Stroke

These are the main types of stroke which we discuss here in detail.

Ischaemic strokes are the most common and are caused by a blood clot that stops the blood flowing to the brain carrying essential oxygen. Blood clots usually form in arteries, in a process called atherosclerosis. This process is also what causes heart attacks to happen and heart conditions such as angina to develop. The British Heart Foundation provides a helpful video explaining the process of atherosclerosis in the brain.

Haemorrhagic strokes are less common but may be more life threatening and cause bleeding within the brain (intracerebral haemorrhage) or on the surface of the brain (subarachnoid haemorrhage).

Bleeding within the brain usually occurs due to a burst blood vessel which causes swelling and the potential for brain cells to die. Bleeding on the surface of the brain often happens as a result of a burst aneurysm which leads to blood leaking into the subarachnoid space. For further information on this type of stroke, download the ‘Bleeding in the brain’ fact sheet from Stroke Association.

Transient ischaemic attack (TIA) is known as a ‘mini-stroke’ and is usually a warning sign that a stroke may occur soon. The symptoms of a TIA are often the same as an ischaemic or haemorrhagic stroke, except they may last for just moments or a few hours. If you think you may be having a TIA, you should call 999 immediately. The Stroke Association provides two videos that explain TIAs.

For more information on types of stroke, download this fact sheet for patients and carers from the Brain and Spine Foundation.

The main symptoms of stroke can be remembered with the acronym F.A.S.T.

• Face – sometimes in stroke, the person’s face may look odd. It may droop on one side, or they may be unable to make a facial expression such as a smile

• Arms – a stroke may make the person have weak or numb arms and be unable to lift both their arms and keep them up

• Speech – a stroke may make a person unable to speak, or their speech may be affected e.g. it may be slurred or not make sense

• Time – it is essential to act quickly if a person experiences any or all of these symptoms. Remember to dial 999 for an ambulance and tell the operator the person is experiencing a suspected stroke

Not everybody who has a stroke will experience these symptoms. Some people may also experience the following symptoms of stroke:

• Paralysis (often affects just one side of the body)

• Vision loss

• Blurred vision

• Feeling dizzy

• Feeling or acting confused

• Being unable to understand what other people are saying

• Balance or coordination problems

• Being unable to swallow

• An extremely painful headache that comes on suddenly

Symptoms may come on suddenly but then disappear, but it is important to go straight to hospital as you may be experiencing a transient ischaemic attack (TIA) or ‘mini stroke’, which could be a warning that further strokes are to follow.

After a stroke or multiple strokes, a person may be left with a number of symptoms which are temporary or long-term. The symptoms that remain will depend upon how severe the stroke was and what part of the brain was damaged. Some people report the following health problems after a stroke:

• Mobility problems e.g. finding it difficult to stand, move around, walk, etc.

• Paralysis

• Extreme fatigue

• Cognitive difficulties such as poor memory, inability to concentrate, lack of spacial awareness

• Communication problems e.g. inability to speak, slurred speech

• Incontinence

• Erectile dysfunction (in men)

• Depression and anxiety

Having a stroke can therefore have a long-term impact on a person’s life, but there are lots of help and support services available to you, and ways to help overcome these difficulties and rehabilitate well.

It is essential that a stroke is diagnosed quickly, so urgent medical attention should be sought if any stroke symptoms are present. If you arrive at hospital with a suspected stroke, you are likely to have a range of tests conducted including scans of the brain. These tests may include: CT scan, MRI scan, carotid ultrasound scan and echocardiogram.

For more information on stroke diagnosis, visit the NHS website.

Upon diagnosis of stroke, you are likely to receive medication and possibly surgery, depending on the type of stroke you have experienced.

If you have experienced an ischaemic stroke caused by a blood clot, you are likely to be given antiplatelet medication such as aspirin, which helps reduce the formation of blood clots. You may be given a procedure called thrombolysis to try to reduce the clot, which supplies medication called alteplase into the body. Thrombolysis is only effective if given within a few hours of the beginning of stroke symptoms. Some people are alternatively given a thrombectomy. Some people are also prescribed anticoagulant medication, if they are prone to blood clots.

If you have experienced a haemorrhagic stroke, which causes bleeding in or on the brain, you may require surgery. This may be required to remove blood and clots from the brain, fix blood vessels, reduce the chance of more bleeding and remove excess spinal fluid.

For more information on surgery, visit the BUPA website.

For more information on treatments for stroke, visit the NHS website.

Stroke will definitely affect your life and may affect your day to day activities in lots of different ways. Most people who survive stroke are able to enjoy life and feel a sense of wellbeing. Some people find their recovery hard, long and difficult. Some people report that it has made them more health conscious and that they take care of themselves more. Some people may need ongoing support and care from family members or professional carers. Everybody experiences stroke differently. There are lots of stroke support services available to you, and you are not alone in your experiences. Read about the experiences of a stroke survivor on the Headway charity website.

Some people experience stroke at a young age, and this can bring about different challenges. The charity Different Strokes supports younger stroke survivors on their journey to recovery. Visit their site if you or someone you know has experienced stroke at a young age, and read some survivor stories.

