When a Stroke Happens

When a stroke happens

What to expect during the first hours, days and weeks after a stroke We’re for life after stroke Introduction

Need to talk? Every year, there are about 152,000 strokes "I was at home with Call our confidential Stroke Helpline on in the UK. That’s more than one every five my wife when I 0303 3033 100. minutes. Most people affected are over started to feel very 65, but anyone can have a stroke, including ill and couldn’t move You may also find our other leaflets helpful. children and babies. my arm. She realised I was having a stroke •• We are the Stroke Association A stroke is sudden and can be life-changing as the FAST test •• What is a stroke? for you and your family. It usually involves helped her identify •• How to prevent a stroke staying in hospital, having tests and being on it. She called 999 •• Life after stroke medication to help prevent further strokes. and I was rushed to •• The road to recovery This leaflet explains what you can expect hospital." to happen when you have had a stroke, We also have lots more useful information. from emergency care to beginning your Darren, stroke survivor To order leaflets and factsheets, or to find out rehabilitation and recovery. more about stroke, please call 0303 3033 100, email [email protected] or visit us at stroke.org.uk. Contents

We are a charity. We rely on your support •• What is a stroke? – page 4 to change lives. •• Symptoms and recovery – page 5

Produced by the Stroke Association’s •• Going into hospital – page 6 Information Service. To see which references •• Further tests – page 8 we have used, visit stroke.org.uk. •• Swallowing – page 9

Please call us on 0115 871 3949 or email •• Rehabilitation – page 10 [email protected] if you are unhappy with •• Meet the stroke team – page 11 us in any way. We will happily discuss any issues •• Leaving hospital – page 14 and help sort them out. •• Discharge plan – page 15

The 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).

2 Stroke Association When a stroke happens 3 What is a stroke? Symptoms and recovery

A stroke is a serious A stroke is a brain attack. It happens when the Signs of a stroke Suspect a stroke? medical emergency blood supply to part of your brain is suddenly A stroke has an immediate effect on how Act FAST. Call 999. that needs urgent cut off or reduced. both the body and mind work.Typical treatment. Don’t symptoms include: F - Facial weakness delay getting to Blood carries essential nutrients and oxygen Can the person hospital – the sooner to your brain. Without blood, your brain cells •• numbness, weakness or paralysis on one smile? you are diagnosed can die or become damaged. side of your body A - Arm weakness and treated, the •• slurred speech, or difficulty finding words Can the person better. About 85% of strokes are caused by a or understanding speech raise both arms? blockage (ischaemic stroke) and about 15% •• sudden blurred vision or loss of sight S - Speech problems are caused by a bleed (haemorrhage) in or •• confusion or unsteadiness, or Can the person around the brain. •• a sudden, severe headache. speak clearly? T - Time to call 999 Our brains control everything we do, think and Recovery if they have any feel – things we can take for granted like being Some people who have a stroke will of these signs. able to move, speak, understand, remember, make a good recovery quite quickly. But see and deal with our feelings. If the part of unfortunately, not everyone gets better. your brain that controls any of these activities Complications such as a chest infection can is damaged, your ability to do them is also make it harder to start recovering. If a stroke affected. is very severe, you may be left with long-term disabilities. A transient ischaemic attack (TIA), sometimes called a mini-stroke, is similar to a stroke, Around 20% of people die from a stroke if but the symptoms do not last very long. You parts of the brain that control vital functions, should treat a TIA as an emergency as it could such as breathing, stop working. mean you are at risk of having a major stroke. See our factsheet ‘Transient ischaemic attack For advice about coping with loss, please see (TIA)’ for more information. our factsheet ‘Bereavement and stroke’.

