Stroke

Every year, an estimated 150,000 people in the UK have a stroke. Most people affected are over 65, but anyone can have a stroke, including children and even babies.

A stroke is the third most common cause of death in the UK. It is also the single most common cause of severe disability. More than 250,000 people live with disabilities caused by stroke.

It could happen to you, or someone you care for. If it does, you'll want to know as much as you can about strokes.

The following information tells you how The Stroke Association can help you if stroke affects your life.

What is a stroke?

Every year, an estimated 150,000 people in the UK have a stroke. That’s one person every five minutes. Most people affected are over 65, but anyone can have a stroke, including children and even babies. Around 1000 people under 30 have a stroke each year.

Stroke is the third most common cause of death in the UK. It is also a leading cause of severe adult disability. More than 250,000 people in the UK live with disabilities caused by stroke.

It could happen to you, or someone you care for. If it does, you'll want to know as much as you can about strokes. This section of the website explains what a stroke is, what causes it, and some of the physical and psychological effects it can have on people's lives.

Brain attack

A stroke is what happens when the blood supply to part of the brain is cut off. Blood carries essential nutrients and oxygen to the brain. Without a blood supply, brain cells can be damaged or destroyed and won’t be able to do their job.

Because the brain controls everything the body does, damage to the brain will affect body functions. For example, if a stroke damages the part of the brain that controls how limbs move, limb movement will be affected.

The brain also controls how we think, learn, feel and communicate. A stroke can also affect these mental processes.

A stroke is sudden and the effects on the body are immediate.

Infarction

Stroke can cause brain tissue to die, and this is called cerebral infarction. An infarct is an area of dead tissue. It can be tiny or affect a larger part of the brain.

Causes of stroke

There are two main causes of stroke

1. The most common type of stroke is a blockage. This is called an ischaemic stroke, which happens when a clot blocks an artery that carries blood to the brain. It may be caused by:

• a cerebral thrombosis, when a blood clot (thrombus) forms in a main artery to the brain;
• a cerebral embolism, when a blockage caused by a blood clot, air bubble or fat globule (embolism) forms in a blood vessel somewhere else in the body and is carried in the bloodstream to the brain; or
• a blockage in the tiny blood vessels deep within the brain (lacunar stroke).

2. The second type of stroke is a bleed, when a blood vessel bursts, causing bleeding (haemorrhage) into the brain. This is called a haemorrhagic stroke. It may be caused by:

• an intracerebral haemorrhage, when a blood vessel bursts within the brain; or
• a subarachnoid haemorrhage, when a blood vessel on the surface of the brain bleeds into the area between the brain and the skull (subarachnoid space).

Common symptoms

The first signs that someone has had a stroke are very sudden. Symptoms include:

• numbness, weakness or paralysis on one side of the body (signs of this may be a drooping arm, leg or lower eyelid, or a dribbling mouth)
• slurred speech or difficulty finding words or understanding speech
• sudden blurred vision or loss of sight
• confusion or unsteadiness
• a severe headache.

Use the Face–Arm–Speech Test (FAST)

Three simple checks can help you recognise whether someone has had a stroke or mini-stroke (transient ischaemic attack – TIA).
F Facial weakness: Can the person smile? Has their mouth or an eye drooped?

A Arm weakness: Can the person raise both arms?

S Speech problems: Can the person speak clearly and understand what you say?

T Test these symptoms.

If you see any of these signs, call 999 immediately.

Transient Ischaemic Attack

A transient ischaemic attack (TIA) often called a mini-stroke, happens when the brain’s blood supply is interrupted for a very brief time.

The symptoms are very similar to a stroke (such as weakness on one side of the body, loss of sight and slurred speech) but they are temporary – lasting a few minutes or hours, and then disappearing completely within 24 hours.
In a TIA, the affected part of the brain is without oxygen for just a few minutes. A TIA is a sign that part of the brain is not getting enough blood and that there is a risk of a more serious stroke in the future. So, you should not ignore signs of a TIA – get medical help as soon as you can.

Stroke can happen to anyone.

A stroke can happen with no obvious cause, to people of any age - but there are factors known to increase the likelihood of it happening. Some of these factors are things that can't be changed. Other risks may be reduced by lifestyle changes or medication.

What cannot be changed

Sex
In people aged under 75, more men have strokes than women.

Age
Strokes are more common in people over 55, and the risk continues to rise with age. Arteries harden and become 'furred up' by a build-up of cholesterol and other debris (atherosclerosis) over many years.

Family history
Having a close relative who has had a stroke increases the risk, possibly because conditions such as high blood pressure and diabetes tend to run in families.

Ethnic background
People from Asian, African and African-Caribbean communities are at greater risk of a stroke. Medical conditions like diabetes and high blood pressure are also more common in some races.

What the doctor can help with

Medical conditions
If they are not treated, over time these conditions may damage the arteries.

• High blood pressure (hypertension)
• Heart disease and irregular heart beat (atrial fibrillation)
• Diabetes

What we can do to help ourselves

Diet
A diet high in fatty foods causes cholesterol to build up in the blood and the arteries to narrow. Too much salt can lead to high blood pressure. Being very overweight (obese) puts extra strain on the heart.

