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Stroke and TIAs

Stroke is the third most common cause of death after heart disease and cancer. While you may be aware of the symptoms of a heart attack and the importance of calling 999 if you suspect one, a stroke is the equivalent of a ‘brain attack’ and so requires prompt action too - so call 999

What happens when you have a stroke?

A stroke is caused when the blood supply to your brain is suddenly cut off or reduced.

As a result, brain cells are deprived of oxygen and other nutrients in the blood and this quickly causes damage or death to cells in affected parts of the brain.

There are two types of Ischemic stroke: this is caused when a blood clot blocks a main artery in your brain. Around 80% of strokes are of this type.

Hemorrhagic stroke: this is caused when a weakened artery in your brain bursts. This allows blood to seep out and press on your brain. It also prevents blood and oxygen reaching other parts of the brain.

>>How to spot the signs of a stroke

The effects of a stroke depend on: how long your brain is deprived of oxygen whereabouts in your brain the artery becomes blocked or bursts and the functions of the affected part of the brain.

Transient Ischaemic Attack (TIA) A ‘mini’ stroke or to use its medical term - transient ischemic attack (TIA) has similar symptoms to a stroke but they may last only a few minutes or hours and disappear completely within 24 hours.

However as the symptoms are so similar there is no way of knowing at first if you are having a stroke or a TIA, so call 999.

A TIA may be a warning sign of a more serious stroke to come. If your symptoms pass quickly and you don't call 999, call your GP practice as soon as possible and explain what happened, so you can ask for an urgent appointment to see your GP.

Could you be at risk of a stroke?

There is no single underlying cause of stroke. There are some things that increase your risk of a stroke that you can’t change.
These are known as ‘non-modifiable’ risk factors and include:
having had a ‘mini’ stroke
increasing age
being of South Asian, African or African Caribbean origin
having a relative who has had a stroke and
having a condition such as diabetes or heart disease.
But others, known as ‘modifiable risk factors’, you can do something about and so lower your risk. These include:
high blood pressure (a contributing factor to more than half of strokes in England, Wales and NI)
high cholesterol (reducing cholesterol level by 1mmol/L reduces the risk of stroke by more than a fifth)
smoking – this doubles your risk and giving up cuts that risk dramatically no matter how long you have been a smoker or how old you are.
drinking alcohol – too much alcohol, particularly binge drinking, as this can raise your blood pressure
lack of regular physical activity – which has a negative effect on your blood pressure, cholesterol and weight
eating an unhealthy diet – generally one too high in calories, fat and salt and doesn’t include at least 5 portions of fruit and vegetables a day.
Can you reduce your risk?
You should make an appointment to see your GP if any of these risk factors apply to you – particularly if your family background puts you at greater risk. By identifying your overall risk of a stroke, you can discuss how to lower your risk of and agree an action plan.
If you have had a stroke or a mini stroke you are more likely to have another, so you need to agree with your doctor how best to reduce your future risk. This can include medication e.g. statins to control cholesterol, medicine to thin the blood or to reduce blood pressure as well as making lifestyle changes.
Helping you make lifestyle changes
You can use the lifestyle quizzes and checklists on the NHS Choices website to see how closely you are to meeting current guidelines on eating, physical activity and exercise. You’ll also find tips on how to fit any changes into your daily routine.
The Stroke Association also offers help and advice on lifestyle changes (LINK).
These suggestions can help you on your way:
If you smoke, take steps to stop. This is the most significant change you can make. The difficulties of giving up smoking are well known, so ask your GP or practice nurse how the NHS can help you. You may have the choice of one-to-one sessions or joining a local group so you can share experiences and tips with others who are trying to give up. Nicotine products and other medication are available on prescription. You may prefer to look on the NHS Smokefree website for more information or call their helpline for advice.
Check out your diet: It should be one that has plenty of fruit and vegetables, plenty of starchy foods such as bread and potatoes and is low in sugar, salt and fat, particularly saturated fat.
Do you drink too much? Although some research suggests some alcohol might be good for your heart, binge drinking and drinking more than the recommended units each week is not. Drinkline is the national alcohol helpline.
Do you take enough regular exercise? Aim for activities that you enjoy, are relatively easy to build into your daily routine and that make you feel slightly breathless but do not cause pain or discomfort. Building up to 30minutes on 5 days a week is recommended. 
As well as increasing your fitness, it can help control your weight, blood cholesterol and blood pressure.

There is no single underlying cause of stroke. There are some things that increase your risk of a stroke that you can’t change.

