Having a stroke can be very traumatic for a person and their family. In addition to immediate medical treatment, stroke can result in months and even years of rehabilitation in order to gain a high level of stroke recovery.

As soon as a stroke happens, tests are needed to make sure the right emergency treatment is given. Time is brain and the quicker the treatment, the better the chance of a good outcome after a stroke.

What to expect when you arrive at the Hospital

The initial assessment may take place in the Accident & Emergency department of the hospital.  The assessment will look at:

• What type of stroke the patient has suffered, the area of damage and how serious it is
• The condition of the heart and lungs
• Problems with swallowing (Dysphagia)

Tests carried out by the medical team will include a brain scan, blood tests, blood pressure tests and an ECG (Electrocardiogram, this looks at the electric activity of the heart) to see what caused the stroke, what damage the stroke has done and what is the best course of medical treatment to take.

These tests should be carried out as soon as possible. The earlier a stroke is diagnosed and treated the better chance a patient has of recovery. 

Thrombolysis

Some strokes can be treated by thrombolysis. This is a clot reducing drug treatment that aims to dissolve the blood clot with powerful blood thinners. It can have a powerful impact in preventing damage to brain cells caused by stroke.

This drug treatment should be carried out within three hours of the onset of stroke, but only in cases of ischaemic stroke or mini-stroke that involve a blockage or blood clot.  Read more about what a stroke is in our What is Stroke? section. 

Swallowing

If a patient has difficulty swallowing after a stroke they should be referred to a speech and language therapist and a dietitian for a more detailed assessment. 

Dysphagia is the medical term for difficulties swallowing.

Due to brain damage caused by a stroke, eating and drinking may be difficult, as the muscles of chewing and swallowing are weakened especially in the early stages. It is common to have a feeding tube in the early stages either through the nose (naso-gastric tube (NG tube)) or through the abdomen (percutaneous endoscopic gastrostomy (PEG tube)).

These tubes can be easily removed if/when the dysphagia resolves. The SLT may x-ray your throat to see what your swallowing difficulties are and what types of food and drink are safe for you to eat. This x-ray is called a videofluoroscopy.

The Speech and Language Therapist may also provide special swallowing therapy to help you swallow safely.

Heart and blood vessels

Further tests on the heart and blood vessels may be carried out.  These tests can help determine what caused the stroke in the first place.

Common Hospital Tests

Blood Pressure - high blood pressure is the most common cause of stroke. A patient's blood pressure will be checked immediately and the necessary medication will be given to stabilise their blood pressure.

ECG (Electrocardiogram) - this test checks the heart for unusual rhythms because irregular heart rhythm is another risk factor for stroke.

Blood tests - samples of blood are taken from the patient in order to check cholesterol levels, clotting and blood sugar.

Brain scan or CAT scan - is an x-ray of the brain. It is recommended that a patient has a brain scan within 24 hours of having stroke.

MRI scan (magnetic resonance imaging) - involves a large tunnel-shaped scanner, which give a very detailed picture of the brain.

Swallow tests - a lot of stroke patients have difficulty swallowing. Patients will be asked to swallow a small amount of water to check if they can swallow properly so that food and liquids don’t get lodged in their windpipe and lungs.

Carotid Doppler Ultrasound - a Doppler probe is placed on the carotid artery on the neck to check the blood flow. This will detect blockages in this artery that may have caused the stroke.

Echocardiogram (Echo) - a Doppler probe is moved over the chest to check the way the heart is working and to look for problems.

Chest x-ray - this will help show the condition of the patient's heart and lungs and will show any obvious causes of stroke.

Hospital Care

Stroke units and other hospital wards

Stroke patients should be cared for in a specialist stroke unit. An acute stroke care unit is a designated ward for stroke patients with a team made up of specialist doctors, nurses and therapists who can give coordinated stroke care to patients.

If an acute stroke unit does not exist in the hospital you will probably be cared for in a geriatric or general rehabilitation ward. 

Care in the hospital

In hospital, you will be under the direct care of a doctor, often a geriatrician (doctor specialising in care for the over 65s), a neurologist (doctor specialising in the nervous system) or a rehabilitation physician (doctor specialising in rehabilitation). 

There will also be registrars and other doctors checking on you regularly.  A team of nurses will be your main carers in the hospital.  

Stroke patients must be closely monitored in the days and weeks after having a stroke as complications can occur. The brain needs time to heal so nurses and doctors will work to prevent any of these complications.

Many people who have a stroke will suffer some form of paralysis or weakness on one side of their body.  This can be either partial or complete depending on the severity of the stroke. 

Assessment

Once a patient is stable they are assessed by a rehabilitation team.  Stroke rehabilitation should start soon after admission and continue throughout time spent in hospital. 

Stroke rehabilitation involves speech therapists, occupational therapists, dietitians and physiotherapists working together as a team to cover all your needs and to help you regain as much independence as possible.

Therapy

Physiotherapy can help you with balance problems, paralysis and muscle weakness. It is important for you to develop an exercise plan that can be continued when they return home after a stroke. 

Speech and language therapy will help you with any swallowing or communication problems.  Speech and Language therapists can recommend solutions to swallowing problems and help your family and friends to work with you to improve understanding and communication.

Day-to-day tasks like washing and dressing can be become difficult after a stroke as co-ordination and movement is impaired.  Occupational therapy can help you to do these things. An Occupational Therapist can also advise you on how to use equipment such as wheelchairs. 

Emotional ups and down, depression and anxiety can occur after a stroke. These can be caused either by the distress that comes from having a stroke, or by changes in the brain as a result of the stroke. A Clinical Psychologist can help you to cope with difficulties you may experience.  

Dietitians make sure your dietary needs are met by assessing your nutritional requirements, monitoring what food you eat and providing advice on the most appropriate food and drink for you.

Discharge from hospital

Patients and their families should receive advice on all parts of the patient’s condition when they are being discharged from hospital. You should receive advice on areas such as stroke prevention; management of medication; management of disabilities and communication difficulties; access to additional information such as grants for house modification and rehabilitation services before the patient is discharged. 

Effective rehabilitation is vital and a plan of continuing care should be drawn up before you leave hospital. 

You should also have a full needs assessment so you know what services and supports are available to you when you get home. 

Some patients will require residential care, but others may only need support from community groups.  A social worker can talk to you about the services and supports in your local area. 

Your GP should also be informed of your care requirements and medication. Members of the stroke care team should speak to your GP and pass on this information. The team should also communicate with your public health nurse and social worker to ensure that your home is safe and comfortable and that your family and/or friends have relevant information on rehabilitation and other services.