When A Stroke Happens When A Stroke

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When a stroke happensWhena strokehappensWhat to expect during the firsthours, days and weeks after a stroke

We’re for life after strokeIntroductionNeed to talk?Call our confidential Stroke Helpline on0303 3033 100.Every year, there are about 152,000 strokesin the UK. That’s more than one every fiveminutes. Most people affected are over65, but anyone can have a stroke, includingchildren and babies.You may also find our other leaflets helpful. We are the Stroke AssociationWhat is a stroke?How to prevent a strokeLife after strokeThe road to recoveryWe also have lots more useful information.To order leaflets and factsheets, or to find outmore about stroke, please call 0303 3033 100,email info@stroke.org.uk or visit us atstroke.org.uk.We are a charity. We rely on your supportto change lives.Produced by the Stroke Association’sInformation Service. To see which referenceswe have used, visit stroke.org.uk.Please call us on 0115 871 3949 or emailquality@stroke.org.uk if you are unhappy withus in any way. We will happily discuss any issuesand help sort them out.A stroke is sudden and can be life-changingfor you and your family. It usually involvesstaying in hospital, having tests and being onmedication to help prevent further strokes.This leaflet explains what you can expectto happen when you have had a stroke,from emergency care to beginning yourrehabilitation and recovery."I was at home withmy wife when Istarted to feel veryill and couldn’t movemy arm. She realisedI was having a strokeas the FAST testhelped her identifyit. She called 999and I was rushed tohospital."Darren, stroke survivorContents What is a stroke? – page 4Symptoms and recovery – page 5Going into hospital – page 6Further tests – page 8Swallowing – page 9Rehabilitation – page 10Meet the stroke team – page 11Leaving hospital – page 14Discharge plan – page 15The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland(SC037789). Also registered in Northern Ireland (XT33805), Isle of Man (No 945) and Jersey (NPO 369).2Stroke AssociationWhen a stroke happens3

What is a stroke?Symptoms and recoveryA stroke is a seriousmedical emergencythat needs urgenttreatment. Don’tdelay getting tohospital – the sooneryou are diagnosedand treated, thebetter.Signs of a strokeA stroke has an immediate effect on howboth the body and mind work.Typicalsymptoms include:A stroke is a brain attack. It happens when theblood supply to part of your brain is suddenlycut off or reduced.Blood carries essential nutrients and oxygento your brain. Without blood, your brain cellscan die or become damaged.About 85% of strokes are caused by ablockage (ischaemic stroke) and about 15%are caused by a bleed (haemorrhage) in oraround the brain.Our brains control everything we do, think andfeel – things we can take for granted like beingable to move, speak, understand, remember,see and deal with our feelings. If the part ofyour brain that controls any of these activitiesis damaged, your ability to do them is alsoaffected.A transient ischaemic attack (TIA), sometimescalled a mini-stroke, is similar to a stroke,but the symptoms do not last very long. Youshould treat a TIA as an emergency as it couldmean you are at risk of having a major stroke.See our factsheet ‘Transient ischaemic attack(TIA)’ for more information.4Stroke AssociationSuspect a stroke?Act FAST. Call 999. numbness, weakness or paralysis on oneside of your body slurred speech, or difficulty finding wordsor understanding speech sudden blurred vision or loss of sight confusion or unsteadiness, or a sudden, severe headache.RecoverySome people who have a stroke willmake a good recovery quite quickly. Butunfortunately, not everyone gets better.Complications such as a chest infection canmake it harder to start recovering. If a strokeis very severe, you may be left withlong-term disabilities.F - Facial weaknessCan the personsmile?A - Arm weaknessCan the personraise both arms?S - Speech problemsCan the personspeak clearly?T - Time to call 999if they have anyof these signs.Around 20% of people die from a stroke ifparts of the brain that control vital functions,such as breathing, stop working.For advice about coping with loss, please seeour factsheet ‘Bereavement and stroke’.When a stroke happens5