These are known as ‘non-modifiable’ risk factors and include:

  • having had a ‘mini’ stroke
  • increasing age
  • being of South Asian, African or African Caribbean origin
  • having a relative who has had a stroke 
  • and having a condition such as diabetes or heart disease

But others, known as ‘modifiable risk factors’, you can do something about, and so lower your risk. These include:

  • high blood pressure (a contributing factor to more than half of strokes in England, Wales and NI)
  • high cholesterol (reducing cholesterol level by 1mmol/L reduces the risk of stroke by more than a fifth)
  • smoking – this doubles your risk and giving up cuts that risk dramatically no matter how long you have been a smoker or how old you are
  • drinking alcohol – too much alcohol, particularly binge drinking, as this can raise your blood pressure
  • lack of regular physical activity – which has a negative effect on your blood pressure, cholesterol and weight
  • eating an unhealthy diet – generally one too high in calories, fat and salt and doesn’t include at least 5 portions of fruit and vegetables a day

Can you reduce your risk?

You should make an appointment to see your GP if any of these risk factors apply to you – particularly if your family background puts you at greater risk. By identifying your overall risk of a stroke, you can discuss how to lower your risk of and agree an action plan.

If you have had a stroke or a mini stroke you are more likely to have another, so you need to agree with your doctor how best to reduce your future risk. This can include medication e.g. statins to control cholesterol, medicine to thin the blood or to reduce blood pressure as well as making lifestyle changes.

Helping you make lifestyle changes

You can use the lifestyle quizzes and checklists on the NHS Choices website to see how closely you are to meeting current guidelines on eating, physical activity and exercise. You’ll also find tips on how to fit any changes into your daily routine.

The Stroke Association also offers help and advice on lifestyle changes.

These suggestions can help you on your way:

  • Do you smoke? If you smoke, take steps to stop. This is the most significant change you can make. The difficulties of giving up smoking are well known, so ask your GP or practice nurse how the NHS can help you. You may have the choice of one-to-one sessions or joining a local group so you can share experiences and tips with others who are trying to give up. Nicotine products and other medication are available on prescription. You may prefer to look on the NHS Smokefree website for more information or call their helpline for advice.
  • Check out your diet: It should be one that has plenty of fruit and vegetables, plenty of starchy foods such as bread and potatoes and is low in sugar, salt and fat, particularly saturated fat.
  • Do you drink too much alcohol? Although some research suggests some alcohol might be good for your heart, binge drinking and drinking more than the recommended units each week is not. Drinkline is the national alcohol helpline.
  • Do you take enough regular exercise? Aim for activities that you enjoy, are relatively easy to build into your daily routine and that make you feel slightly breathless but do not cause pain or discomfort. Building up to 30minutes on 5 days a week is recommended. As well as increasing your fitness, it can help control your weight, blood cholesterol and blood pressure.

Recognising symptoms

The first signs of a stroke can be very sudden. Applying the FAST test can indicate whether the symptoms you are observing suggest the person is having a stroke or TIA:
Face. Can they smile? Has their face fallen on one side?
Arms. Can they raise both arms and keep them there?
Speech. Can the person speak clearly and understand what you say? Is their speech slurred?
Time. Time to call 999 if you see any single one of these signs.
Ambulance staff are trained to assess people with a suspected stroke and get them to an appropriate hospital for tests and urgent treatment. The sooner you receive appropriate treatment, the better your chances of a good recovery.

The FAST test

The first signs of a stroke can be very sudden. Applying the FAST test can indicate whether the symptoms you are observing suggest the person is having a stroke or TIA:

Face. Can they smile? Has their face fallen on one side?
Arms. Can they raise both arms and keep them there?
Speech. Can the person speak clearly and understand what you say? Is their speech slurred?
Time. Time to call 999 if you see any single one of these signs.

Ambulance staff are trained to assess people with a suspected stroke and get them to an appropriate hospital for tests and urgent treatment. The sooner you receive appropriate treatment, the better your chances of a good recovery.

Diagnosis and treatment for a stroke

If you call 999 and the ambulance staff suspect a stroke, you should be taken to a large hospital with facilities to diagnose and treat stroke. On arrival at A&E you should be quickly moved to a specialist stroke unit or ward for tests to confirm whether you have had a stroke. This will ensure you receive the appropriate emergency treatment.
If you have had a stroke, you should have a scan that produces an image of your brain to show where the damaged area is and what damage has been done. This might be a CT (computed tomography) scan or a more detailed MRI (magnetic resonance imaging) scan. You should have a scan within 24 hours if doctors think you've had a stroke. 
Contact the Stroke Association for more information about what you should expect from the NHS if you've had a stroke.
Early and longer term treatment after a stroke
Each part of the brain has specific functions although the different parts also work together. How a stroke affects you, physically and mentally, will depend on:
the type of stroke you’ve had
how bad it was and
which parts of your brain are affected.
Brain cells can’t grow back but the brain has a remarkable ability to recover over the following days and months. This is a gradual process, so it's difficult to know whether symptoms evident in the first few days will remain several months later.
Some common effects of a stroke are:
weakness or paralysis on one side of your body
difficulty swallowing (known as dysphagia)
problems talking coherently and with reading and writing
problems with bladder and bowel control
memory problems and difficulty concentrating
problems with your vision
On a specialist stroke unit or stroke ward, you are cared for by a range of experienced health professionals - doctors, nurses, physiotherapists, occupational therapists and speech therapists - whose main job is to assess and care for people who have had a stroke and stimulate their recovery.
Staff on a stroke unit follow what is known as a ‘stroke care pathway’, this is to ensure your condition is thoroughly assessed and closely monitored and you get all the treatment and rehabilitation support you need from the appropriate health professionals. You and/or your family should be involved in developing your care plan and understand what it is hoped can be achieved within an agreed time frame.
The aim of your treatment and rehabilitation programme is to help you regain, where possible, the abilities you lost as a result of the stroke and to help you and your carers adapt to life afterwards. 
You may be on a stroke ward for a couple of weeks or move to another ward to start your rehabilitation. Once your hospital care is finished, a further assessment of your condition should be arranged involving all relevant health professionals. This should be followed by discussion on your future care needs and the drawing up of your care plan. You and your family should play an active part at all stages of this process.
Risk of further TIAs or stroke
Whether your symptoms prompt you to go to hospital or because the symptoms passed quickly, you opt to make an appointment with your GP, it is important to assess your  risk of further TIAs or a stroke and take appropriate action. What should happen if you have a suspected TIA is explained in the NICE guidance mentioned below. The Stroke Association also has information on how TIAs should be managed by the NHS.
Best treatment guidance
The National Institute for Health and Care Excellence (NICE) has produced guidance on the early assessment and treatment of NHS patients following a stroke or a ‘mini’ stroke. 
NICE has also produced a Quality Standard for stroke. A Quality Standard describes the level of care NHS organisations should be working towards when caring for people with a specific condition. See Help and Support for a link to this standard.

Diagnosis

If you call 999 and the ambulance staff suspect a stroke, you should be taken to a large hospital with facilities to diagnose and treat stroke. On arrival at A&E you should be quickly moved to a specialist stroke unit or ward for tests to confirm whether you have had a stroke. This will ensure you receive the appropriate emergency treatment.

If you have had a stroke, you should have a scan that produces an image of your brain to show where the damaged area is and what damage has been done. This might be a CT (computed tomography) scan or a more detailed MRI (magnetic resonance imaging) scan. You should have a scan within 24 hours if doctors think you've had a stroke. 

Contact the Stroke Association for more information about what you should expect from the NHS if you've had a stroke.

Early and longer term treatment after a stroke

Each part of the brain has specific functions although the different parts also work together. How a stroke affects you, physically and mentally, will depend on:

  • the type of stroke you’ve hadhow bad it was andwhich parts of your brain are affected.
  • Brain cells can’t grow back but the brain has a remarkable ability to recover over the following days and months. 
  • This is a gradual process, so it's difficult to know whether symptoms evident in the first few days will remain several months later.

Some common effects of a stroke are:

  • weakness or paralysis on one side of your body
  • difficulty swallowing (known as dysphagia)
  • problems talking coherently and with reading and writing
  • problems with bladder and bowel control
  • memory problems and difficulty concentrating
  • problems with your vision

On a specialist stroke unit or stroke ward, you are cared for by a range of experienced health professionals - doctors, nurses, physiotherapists, occupational therapists and speech therapists - whose main job is to assess and care for people who have had a stroke and stimulate their recovery.

 Staff on a stroke unit follow what is known as a ‘stroke care pathway’, this is to ensure your condition is thoroughly assessed and closely monitored and you get all the treatment and rehabilitation support you need from the appropriate health professionals.

You and/or your family should be involved in developing your care plan and understand what it is hoped can be achieved within an agreed time frame.
The aim of your treatment and rehabilitation programme is to help you regain, where possible, the abilities you lost as a result of the stroke and to help you and your carers adapt to life afterwards. 

You may be on a stroke ward for a couple of weeks or move to another ward to start your rehabilitation.

Once your hospital care is finished, a further assessment of your condition should be arranged involving all relevant health professionals.

This should be followed by discussion on your future care needs and the drawing up of your care plan. You and your family should play an active part at all stages of this process.

Risk of further TIAs or stroke

It is important that any time you develop symptoms of a stroke or TIA you take these seriously. 3 in 10 people will go on to have another stroke or TIA, so whether you go to hospital or to your GP, your risk should be assessed.

Once this has been done you will be referred to a specialist TIA clinic (within 24 hours if you are at high risk or within a week if your risk is lower). A TIA is serious so don't ignore it. The Stroke Association has more detailed information on how TIAs should be managed by the NHS.

What should happen if you have a suspected TIA is explained in the NICE guidance mentioned below. The Stroke Association also has information on how TIAs should be managed by the NHS.

Best treatment guidance

The National Institute for Health and Care Excellence (NICE) has produced guidance on the early assessment and treatment of NHS patients following a stroke or a ‘mini’ stroke. 

NICE has also produced a Quality Standard for stroke. A Quality Standard describes the level of care NHS organisations should be working towards when caring for people with a specific condition. See Help and Support for a link to this standard.

Help and support following a stroke

The long term effects of a stroke vary from person to person. Nevertheless it is a major event in anyone’s life and the emotional consequences can last for many months.

A range of emotions - anger, anxiety and frustration – are common and it is important to seek help if you find it difficult to cope.
The health professionals and social care staff involved in your care also recognise this and can discuss and help you with the support you need to regain your confidence, make daily living easier and get back as much independence as possible.
If your partner will be providing support when you come home, they are entitled to a carer’s assessment. This can identify any help they need to care for you.
The Stroke Association has a comprehensive website, a wide range of publications that address the medical, emotional and practical consequences of having a stroke. They also have a telephone helpline and local Life After Stroke services. These may vary across the country but aim to offer practical help and a chance to meet other families whose lives have been touched by a stroke.  You can find out more from their website or by calling the helpline.
Financial support
If you need help with personal care or watching over to make sure you are all right, you may be eligible to claim a non means-tested benefit – Personal Independence Payment (PIP) if you are under 65 or Attendance Allowance if you are 65 and over. 
You can find out more about these and other benefits you may be entitled to claim by visiting our benefits section or by calling Age UK on 0800 169 65 65.
Further information
GOV UK
Website: www.gov.uk
This website has useful information on benefits you or your carer may be eligible to receive under the heading ‘benefits.'
NHS Choices website 
www.nhs.uk 
You can find information about stroke – risk factors, symptoms and treatment in the Health A-Z section.
By following the link below, you can find out what to expect from the NHS to help you manage a long term condition such as a stroke.
http://www.nhs.uk/Conditions/Stroke/Pages/recovery.aspx
NICE guideline CG68 Early assessment and treatment of people who have had a stroke or TIA. 
Website: www.nice.org.uk/CG68 
There is a version for the public that you can download. You can find it under the heading 'Information for the public'.
The Stroke Association 
www.stroke.org.uk    
Helpline: 0303 3033 100
The Stroke Association is the only UK charity solely concerned with combating stroke in people of all ages.

A range of emotions - anger, anxiety and frustration – are common and it is important to seek help if you find it difficult to cope.

The health professionals and social care staff involved in your care also recognise this and can discuss and help you with the support you need to regain your confidence, make daily living easier and get back as much independence as possible.

If your partner will be providing support when you come home, they are entitled to a carer’s assessment. This can identify any help they need to care for you.

The Stroke Association has a comprehensive website, a wide range of publications that address the medical, emotional and practical consequences of having a stroke. They also have a telephone helpline and local Life After Stroke services. These may vary across the country but aim to offer practical help and a chance to meet other families whose lives have been touched by a stroke.  You can find out more from their website or by calling the helpline.

Financial support

If you need help with personal care or watching over to make sure you are all right, you may be eligible to claim a non means-tested benefit – Personal Independence Payment (PIP) if you are under 65 or Attendance Allowance if you are 65 and over. 

You can find out more about these and other benefits you may be entitled to claim by visiting our benefits section or by calling Age NI on 0808 808 7575.

Further information

GOV UK

This website has useful information on benefits you or your carer may be eligible to receive under the heading ‘benefits.'

NHS Choices

You can find information about stroke – risk factors, symptoms and treatment in the Health A-Z section.

Or find out what to expect from the NHS to help you manage a long term condition such as a stroke.

NICE guideline CG68

Early assessment and treatment of people who have had a stroke or TIA. Website:  There is a version for the public that you can download. You can find it under the heading 'Information for the public'.

The Stroke Association 

Helpline: 0303 3033 100The Stroke Association is the only UK charity solely concerned with combating stroke in people of all ages.

For more information: Call Age NI Advice: 0808 808 7575

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