Too much alcohol
Regular heavy drinking raises blood pressure. Binge drinking (drinking a lot of alcohol in a short time) can cause a blood vessel in the brain to burst.

Exercise
An inactive lifestyle can contribute to furring of the arteries. Regular exercise helps keep the heart and bloodstream healthy.

Smoking
Smoking causes higher blood pressure and makes the blood thicker. The chemicals in tobacco smoke are absorbed into the body, damaging blood vessel walls.

Reduce your risk

• Have your blood pressure checked regularly
• Stop smoking
• Take regular exercise
• Avoid heavy drinking
• Cut down on salt and fatty foods
• Eat plenty of fruit and vegetables

Damage to the brain

A stroke causes damage to the brain, which affects how the body works.

Because stroke is a brain injury, the effects, or symptoms, will depend on the part of the brain that is affected.

Every stroke is different and people who have a stroke are affected in different ways. For some, the symptoms are quite mild and last a short time (just a few minutes or hours in the case of a TIA or mini-stroke). Other strokes may cause more severe and lasting damage.

When a stroke happens, some brain cells are damaged and others die. Dead brain cells can’t start working again, but those just outside the area of the dead cells may recover as the swelling caused by the stroke goes down.

It’s also possible that other parts of the brain can learn to take over from areas that have died. Most recovery happens in the first few months, but people can continue to recover for several years after the stroke.

Different parts of the brain control different parts of the body

The right half of the brain controls the left side of the body and vice versa. Common symptoms like weakness in parts of the body or not being able to use an arm or leg (paralysis) happens on the opposite side of the body to the stroke side of the brain.

In most people, the left half of the brain is responsible for language (talking, understanding, reading and writing), and the right half is responsible for perceptual skills (making sense of what you see, hear and touch) and spatial skills (judging size, speed, distance or position in space).

The effects of a stroke will depend on:

• the part of your brain that has been injured
• how bad the injury is
• your general health when the stroke happens.

Common problems

There are several problems or disabilities stroke survivors may face in the first few weeks after having a stroke. Most of these will improve over time as the brain recovers. In severe cases, they may cause long-term disability.

Weakness or paralysis Weakness, clumsiness or paralysis (hemiplegia) is one of the most recognisable and most common symptoms of a stroke. It usually happens on one side of the body. Weakness or paralysis of an arm or leg is often made worse by stiffness (spasticity) of the muscles and joints.

Balance
Unsteadiness (loss of balance) can be caused by damage to the part of the brain that controls balance. Or it may happen because of paralysis resulting in muscle weakness.

Swallowing
About 50 per cent of people have difficulty with swallowing after a stroke (dysphagia). This can be dangerous if food ‘goes down the wrong way’ and gets into the windpipe.

All stroke patients have a swallow test in hospital and are only allowed to drink and eat when it is shown they can swallow. Some people may need fluid thickeners and help with eating for a while.

Sleep and tiredness
Most people suffer from extreme tiredness (fatigue) in the first few weeks after a stroke. Many also have difficulty sleeping, which makes them even more tired.

Speech and language
Many people experience problems with speaking and understanding, and with reading and writing. This difficulty with language is called dysphasia (also known as aphasia)

When a person finds it hard to understand what is being said, it is called receptive dysphasia. Sometimes a person may understand what is being said but can’t find the right words to express what they want to say – this is called expressive dysphasia. People often have a mixture of both types of dysphasia.

Dysphasia is most common with strokes that damage the left side of the brain. The exception is in some left-handed people whose language area is on the right side of their brain.

Eyesight
A stroke can damage the parts of the brain that receive, process and interpret information that the eyes send. Sometimes, people who have had a stroke may have double vision or lose half of their field of vision – they can see everything over to one side but are blind on the other.

This can cause clumsiness and seemingly odd behaviour (like not eating food on one side of a plate). 

Perception and interpreting
People may have difficulty recognising familiar objects or knowing how to use them. They may also have problems with skills like telling the time if the brain can’t interpret what the eyes see.

Mental processes
A stroke often causes problems with mental processes such as thinking, learning, concentrating, remembering, making decisions, reasoning and planning. People may lose short-term memory, which makes it difficult to pay attention and concentrate.

Bladder and bowels
Difficulty controlling the bladder and bowels (incontinence) is not unusual after a stroke. Most people regain control in a few weeks.

Mood swings
Emotional ups and downs are very likely after a stroke. Depression, sadness, anger, anxiety, low self-esteem and loss of confidence are common. Sometimes people find it hard to control their emotions and may cry, swear or laugh at inappropriate times. They may find that their inhibitions are lifted and their behaviour seems out of character.

Sensation
Some people have problems with sensation – they feel too much or too little. They may be very sensitive to colour, sound and light. Or they may not feel painful sensations like heat or sharp objects, which can cause accidents and injuries.

Pain
Pain can be caused by the stroke (for example, shoulder pain and spasticity), or may be caused by problems the person had before the stroke being made worse.

Recovering from a stroke takes time

After an initial spurt of recovery in the first few weeks, the mending process is very gradual. It may take more than a year before the person has made the best possible recovery, and some people continue to improve over a much longer period.

For more information please contact www.stroke.org.uk