4 Stroke Association When a stroke happens 5 Going into hospital

You may need a When you have had a stroke, you should go •• A CT (computer tomography) scan is a "When I was in the number of tests to to a hospital with a specialist stroke ward for form of X-ray of the brain. The results ambulance the confirm that you care and assessment. At first, you may go to show which part of the brain has been paramedic asked me have had a stroke. accident and emergency (A&E) or another damaged by the stroke and tell the doctor to write my name They help to find out assessment ward, but it is likely you will if it was caused by a blockage or bleeding. but I couldn’t. I was what has happened quickly be taken to an acute (or hyper-acute) •• MRI (magnetic resonance imaging) scans lucky to receive and rule out other stroke unit for the best possible treatment. are taken in a large tunnel-shaped scanner thrombolysis. An conditions. If you that produces more detailed pictures of hour later I could talk are not sure what is Brain scans and tests the blood vessels in the brain. again." happening, always At first you will need to have tests to confirm ask. you have had a stroke and to make sure that Thrombolysis Pam, stroke survivor you receive the right emergency treatment. If you have had a stroke caused by a blood The quicker your stroke is diagnosed and clot, you may be given a ‘clot-busting’ treated, the better your recovery will be. treatment called thrombolysis to improve your chances of recovery. Thrombolysis can If you have had a stroke you should have only be given within four and a half hours of a brain scan as soon as possible – always your stroke symptoms starting, though the within 12 hours of your stroke (or sooner if sooner it is given the better. This treatment you could benefit from urgent treatment). is becoming more widely available in You could have one or both of the following hospitals throughout the UK. scans. Blood-thinning medication Unless your brain scan shows that you have had a bleed, you should be given aspirin (an anti-platelet drug) as soon as possible. Aspirin makes the blood less sticky and stops clots forming, which helps to prevent another stroke. If you cannot take aspirin you should be offered a different type of drug such as clopidogrel.

6 Stroke Association When a stroke happens 7 Further tests Swallowing

Other tests to serious chest infections and pneumonia. A swallow test To identify why you had a stroke, and to find If you have difficulty swallowing, you may be is essential for out which treatments you need to help prevent given puréed food or thickened drinks. You anybody who has a further stroke, doctors may carry out the can also have fluids through a drip to stop had a stroke. A following tests. you getting dehydrated, and receive your speech and language medication in a safe way. therapist or another •• High blood pressure is the most common trained professional cause of a stroke. You will have your blood You may also have a test called a will carry out your pressure checked and be given medication videofluoroscopy. This is a type of video swallow test. to reduce it (if needed). X-ray that helps to find out exactly what is •• An ECG (electrocardiogram) records causing your swallowing problems. the rhythm and electrical activity of your heart. This test can help to diagnose a Tube feeding type of irregular heartbeat called atrial Your overall recovery will be better if you fibrillation (AF). AF increases your risk of can start to eat and drink again. If this is not having a stroke, but it can be managed with possible, you can be given food and drink medication. through a tube. There are two types of tube: •• Blood tests can check if you have high cholesterol levels, blood-clotting problems •• a nasogastric (NG) tube, which goes up or high blood sugar levels (diabetes), all of your nose and down your throat into your which increase your risk of having a stroke. stomach, and •• A carotid doppler examines the rate the •• a gastrostomy tube (PEG), which goes blood flows through the carotid arteries in straight into your stomach. the front of your neck. A doctor uses this if they think your stroke might have been If you have a tube fitted, this can be removed caused by the narrowing of this artery. in the future if you can swallow safely again. To help your mouth feel fresh, you (or a family member) can regularly brush your teeth and Swallowing keep your mouth moist with a wet swab.

If you cannot swallow properly after your For more information see our factsheet stroke, there is a risk that food and drink may ‘Swallowing problems after stroke’. get into your lungs (aspiration), which can lead

8 Stroke Association When a stroke happens 9 Rehabilitation Meet the stroke team

Early rehabilitation can help you to be more Nurses, clinical nurse specialists and Your stroke team independent as you relearn the skills you have healthcare assistants includes doctors, lost, learn new skills and find ways to manage These are your main carers in hospital. You nurses, therapists any long-term disabilities you may have. To may have a main named nurse or team (led by and other specialists start your rehabilitation while in hospital, you a ward manager) and they will: who will assess may stay on the stroke ward or move to a you and work out specialist rehabilitation ward. •• provide day-to-day care, making sure you a rehabilitation are safe and comfortable programme tailored Don’t be afraid to ask what your rehabilitation •• help you get out of bed and move around, to your needs. is likely to include. If you know what is sometimes by using a hoist, and happening to you and what is expected of you, •• help you with eating and drinking. you will start to feel more confident and in control of your progress. In the first few days it Good nursing care at this early stage helps is normal to feel very tired, anxious, emotional avoid complications after your stroke. For or depressed, and to lose your appetite. With example, if you have paralysis in your arm or help and reassurance from the stroke team, leg, a nurse can make sure you are positioned you’ll usually notice improvements in the first and supported correctly to prevent further few weeks after your stroke. damage or pain. If you cannot move about in bed yourself, you may need a special mattress or to be moved regularly to avoid pressure Meet the stroke team sores and blood clots forming.

Doctors The consultant is responsible for your care Some people have difficulty controlling while you are in hospital, but you may see their bladder soon after a stroke. Your registrars and junior doctors more often. Your medical team can assess the reason consultant will usually be a stroke physician, or for this and work out a plan to help you they may be a general physician, neurologist manage. or geriatrician.

10 Stroke Association When a stroke happens 11 Meet the stroke team

"On the left side Physiotherapist Occupational therapist "I was really scared of my face and leg, If you have balance problems, paralysis or If you are confused, lack some co-ordination, when I had a stroke I can’t feel very muscle weakness, a physiotherapist can: are not able to concentrate or cannot see at the age of 23. much. I can walk properly, an occupational therapist can: I wish I had taken though and I feel I’m •• help you to sit, stand or lie down, and counselling as I still extremely lucky." •• develop exercises to help you move more •• teach you how to get dressed, use the toilet have panic attacks easily and stop any weak limbs becoming and wash yourself, and and headaches." Maggie, stroke survivor stiff and painful (spasticity). •• give you advice on equipment, including a wheelchair or adaptations. They may visit Claire, stroke survivor Speech and language therapist your home before you leave hospital. If you have difficulty with swallowing or communicating, a speech and language Ophthalmologist therapist can: It is common to have problems with your vision after a stroke. An ophthalmologist •• help with swallowing problems or orthoptist can assess your vision and •• suggest ways to help you communicate recommend special glasses or other visual aids. using exercises, speech, reading and writing, and Clinical psychologist •• explain to family and friends how they can A clinical psychologist can help you deal with help you to communicate. emotional problems after a stroke. These may include anxiety, depression and mood swings. Dietitian They can also help if you have problems A dietitian can recommend a healthy and concentrating, planning or remembering nutritious diet if you have swallowing things. problems, are being fed using a tube, are underweight, have lost your appetite or Pharmacist have diabetes. The pharmacist makes sure your medication is correct and in a safe form for you to take. They can also give you information about your medication.

12 Stroke Association When a stroke happens 13 Leaving hospital Discharge plan

•• England – for details Everyone’s stroke is different and your Once you are well enough to leave hospital, "Being a carer for a of the Patient Advice stay in hospital could be for a few days or the stroke team will produce a discharge plan stroke survivor can and Liaison Service a few months, depending on how serious to make sure all the support you need from be incredibly hard. (PALS), call NHS Direct your stroke is and how well you respond health and social services is in place before I felt very isolated on 0845 4647 or visit to treatment and rehabilitation. you go home. This could include referrals to and afraid when www.pals.nhs.uk. community rehabilitation or a warfarin clinic he was discharged A significant amount of recovery usually (if you are on warfarin). from hospital as I •• Northern Ireland – for happens within the first few weeks, but didn’t know what to details of the Patient you are likely to notice improvements A hospital social worker may also be involved expect." and Client Council continuing for many months and even in arranging any practical help at home. This (PCC), call years later. Your recovery will be a gradual could include carers coming in to help you and Christine, carer 0800 917 0222 or visit process and you will usually continue your recommending suitable adaptations for your www.patientclient rehabilitation after leaving hospital. To home, but services vary across the UK. council.hscni.net. find out more about rehabilitation, see our leaflet 'The road to recovery'. If there isn’t a hospital social worker, you •• Scotland – call the or your family can contact your local social NHS Inform Helpline Useful contacts services and ask them to visit you to assess on 0800 22 44 88 You may need help finding out what is your needs and the needs of your carer (if you or visit happening in hospital, or perhaps you are have one). For more information about being www.cas.org.uk/ not happy with the care you or your loved a carer, see our factsheet ‘Stroke: a carer’s patientadvice. one has received. The organisations guide’. on the left can help you deal with your •• Wales – for details situation or make a formal complaint. Once you’re home, help is available of Independent Community Health •• Call our Stroke Helpline to find out what Councils (CHCs), support is available in your area, such as call 0845 644 7814 or stroke clubs or carers' centres. visit www.community •• Ask social services about what practical healthcouncils.org.uk. support you’re entitled to. •• Ask your therapist what exercises you can do at home to help improve your recovery.

14 Stroke Association When a stroke happens 15 We are the Stroke Association

We believe in life after stroke. That’s why we support stroke survivors to make the best recovery they can. It’s why we campaign for better stroke care. And it’s why we fund research into finding new treatments and ways of preventing stroke.

We’re here for you. If you’d like to know more please get in touch.

Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Email: [email protected] Textphone: 18001 0303 3033 100