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.

Designed to Care is dedicated to providing you with stroke clothing options to maintain your independence, dignity and assist with everyday care. Our open back and side zip clothing are particularly helpful in the case of stroke – choose the side that is easiest to ‘dress from’ and our clothes will work with you. Also, by replacing all buttons with pop-fasteners, you will find dressing quicker and easier.

A stroke is considered to be a chronic condition by HMRC, click here to find out more about chronic illness and disabled vat relief on adaptive stroke clothing

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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.


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.


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.












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: