A stroke occurs when blood flow to the brain is interrupted and brain cells die. A stroke can lead to permanent brain damage or death, so should always be treated as a medical emergency.

If you or someone near you might be having a stroke, call triple zero (000) and ask for an ambulance.
Early treatment of strokes can make an enormous difference to your recovery. Long term rehabilitation is also pivotal to maximising recovery, as the brain can change and develop to learn new ways of doing things.

In the short term, people having a stroke can experience a variety of problems, including trouble speaking, understanding, moving or seeing. Other symptoms of stroke include:

• sudden paralysis or weakness of the face, arms, hands or legs, usually on one side only
• numbness in the limbs, on the face or on any part of the body
• problems swallowing
• loss of normal vision in one or both eyes
• an extreme or unusual headache, which may start like a thunderclap
• loss of consciousness or extreme drowsiness.

Not everybody gets all these symptoms – it depends on what part and how much of the brain is affected

In the long term, even after rehabilitation, people who have had a stroke might have:

• weakness or paralysis down one side of the body
• trouble speaking or thinking clearly
• problems with eyesight
• poor control of bowel or bladder
• pain
• depression and anxiety
• difficulty with emotions and behaviour.

There are two main types of stroke, plus something known as a transient ischaemic attack.

Blocked artery – ischaemic stroke

An ischaemic stroke occurs when the blood supply to part of the brain is blocked. Usually, this is because an artery narrows and narrows until no blood can get through. Sometimes, it is because a block clot that has formed somewhere else, like in the heart or in an artery in the neck, breaks off and lodges in an artery in the brain.

Bleed in brain – haemorrhagic stroke

A haemorrhagic stroke occurs when a blood vessel in the brain leaks or bursts. The blood spills into the brain and damages surrounding brain tissue.

Transient ischaemic attack

A transient ischaemic attack, or TIA, can be considered a mini-stroke from which you recover fully. If you have a TIA, take it seriously and see you doctor. It is really a warning sign that a stroke might come soon.

A stroke happens when blood flow to an area of the brain is disrupted or cut off. This deprives the brain cells of oxygen. Within minutes, brain cells that are deprived of oxygen start to die. If the blood flow isn’t restored to the area quickly, whole areas of the brain can die.

The problems this causes will depend on the area of the brain affected, the extent of the damage and how rapidly the person gets treated.

You are more likely than others to have a stroke if you:

• have high blood pressure
• have high cholesterol levels
• have diabetes
• have heart disease
• smoke
• are obese
• binge drink
• use illicit drugs
• have a close relative who has had a stroke.

Some children get stroke too. These are usually caused by medical conditions or direct injuries to the brain.

If you have a stroke, you will be admitted to hospital for a physical examination. The doctors are likely to ask for your medical history, and a range of tests that could include:

• computer tomography (CT) scan to show the stroke, bleeding or other condition affecting the brain
• magnetic resonance imaging (MRI) to show the damaged brain tissue
• ultrasound, which may be used to show fatty deposits and blood flow in the arteries of the neck
• blood tests to measure clotting ability, plus levels of cholesterol, blood sugar and other critical chemicals
• echocardiogram (ECG) to check for the possible source of blood clots in the heart
• cerebral angiogram to show blood flow and blockages in the arteries in the brain and neck.

Treatment

There are three phases of treatment:

• immediate care
• emergency medical care
• rehabilitation and long term medical care.

Immediate care

If you think someone might have had a stroke, act FAST. The word FAST can help you decide whether someone has had a stroke, and guide you what to do.

• Face – ask them to smile and see if one side of their face or mouth droops.
• Arms – can they lift both arms?
• Speech – ask them to repeat a sentence – is their speech slurred?
• Time is critical – if they show any of the three signs, dial triple zero (000) and ask for an ambulance.

Emergency medical care

The sooner you get emergency medical care, the higher the chance of a good recovery.

If you have an ischaemic stroke, you might be offered treatment with a medication that dissolves the clot and gets blood flowing to your brain again. This must happen within hours of the stroke starting. You will probably also receive other medication to break down clots and stop them forming.

Some people will be offered an angioplasty. In this procedure, a doctor inserts a tiny tube into the blocked blood vessel to capture and remove the blood clot. They might also insert a small metal coil known as a stent.

