Stroke

What is stroke?

A stroke occurs when blood supply to part of the brain is interrupted, either by a clot or by bleeding. Brain tissue dies rapidly without oxygen, so treatment is intensely time critical. Recognising the sudden onset of face, arm or speech symptoms and calling emergency services immediately is the single most important determinant of outcome.

Causes

• Ischaemic stroke from a clot blocking a brain artery
• Cardioembolism, frequently from atrial fibrillation
• Small vessel disease
• Haemorrhagic stroke from a ruptured vessel
• Carotid artery atherosclerosis
• Arterial dissection in younger patients

Symptoms

• Sudden facial drooping on one side
• Sudden weakness or numbness of one arm or leg
• Slurred or garbled speech, or difficulty understanding
• Sudden loss or blurring of vision
• Sudden severe headache with no known cause
• Sudden dizziness, loss of balance or coordination
• Confusion

Risk factors

• Hypertension, the single largest modifiable risk factor
• Atrial fibrillation
• Smoking
• Diabetes
• High cholesterol
• Obesity and physical inactivity
• Excess alcohol
• Previous stroke or transient ischaemic attack

Diagnosis

• Immediate CT brain to distinguish clot from bleed
• CT angiography to identify large vessel occlusion
• MRI for small or posterior strokes
• ECG and prolonged monitoring for atrial fibrillation
• Carotid imaging
• Blood glucose measurement to exclude a mimic

Treatment

• Thrombolysis within the treatment window for ischaemic stroke
• Mechanical thrombectomy for large vessel occlusion
• Admission to a specialist stroke unit
• Antiplatelet therapy and later anticoagulation where indicated
• Blood pressure and cholesterol management
• Early multidisciplinary rehabilitation
• Neurosurgical intervention for selected haemorrhages

Self care

• There is no self care for a suspected stroke; call emergency services immediately
• Note the exact time symptoms started, since it decides treatment eligibility
• Do not give food, drink or aspirin before assessment
• After a stroke, follow the rehabilitation programme consistently
• Take blood pressure and antiplatelet medicines exactly as prescribed

When to see a doctor

Book an appointment if:

• Symptoms that came and went completely, which may have been a transient ischaemic attack
• Blood pressure readings that stay high at home
• New irregular pulse or palpitations
• Worsening weakness, speech or swallowing after discharge
• Low mood or memory problems during recovery

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Keep blood pressure controlled, the single largest factor
• Take anticoagulation as prescribed if you have atrial fibrillation
• Stop smoking
• Manage diabetes and cholesterol
• Stay physically active and keep to a healthy weight
• Limit alcohol and reduce dietary salt

Outlook

Outcome depends heavily on how quickly treatment starts and how much brain tissue is affected. Clot busting drugs and thrombectomy given within the treatment window can produce substantial recovery. Many people regain significant function with rehabilitation, though some are left with lasting weakness, speech or cognitive difficulty. Risk of a further stroke is highest in the first weeks, which is why secondary prevention begins immediately.

Related conditions

Common questions