, a balanced diet should include a small amount of unsaturated fat, which will actually help reduce your cholesterol levels.

Foods high in unsaturated fat include:

• oily fish,
• avocados,
• nuts and seeds,
• sunflower, rapeseed, olive and vegetable oils.

Exercise

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 lower your cholesterol level, and also keep your blood pressure at a healthy level.

The recommended level of cholesterol is 5 millimoles per litre of blood or 5mmol/litre. A millimole is a unit of measurement that is used by chemists and biologists to measure things that are extremely small.

Blood pressure is measured using two figures. One figure represents the pressure of the heart as it contracts to pumps blood around the body. This is known as the systolic pressure. The second figure represents the pressure of the heart as it expands and fills with blood, while waiting for the next contraction. This is known as the diastolic pressure.

For most people, a healthy 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 and 120/80mmHG.

For most people, 30 minutes of vigorous exercise a day at least five times a week is recommended. The exercise should be strenuous enough to leave your heart beating faster, and you should feel slightly out of breath. Examples of vigorous exercise are going for a brisk walk, or walking up a hill.

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.

Smoking

Smoking is a major risk factor for strokes because it raises your blood pressure and can cause a build-up of fatty plaques in your arteries.

The NHS Smoking Helpline can offer you advice and encouragement to help you quit smoking. You can call on 0800 022 4 332, or visit the NHS Go smokefree website.

Your GP or pharmacist will also be able to provide you with help and advice about giving up smoking.

Alcohol

Excessive alcohol consumption can lead to high blood pressure and an irregular heartbeat (atrial fibrillation). Both are major risk factors for stroke.

Glossary

Arteries

Arteries are blood vessels that carry blood from the heart to the rest of the body.

Obesity

Obesity is when a person has an abnormally high amount of body fat.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

High blood pressure

Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.

Heart

The heart is a muscular organ that pumps blood around the body.