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Having a stroke/stroke treatment

One in five people have a stroke at some time in their life.  Stroke can strike at any age. It could happen to you, a friend or family member.
Knowledge of what a stroke can do to a person can also help to reduce its impact.

Until recently many people, including doctors, believed that little or nothing could be done after a person had a stroke.
We now know that strokes can be treated. If the right actions are taken quickly after a stroke, a person may not have major long term disability.
Recognising the symptoms of stroke and accessing treatment immediately is important.

This leaflet explains:

  • what a stroke is
  • what causes stroke
  • how stroke can affect a person’s life
  • stroke treatment.

What is a stroke?

“I woke up and suddenly I had a pain in my head.  I couldn’t speak properly. I felt as though my ability to speak was just going from me. Then my sight went for a couple of minutes.”
                            -Marie Walsh, 34, Dublin.

A stroke is a brain attack. It is caused by an interruption of the blood supply to part of the brain.  If the brain stops getting important nutrients and oxygen from the blood, the brain cells can become damaged and die.

This can affect different parts of the body. For example, if a stroke damages the part of your brain that controls the movement of your limbs, you may not be able to move one of your arms or legs.
A stroke can also affect mental processes such as how you feel, think, communicate, or learn.

How do you recognise a stroke?

“On the third morning since my headache began I woke up and I had no power in my left leg. I began to think that something more serious wFASTas going on. ”    -Trish Gavigan, 41, Mullingar.

How to Act F.A.S.T.

A simple test can help you recognise a stroke:

Face; has their face fallen on one side?  Can they smile?
Arm; can they raise both arms and keep them there?
Speech; is their speech slurred?
Time to call 999 if you see any single one of these signs.
 
Other stroke symptoms include:

  • Numbness, weakness, or paralysis on one side of the body
  • Slurred speech, difficulty thinking of words or understanding other people
  • Confusion
  • Sudden blurred vision or sight loss
  • Being unsteady on your feet
  • Severe headache

What causes stroke?

“They found a hole in Michael’s heart.  That was the problem.   A blood clot went through the hole that went to his brain leading to the stroke”.
-Therese McGovern talking about her husband Michael McGovern (39), Longford.

1. Over 80 per cent of strokes are caused by a blockage of an artery supplying blood to the brain. This is known as an ischaemic stroke. There are three main types of ischaemic stroke:

  • A blood clot that forms in a main artery to the brain.
  • A partial clot that may form in the heart or the blood vessels of the neck. This partial clot can be carried in the bloodstream to the brain and get lodged in an artery. This is a cerebral embolism.
  • A blockage that occurs in the tiny blood vessels deep in the brain. This is a lacunar stroke.
2. Up to 20 per cent of strokes are caused by a bleed into the brain from a burst blood vessel. This is called a cerebral haemorrhage.

3. A Transient Ischaemic Attack (TIA) or “mini-stroke” is a sudden and brief disturbance of the brain caused by small clots. 

Stroke symptoms from a TIA last less than 24 hours before going away.

TIAs do not cause any long term damage. However, they are a serious warning sign that you may have a full stroke in the near future.  Approximately 10% of people with a TIA will have a stroke within a week and 20% of people will have a stroke within a month.  TIAs should not be ignored and urgent medical attention is required.

Why does a stroke happen?

It may not be obvious why someone has had a stroke. Contrary to popular belief, stress – either long-term or after a sudden event – is not a major cause of stroke.

A stroke can happen to anyone. Some people are at greater risk of stroke for reasons beyond their control, such as their age and family history. Research shows that people from Asian and African communities are more likely to have a stroke.

The good news is that by making small changes to your lifestyle and by taking medications for certain conditions as directed by your doctor, you can reduce your risk of stroke. 

Read more on how to prevent a stroke in our leaflet Preventing Stroke.

To reduce your risk of stroke:
Don’t smoke
Take regular exercise
Cut down on salt and fatty foods
Eat plenty of fruit and veg
Get regular blood pressure checks
Don’t drink alcohol heavily

Is there any treatment for stroke?

The stroke services in a hospital can help improve your recovery after a stroke. Stroke services can start medical care early and put a plan in place to reduce your risk of further strokes.
Drug treatment in the early hours after stroke may also help some people. Treatments such as the clot-busting drug, thrombolysis aim to break up the blood clot with powerful blood thinners.

Do people recover after a stroke?

The brain needs time to heal and recovery can take many months.
Recovery is different for each person. Some people may recover and have only a slight disability. Other people may have more serious disabilities. In general, most recovery is made in the first year, but you can still make progress after this time.
Unfortunately, some people will not recover from a stroke. People who are dying as a result of a stroke should be given end-of-life care.

Stroke Treatment in the Hospital

“At the hospital I was met by the stroke physician. I had no pain and I wasn’t frightened but they told me my blood pressure was sky high. I was moved into intensive care for a few days. Then I was moved to the high dependency unit for three or four more days.”
                         -Seamus Mills, 62, Artane, Dublin.

When you come to hospital after having a stroke you may be assessed in the Accident & Emergency Department. 
This assessment is essential to ensure you are given the right emergency treatment.  The assessment will check:

  • What type of stroke you have had, the area of your brain that was damaged and how serious the damage is.
  • The condition of your heart and lungs
  • Problems you may have swallowing.

You may then need to have a number of other tests including a brain scan, blood tests, blood pressure tests and an electrocardiogram (ECG).

These tests should be carried out as soon as possible. The earlier your stroke is diagnosed the better chance you have of making a good recovery. 