If you are caring for someone who has experienced stroke, this is likely to affect your daily life too. There is lots of carer support available to you; you may wish to find information from the Stroke4Carers website, which covers lots of topics such as money, benefits, legal issues, carers rights, and practical advice and tips.

If you are finding daily activities difficult due to stroke, such as getting dressed, leaving the house, undertaking chores, using the bathroom, you may need to have an Occupational Therapy (OT) assessment. This can usually be arranged through your local council’s social services department. An OT will carry out an assessment of your skills and difficulties, and may be able to recommend different ways of doing things and ways to adapt your environment to make these tasks easier. Sometimes, they are able to recommend daily living aids that can help.

Read on to find out more about stroke aids for daily living that may help you around the home.

Stroke can sometimes leave you with physical or cognitive post-stroke symptoms that make some daily activities challenging. There is equipment available that can help with daily tasks, called daily living aids. At NRS Healthcare, we are experts in daily living aids. We have a team of Occupational Therapists (OTs) who are able to advise you how to use stroke products in the home to make certain tasks easier.

Here is a list of tasks that some people find difficult because of the symptoms of stroke, and examples of stroke products that are available to help:

• Taking a bath: bath lift, bath rail, bath step

• Having a shower: shower stool or shower chair

• Using the toilet: toilet frame with seat, raised toilet seat, or commode

• Carrying things around the home: household trolley

• Preparing food and drinks: kitchen spread board, automatic chopper, kettle tipper

• Using standard cutlery: large handled cutlery, weighted cutlery, knife and fork in one

• Standing for long periods: perching stool

• Getting in and out of bed: bed rails, mattress elevators, bed ladders

• Getting up from and sitting down in a chair: rise and recline chairs, lifting cushions and chair raisers

• Transferring a person from one position to another: slide sheets, turning aids, handling belts, hoists

• Drinking from a standard cup: one way straws, drinking bottles, large handled mugs, spout mugs

• Remembering things: memo minder

• Managing medication: automatic pill dispensers, pill organisers

• Getting dressed: dressing stick, bra angel, sock aid, leg lifter

• Getting help in an emergency: SOS pendant telephone system, automatic telephone dialler

• Incontinence: incontinence underwear and pads, waterproof chair and bed pads, waterproof bedding

If you are unsure what stroke products may help you, contact our Occupational Therapist Product Advice team by email productadvice@nrshealthcare.co.uk or telephone 0345 121 8111.

Everyone recovers differently from stroke. Some people recover more easily and quickly than others. It depends what type of stroke you have had, what part of your brain was affected, and what damage was caused there.

There is a lot of support for stroke available, and you are likely to have a team of healthcare professionals to help you recover. For example, if you are left with difficulties walking or moving, balance or coordination problems, you may benefit from seeing a physiotherapist. For more information, read the Stroke Association leaflet Physiotherapy after stroke.

If you are experiencing mental health issues, such as anxiety or depression, your GP may be able to refer you to a counselling service. If you have difficulty communicating or swallowing, a speech and language therapist will be able to support you.

Stroke Association provides a wealth of information about the after effects of stroke and the treatments that may help.

Stroke diet

Eating a healthy, balanced diet can help reduce the risk of developing high cholesterol and high blood pressure, which consequently reduces the risk of stroke. For a person who has experienced stroke, following a healthy stroke diet is important to reduce the risk of this happening again.

A healthy diet for stroke survivors should aim to reduce fat, sugar, salt and cholesterol, and increase the amount of vitamin rich fruit and vegetables, proteins and fibre. Consuming high levels of trans fats and saturated fats increases a person’s risk of developing atherosclerosis, which can lead to stroke or heart conditions such as angina. Eating too much salt can lead to high blood pressure, which increases your risk of damage to the blood vessels, which may increase your risk of stroke in the long term.

For more stroke diet advice, download the Stroke Association Healthy Eating and Stroke leaflet.

The NHS website provides lots of healthy eating information, recipes and weight loss advice you may find helpful.

Some people choose to take vitamin and mineral supplements for stroke recovery or because they believe these may reduce the risk of developing stroke. Popular supplements for stroke risk reduction include vitamin D, folic acid and NAC (N-acetyl cysteine). However, there is little scientific evidence that stroke supplements do reduce the risk of stroke, and some may even have the opposite effect, or may affect other healthcare conditions. Therefore, always speak to your GP before taking supplements of any sort.

Exercise for stroke

Regular, moderate intensity exercise is one of the best ways to reduce your risk of stroke, because it helps reduce blood pressure, cholesterol levels and helps you maintain a healthy weight. The recommended amount is only around half an hour of aerobic exercise per day, which includes anything that gets your heart pumping, such as swimming, fast walking or running.

For stroke survivors, it is important to try to establish some level of exercise where possible, to reduce the risk of stroke happening again, and to help with recovery. Exercise for stroke survivors may be limited by the physical after-effects of their stroke, but there are many ways to get active again, including gentle walks and chair based exercises. Your physiotherapist or GP will be able to advise.