Going into hospitalYou may need anumber of tests toconfirm that youhave had a stroke.They help to find outwhat has happenedand rule out otherconditions. If youare not sure what ishappening, alwaysask.When you have had a stroke, you should goto a hospital with a specialist stroke ward forcare and assessment. At first, you may go toaccident and emergency (A&E) or anotherassessment ward, but it is likely you willquickly be taken to an acute (or hyper-acute)stroke unit for the best possible treatment.Brain scans and testsAt first you will need to have tests to confirmyou have had a stroke and to make sure thatyou receive the right emergency treatment.The quicker your stroke is diagnosed andtreated, the better your recovery will be.If you have had a stroke you should havea brain scan as soon as possible – alwayswithin 12 hours of your stroke (or sooner ifyou could benefit from urgent treatment).You could have one or both of the followingscans.6Stroke Association A CT (computer tomography) scan is aform of X-ray of the brain. The resultsshow which part of the brain has beendamaged by the stroke and tell the doctorif it was caused by a blockage or bleeding. MRI (magnetic resonance imaging) scansare taken in a large tunnel-shaped scannerthat produces more detailed pictures ofthe blood vessels in the brain."When I was in theambulance theparamedic asked meto write my namebut I couldn’t. I waslucky to receivethrombolysis. Anhour later I could talkagain."ThrombolysisIf you have had a stroke caused by a bloodclot, you may be given a ‘clot-busting’treatment called thrombolysis to improveyour chances of recovery. Thrombolysis canonly be given within four and a half hours ofyour stroke symptoms starting, though thesooner it is given the better. This treatmentis becoming more widely available inhospitals throughout the UK.Pam, stroke survivorBlood-thinning medicationUnless your brain scan shows that you havehad a bleed, you should be given aspirin(an anti-platelet drug) as soon as possible.Aspirin makes the blood less sticky andstops clots forming, which helps to preventanother stroke. If you cannot take aspirinyou should be offered a different type of drugsuch as clopidogrel.When a stroke happens7

Further testsSwallowingOther testsTo identify why you had a stroke, and to findout which treatments you need to help preventa further stroke, doctors may carry out thefollowing tests. High blood pressure is the most commoncause of a stroke. You will have your bloodpressure checked and be given medicationto reduce it (if needed). An ECG (electrocardiogram) recordsthe rhythm and electrical activity of yourheart. This test can help to diagnose atype of irregular heartbeat called atrialfibrillation (AF). AF increases your risk ofhaving a stroke, but it can be managed withmedication. Blood tests can check if you have highcholesterol levels, blood-clotting problemsor high blood sugar levels (diabetes), all ofwhich increase your risk of having a stroke. A carotid doppler examines the rate theblood flows through the carotid arteries inthe front of your neck. A doctor uses thisif they think your stroke might have beencaused by the narrowing of this artery.SwallowingIf you cannot swallow properly after yourstroke, there is a risk that food and drink mayget into your lungs (aspiration), which can lead8Stroke AssociationA swallow testis essential foranybody who hashad a stroke. Aspeech and languagetherapist or anothertrained professionalwill carry out yourswallow test.to serious chest infections and pneumonia.If you have difficulty swallowing, you may begiven puréed food or thickened drinks. Youcan also have fluids through a drip to stopyou getting dehydrated, and receive yourmedication in a safe way.You may also have a test called avideofluoroscopy. This is a type of videoX-ray that helps to find out exactly what iscausing your swallowing problems.Tube feedingYour overall recovery will be better if youcan start to eat and drink again. If this is notpossible, you can be given food and drinkthrough a tube. There are two types of tube: a nasogastric (NG) tube, which goes upyour nose and down your throat into yourstomach, and a gastrostomy tube (PEG), which goesstraight into your stomach.If you have a tube fitted, this can be removedin the future if you can swallow safely again.To help your mouth feel fresh, you (or a familymember) can regularly brush your teeth andkeep your mouth moist with a wet swab.For more information see our factsheet‘Swallowing problems after stroke’.When a stroke happens9

RehabilitationMeet the stroke teamEarly rehabilitation can help you to be moreindependent as you relearn the skills you havelost, learn new skills and find ways to manageany long-term disabilities you may have. Tostart your rehabilitation while in hospital, youmay stay on the stroke ward or move to aspecialist rehabilitation ward.Don’t be afraid to ask what your rehabilitationis likely to include. If you know what ishappening to you and what is expected of you,you will start to feel more confident and incontrol of your progress. In the first few days itis normal to feel very tired, anxious, emotionalor depressed, and to lose your appetite. Withhelp and reassurance from the stroke team,you’ll usually notice improvements in the firstfew weeks after your stroke.Meet the stroke teamDoctorsThe consultant is responsible for your carewhile you are in hospital, but you may seeregistrars and junior doctors more often. Yourconsultant will usually be a stroke physician, orthey may be a general physician, neurologistor geriatrician.10 Stroke AssociationNurses, clinical nurse specialists andhealthcare assistantsThese are your main carers in hospital. Youmay have a main named nurse or team (led bya ward manager) and they will: provide day-to-day care, making sure youare safe and comfortable help you get out of bed and move around,sometimes by using a hoist, and help you with eating and drinking.Your stroke teamincludes doctors,nurses, therapistsand other specialistswho will assessyou and work outa rehabilitationprogramme tailoredto your needs.Good nursing care at this early stage helpsavoid complications after your stroke. Forexample, if you have paralysis in your arm orleg, a nurse can make sure you are positionedand supported correctly to prevent furtherdamage or pain. If you cannot move about inbed yourself, you may need a special mattressor to be moved regularly to avoid pressuresores and blood clots forming.Some people have difficulty controllingtheir bladder soon after a stroke. Yourmedical team can assess the reasonfor this and work out a plan to help youmanage.When a stroke happens11