Clot-busting drugs

Some strokes can be treated by thrombolysis, a clot-busting drug.  This drug treatment is only effective if received within 4.5 hours of your stroke starting.  Thrombolysis is not suitable for everyone. Doctors should check if it would be a good treatment for you.

Swallowing

Difficulties swallowing are common in the first few days after stroke. You may find it hard to eat or drink.

If you have difficulty swallowing you may be referred to a speech and language therapist for an assessment.  While you waiting to be assessed you may be given fluids through an intravenous drip .  Insulin may also be given to keep their blood sugar levels stable.

In some cases a people need to have feeding tube until it is safe for them to eat and drink.

Hospital tests explainedBlood pressure

Blood pressure: High blood pressure is the most common cause of stroke. Your blood pressure will be checked immediately. You will receive medication if you need it.

ECG (electrocardiogram): Irregular heart rhythms can increase your risk of stroke. This test checks your heart for unusual rhythms.

Blood tests: Samples of blood are taken in order to check your cholesterol levels, your blood’s ability to clot and your  blood sugar levels.

Brain scan or CAT scan (computerised resonance imaging):
This is an x-ray of the brain. You should have a brain scan within 24 hours of having a stroke.

MRI scans (magnetic resonance imaging):
give a very detailed picture of the brain. To do this test, you will be placed in a large tunnel-shaped scanner.

Carotid Doppler ultrasound: detects blockages in the carotid artery which may have caused the stroke. A Doppler probe is placed on the artery on your neck to check the blood flow.

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

Chest x-ray: this will help show the condition of your heart and lungs.

Videofluoroscopy Swallow Test: A swallow test may be carried out when you come to hospital. A further x-ray called a videofluoroscopy may be done if you continue to have difficulties swallowing. This x-ray tests what food and drink you can swallow safely so that food and liquids don’t get lodged in your windpipe and lungs.

Stroke Unit and Stroke Team

After a stroke you should be cared for in a specialist stroke unit. 
A stroke unit is a separate area of  a hospital ward for stroke patients. It is staffed by a stroke team of doctors, nurses and therapists.

If the hospital does not have a stroke unit you may be cared for in a general medical or rehabilitation ward. 
In hospital, you should be cared for a doctor expert in stroke. This could be a geriatrician (a doctor who cares for older people), a neurologist or a rehabilitation physician. 
Registrars and junior doctors will check on you regularly. A team of nurses will also care for you.  

You must be closely monitored in the days and weeks after stroke as complications can occur. 
Your brain needs time to heal so nurses and doctors will work to prevent any complications. Once you are stable you will be assessed by a rehabilitation team.  Rehabilitation should start soon after you come to hospital  and continue throughout your hospital stay. 

The rehabilitation team includes Speech and Language Therapists, Occupational Therapists, Physiotherapists, Dieticians, Nurses, Psychologists and Social Workers. They work together to help you make the best recovery possible.
For more information on rehabilitation read our Stroke Rehabilitation leaflet.

Glossary of Terms

Aneurysm
A permanent abnormal balloon-like bulging of an arterial wall.  The bursting of an aneurysm in a brain artery or blood vessel causes a haemorrhagic stroke.
Aphasia
Aphasia is a language impairment caused when areas of the brain that control language become damaged. Aphasia can affect the ability to talk or understand what is said, as well as the ability to read and write or spell. or write or understand spoken or written language. A person with aphasia may also have trouble with numbers or facial expression and gesture. Aphasia varies in type and severity, does not affect intelligence and can change over time.
Apraxia/dyspraxia
An inability to coordinate movements even though there is no damage to the muscles needed for the movement.
Arrhythmia
An irregular or unpredictable heart beat.
Atrial Fibrillation (AF)
An abnormal heart rhythm where the pulse is irregular.
Cerebellar Stroke
A stroke that strikes the cerebellum area of the brain, which controls balance and coordination.
Cerebrovascular
This term is for blood vessels of the brain.  A stroke is a cerebrovascular accident.
CT Scan
Computerised tomography – a series of X-rays at different levels of the brain.
Dysarthria
Dysarthria occurs when the muscles used for speaking are weak. People with dysarthria may have slurred speech or the voice may become soft or weak.
Dysphagia
Difficulty with swallowing.
Embolic stroke
A stroke resulting from the blockage of an artery by a blood clot (or embolus).
Haemorrhage
Bleeding into or around the brain.
Hemiparesis
Muscle weakness down one side of the body.
Infarct
The area of dead brain cells caused by disruption of the blood flow to the brain.
Intracerebral haemorrhage
A stroke caused by bleeding within the brain.
Ischaemia
An interruption or blockage of blood flow to the brain.
Lability
An uncontrollable outburst of emotion from laughing to crying without real cause.  It may only last a few weeks, or continue for a long period.
Penumbra
An area of surviving brain cells surrounding the initial site of brain damage from stroke. The brain cells in the penumbra are at risk of permanent damage, but not yet irreversibly damaged.
Perseveration
Getting stuck on one idea, action or response.
Rigidity
Loss of flexibility in thinking or movement.
Subarachnoid haemorrhage
A stroke caused by bleeding usually from an aneurysm.  The bleeding usually occurs into the cerebrospinal fluid, the protective fluid layer around the brain.
Transient Ischaemic Attacks (TIAs)
TIAs, are temporary interruptions of the blood supply to an area of the brain, often caused by a carotid stenosis (narrowing of the artery).  A TIA can last up to 24 hours, but most last only a few minutes and cause no permanent damage or disability.  A TIA is sometimes called a "'mini stroke".