Some people who have limited mobility after stroke will be given exercises for stroke rehabilitation by their physiotherapists. This may include a range of very low intensity exercises, and practicing skills that you are finding difficult. For example, if you are experiencing weakness in the arms after stroke, you may be given some exercises that help you start to use your arm, and rebuild strength, muscle and coordination. For more information on this, download the Stroke Association’s Physiotherapy after stroke leaflet.

Smoking and stroke

Quitting smoking is one of the best ways to reduce your risk of having a stroke. Smoking makes your blood more likely to clot because it is thicker, reduces the amount of oxygen carried by your blood, and makes your arteries narrower, which significantly increases your risk of having a stroke. Smokers are more likely to experience stroke, and more likely to die if they do have a stroke, compared to non-smokers. For more information on stroke risk and smoking, read the Stroke Association’s leaflet on Smoking and the risk of stroke. Visit the NHS website for advice on how to stop smoking.

Stroke and employment

Many people who have experienced stroke are able to work. Some may choose to change jobs or work part time, whereas others go back to their same employment. Your employer has to treat you equally and fairly if you do return to work, and has to make reasonable adjustments to ensure you are able to do your job, despite any disabilities you may have.

If you are unable to work for a short or long term period, you may wish to explore disability benefits that you are entitled to receive – for more information, visit the Money Advice Service.

For more information on returning to work after stroke, visit the Stroke Association website.

Stroke Association’s My Stroke Guide – a self-management tool to support all people affected by stroke, which includes a social forum to share experiences and local support group information

Stroke Survivors Forum – a place for anybody affected by stroke to discuss a variety of topics, ask questions and find out how other people deal with stroke

Positive Thinking Stroke Survivors Facebook Group – a group of stroke survivors from across the world, united on Facebook to share positive attitudes, experiences and advice

Different Strokes Facebook Group – a group for young stroke survivors and their families.

ACT F.A.S.T campaign – Public Health England’s official campaign website, designed to educate the public about stroke symptoms

British Heart Foundation – the leading UK heart charity which provides lots of advice about healthy living to prevent heart disease and related health conditions such as stroke

Brain and Spine Foundation – a UK charity providing information and research for all neurological health conditions related to the brain and spine

Different Strokes – a charity for young survivors of stroke, providing practical information related to a young person’s experiences, survivor case studies and a helpline

Headway – the Brain Injury Association that aims to improve life after brain injury, through a helpline, informative website, local groups and branches, financial assistance and specialist nurses

NHS Choices – source of official medical advice and information in the UK, related to all aspects of stroke and other healthcare conditions, as well as lifestyle advice

Stroke Association – the leading UK charity that provides a wealth of information about all aspects of stroke, as well as an online self-management tool, social forum, helpline, local support services and grants for funding equipment for stroke survivors

Alteplase

– a drug used to treat heart attacks and strokes by breaking up blood clots

Aneurysm

– where the wall of an artery becomes weak and may become misshapen or rupture, which leads to internal bleeding

Anticoagulant

– drugs that help prevent blood from clotting, given to people at risk of stroke, heart attack etc

Atherosclerosis

– build-up of fat inside the arteries which makes them narrower, making a person more susceptible to heart attack and stroke

Arteries

– blood vessels which look like tubes in the body, and which circulate blood from the heart under high pressure

Blood vessel

– tubes that carry blood around the body and which take the form of a vein, artery or capillary

CT scan

– computerised tomography scan that uses x-rays to look inside the body to see organs, bones, blood vessels, etc

Carotid ultrasound scan

– tests for narrowed carotid arteries, which are the two main ones that carry blood to and from the head/neck

Echocardiogram

– heart and blood vessels scan, similar to an ultrasound

Folic acid

– a form of vitamin B9 which is important for brain function

High cholesterol

– cholesterol is a substance made in the body, which is required to help build cells, however too much or high levels of cholesterol can be dangerous and put people at higher risk of stroke and heart attack

Hypertension

– another term to describe high blood pressure, which can increase a person’s risk of developing serious health conditions such as stroke, and which is easy to test using a blood pressure monitor

Intracerebral haemorrhage

– bleeding within the brain

Ischaemic

– blood and oxygen supply to the tissues is restricted and, in the case of stroke, blood supply to the brain is reduced

MRI scan

– a magnetic resonance imaging scan that uses magnetic fields to look inside the body, to look at organs, breasts, brain, spine, blood vessels, etc

NAC (N-acetyl cysteine)

– a dietary supplement which is a form of an essential amino acid and antioxidant made in the body

Obesity

– being overweight with a high level of body fat

Thrombectomy

– a surgical procedure to remove veins or arteries, used in stroke care or for other conditions such as deep vein thrombosis

Thrombolysis

– a procedure to dissolve blood clots by transferring medication into the body

Trans fats

– unsaturated fats in foods that raise cholesterol levels and cause clogged arteries

Saturated fats

– found in foods, too much of these fats may increase cholesterol and risk of stroke or heart attack

Subarachnoid haemorrhage

– bleeding on the surface of the brain

Subarachnoid space

– this is an area within the central nervous system that contains delicate tissue and spinal fluid. In some types of stroke, blood may leak into this area