Meet the stroke team"On the left sideof my face and leg,I can’t feel verymuch. I can walkthough and I feel I’mextremely lucky."Maggie, stroke survivorPhysiotherapistIf you have balance problems, paralysis ormuscle weakness, a physiotherapist can: help you to sit, stand or lie down, and develop exercises to help you move moreeasily and stop any weak limbs becomingstiff and painful (spasticity).Speech and language therapistIf you have difficulty with swallowing orcommunicating, a speech and languagetherapist can: help with swallowing problems suggest ways to help you communicateusing exercises, speech, reading andwriting, and explain to family and friends how they canhelp you to communicate.DietitianA dietitian can recommend a healthy andnutritious diet if you have swallowingproblems, are being fed using a tube, areunderweight, have lost your appetite orhave diabetes.12 Stroke AssociationOccupational therapistIf you are confused, lack some co-ordination,are not able to concentrate or cannot seeproperly, an occupational therapist can:"I was really scaredwhen I had a strokeat the age of 23.I wish I had takencounselling as I still teach you how to get dressed, use the toilet have panic attacksand headaches."and wash yourself, and give you advice on equipment, including aClaire, stroke survivorwheelchair or adaptations. They may visityour home before you leave hospital.OphthalmologistIt is common to have problems with yourvision after a stroke. An ophthalmologistor orthoptist can assess your vision andrecommend special glasses or other visual aids.Clinical psychologistA clinical psychologist can help you deal withemotional problems after a stroke. These mayinclude anxiety, depression and mood swings.They can also help if you have problemsconcentrating, planning or rememberingthings.PharmacistThe pharmacist makes sure your medicationis correct and in a safe form for you to take.They can also give you information about yourmedication.When a stroke happens13

Leaving hospital England – for detailsof the Patient Adviceand Liaison Service(PALS), call NHS Directon 0845 4647 or visitwww.pals.nhs.uk. Northern Ireland – fordetails of the Patientand Client Council(PCC), call0800 917 0222 or visitwww.patientclientcouncil.hscni.net. Scotland – call theNHS Inform Helplineon 0800 22 44 88or visitwww.cas.org.uk/patientadvice. Wales – for detailsof IndependentCommunity HealthCouncils (CHCs),call 0845 644 7814 orvisit www.communityhealthcouncils.org.uk.14 Stroke AssociationDischarge planEveryone’s stroke is different and yourstay in hospital could be for a few days ora few months, depending on how seriousyour stroke is and how well you respondto treatment and rehabilitation.A significant amount of recovery usuallyhappens within the first few weeks, butyou are likely to notice improvementscontinuing for many months and evenyears later. Your recovery will be a gradualprocess and you will usually continue yourrehabilitation after leaving hospital. Tofind out more about rehabilitation, seeour leaflet 'The road to recovery'.Useful contactsYou may need help finding out what ishappening in hospital, or perhaps you arenot happy with the care you or your lovedone has received. The organisationson the left can help you deal with yoursituation or make a formal complaint.Once you are well enough to leave hospital,the stroke team will produce a discharge planto make sure all the support you need fromhealth and social services is in place beforeyou go home. This could include referrals tocommunity rehabilitation or a warfarin clinic(if you are on warfarin).A hospital social worker may also be involvedin arranging any practical help at home. Thiscould include carers coming in to help you andrecommending suitable adaptations for yourhome, but services vary across the UK."Being a carer for astroke survivor canbe incredibly hard.I felt very isolatedand afraid whenhe was dischargedfrom hospital as Ididn’t know what toexpect."Christine, carerIf there isn’t a hospital social worker, youor your family can contact your local socialservices and ask them to visit you to assessyour needs and the needs of your carer (if youhave one). For more information about beinga carer, see our factsheet ‘Stroke: a carer’sguide’.Once you’re home, help is available Call our Stroke Helpline to find out whatsupport is available in your area, such asstroke clubs or carers' centres. Ask social services about what practicalsupport you’re entitled to. Ask your therapist what exercises you cando at home to help improve your recovery.When a stroke happens15

We are the Stroke AssociationWe believe in life after stroke. That’s why wesupport stroke survivors to make the bestrecovery they can. It’s why we campaignfor better stroke care. And it’s why we fundresearch into finding new treatments andways of preventing stroke.We’re here for you. If you’d like to knowmore please get in touch.Stroke Helpline: 0303 3033 100Website: stroke.org.ukEmail: info@stroke.org.ukTextphone: 18001 0303 3033 100 Stroke AssociationLeaflet 4, version 1Published December 2012(Next review due – December 2014).Item code: A01L04

hours, days and weeks after a stroke When a stroke happens. 2 Stroke Association n tro n 3 The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland . There are two

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