If there is a large area of bleeding, you might need surgery to remove the blood and reduce the pressure on the brain. There are also other types of surgery to deal with a haemorrhagic stroke.

Emergency medical care can make a significant difference to your recovery.

Rehabilitation and long term medical care

If you’ve had a stroke, you will be offered rehabilitation, which starts within hours or days. It will help speed your recovery and will help you relearn or find new ways of doing things that have been affected by your stroke.

You might be offered rehab at home, or while living at home but visiting a day rehab centre, or while staying in a rehab unit.

Rehab takes time – it is not unusual for you to keep improving for a year or more.

You will also be advised to do all you can to reduce the risk of another stroke. That might or might not include:

• medications to reduce your blood pressure
• medications to thin your blood
• medication to reduce your cholesterol.

Rehabilitation

Ideally, you will be cared for by a multidisciplinary stroke team that changes as your needs change. It could include:

• doctors such as a GP and a neurologist or geriatrician
• a physiotherapist to help you remain active and mobile
• a speech pathologist who can help you manage communication and swallowing problems
• an occupational therapist who can help you with advice around mobility and independence
• a dietitian to help you with food choices and preparation, particularly if you have difficulties with swallowing and eating
• a social worker or a psychologist or counsellor to help you manage both the practical and the emotional aspects of the condition.

You might move at some time from the hospital to a specialised rehabilitation unit, or you might continue your rehabilitation from home as an outpatient or through a community health service.

If you’ve had a stroke, you’ll need time to recover and adjust. How much the stroke affects your life depends on what part of your brain was affected, what sort of treatment you got and your rehabilitation. It might have little effect, or it might have a significant effect, or anything in between.

If you are severely affected, the stroke can affect relationships, work and income, caring for yourself and moving about. You might need to learn basic skills like walking and speaking again, and you might need to cope with pain, tiredness and personality changes. Some people lose much of their independence and are unable to do things they took for granted, such as drive.

But others are not so severely affected.

Either way, you will probably need time to come to terms with what has happened and what it means for you. You might feel a lot of different emotions at different times, including anger, denial, anxiety, depression and more.

It can help to learn as much as possible about stroke and about the services and support available from an organisation such as the Stroke Association. But take your time and do it at your own pace.

Psychological and emotional support

If you’ve had a stroke, you may need some emotional support to adjust to the changes for you and your family. You might be able to get the support you need from your partner, your family and your friends, but you can also look for support from a professional such as a psychologist, counsellor or social worker.

Diet, exercise and lifestyle

You should aim to eat a healthy diet with lots of fruit, vegetables and fibre. It should be low in saturated fat, alcohol and salt. A dietitian can help.

If you have difficulty swallowing, a speech pathologist can recommend safe ways to eat and drink.

Exercise can be vital for stroke recovery and can reduce the risk of another stroke. A physiotherapist or exercise physiologist can recommend an exercise program to suit you, even if you have difficulties with walking or balance.

Relaxation techniques such as mindfulness, meditation or deep breathing can help manage stress.

If you smoke, quit. That will reduce your risk of another stroke.

Household and other adaptations

If your stroke has affected your mobility and independence, you might be able to make some changes to your house. Ramps for wheelchairs, grab rails for bathing and hoists for lifting someone from a bed to a chair, can increase your mobility and independence, while helping those who care for you. An occupational therapist can provide advice on this.

Equipment and assistive technology

There is also a lot of equipment and special aids that can help people who need it to move about, do routine tasks and communicate. Some examples includes:

• manual or powered wheelchairs
• computer software and Apps
• communication aids, including speech generating devices.

You can get advice on this from occupational therapists, speech pathologists and other health professionals.

Personal and nursing care

If your mobility has been affected significantly, you might need help with daily tasks such as bathing, going to the toilet, getting dressed and communicating. The need for care might be temporary, or it might be permanent. Some of the care can be provided by family or friends. You may also be able to get nursing care through your local hospital, community health centre or nursing service.

Sources:

Stroke Foundation (About Stroke, facts and figures about stroke, stroke symptoms), The Mayo Clinic (Stroke Symptoms and causes, stroke diagnosis and treatments) Beyond Blue (Depression and anxiety after stroke), Brain Foundation (disorders Stroke).

Last updated November 2017