Ischaemic stroke: FAST signs, emergency treatment and recovery

The NHS says a stroke is when blood stops flowing to a part of your brain, that it can affect things like speech and movement and take a long time to recover from, and that it needs urgent help in hospital because it can be life-threatening. NHS inform describes two main causes: ischaemic, where the blood supply stops due to a blood clot, which is the cause of a stroke in most cases, and haemorrhagic, where a weakened blood vessel supplying the brain bursts.

The BHF explains that all types of stroke disrupt blood flow to the brain, so brain cells are damaged because they are not getting the oxygen and nutrients they need, and that the effects depend on which part of the brain is affected, which may alter speech, thinking and movement. It describes ischaemic strokes as blood-clot strokes, in which an artery supplying blood to the brain is blocked.

NHS inform describes the main symptoms: the face, where one side may drop, you cannot smile or the mouth or eyelid droops; the arms, where you may not be able to lift both arms and keep them there because of weakness or numbness in one arm or leg; and speech, which may be slurred, garbled, nonsensical or absent despite appearing awake. This is remembered as FAST: Face, Arms, Speech, Time to call 999. You might not have all of them.

Other possible sudden symptoms include complete paralysis of one side of the body, blurred vision or loss of sight in one or both eyes, difficulty understanding others, difficulty finding words, problems with balance and co-ordination, very severe headache, vertigo and loss of feeling on one side. A transient ischaemic attack (TIA, or mini-stroke) has the same symptoms but lasts only minutes to hours before disappearing completely; NHS inform says never to ignore it, as it is a serious warning sign of a higher risk of stroke in the near future, and to contact the GP urgently or phone 111 if the practice is closed.

• Face: one side drooping, unable to smile.

• Arms: unable to lift both arms and keep them up.

• Speech: slurred, garbled or lost.

• Time: call 999 immediately.

• Sudden loss of vision, balance problems, severe headache or vertigo.

NHS inform says strokes are a medical emergency and the sooner you receive treatment the less damage to the brain is likely, and advises to phone 999 now if you think you or someone you know is having a stroke. Do not drive if you think you have had a stroke or TIA, and even if symptoms go away it is still important to go to hospital for urgent assessment.

The BHF says it is essential to dial 999 if you have symptoms that could be a stroke, and not to delay because you think hospitals are too busy, since the NHS still has systems to treat people who need urgent stroke treatment. Delay makes serious damage more likely, intensive care more likely and hospital stay longer. It adds that you could lose millions of nerve cells for every minute without treatment.

NHS inform says strokes are usually diagnosed by physical tests and brain scans. Even when physical symptoms are obvious, a brain scan is needed to determine whether a blocked artery (ischaemic) or a burst blood vessel (haemorrhagic) caused the stroke, which part of the brain is affected and how severe it is. Everyone with suspected stroke should receive a brain scan as soon as possible on reaching hospital, especially people who might benefit from clot-busting drugs (thrombolysis) or a procedure to unblock blood vessels (thrombectomy), those on anticoagulants and those with lower consciousness. The two main scans are CT and MRI.

Other tests may include checking pulse for an irregular heartbeat, blood pressure, blood tests of cholesterol and sugar, an ECG, an echocardiogram, heart monitoring for atrial fibrillation and a carotid ultrasound to look for narrowing of the neck arteries. These help find the cause so that a second stroke can be prevented.

The NHS says treatment depends on the type of stroke. In the first 24 hours it may include medicine to get rid of blood clots in the brain (thrombolysis), surgery to remove a blood clot (thrombectomy) or drain fluid from the brain, and a procedure to stop pressure building up inside the skull. While in hospital, a team of doctors, specialists and therapists helps you start recovery. Longer-term treatments often include anticoagulants to stop clots forming, medicines to lower blood pressure, and statins to lower cholesterol.

The BHF says that after getting to hospital you will be taken for tests, and depending on how serious the stroke is and the type, you may be given medication or surgery, and that the length of stay depends on the type and severity of stroke, treatment, general health and how quickly you recover. When you are ready to leave, the stroke team works with you and your family to arrange the support you need.

The BHF says a stroke affects people in different ways: some see most improvement in the first few weeks in hospital, for others it takes months or sometimes years. Rehabilitation begins in hospital, led by specialists such as nurses, physiotherapists and occupational therapists, and aims to return you as close as possible to how you were before. It can help arrange home adjustments, ongoing treatment such as physiotherapy, and support for family and carers. The BHF notes that a stroke may increase the risk of vascular dementia and that it is normal to feel anxious, angry and upset afterwards, so talk about feelings and ask your GP about talking therapy.

Support is available through the Stroke Association, the BHF and local services. If you are the carer, look after your own health and ask about carers' support.

NHS inform lists risk factors including poor diet, lack of exercise, obesity, smoking, drinking too much alcohol, high cholesterol, high blood pressure, diabetes and atrial fibrillation. People over 65 are most at risk, although strokes can happen at any age including in children; a close relative with a stroke, south Asian, African or Caribbean ethnicity, and previous stroke, TIA or heart attack also raise risk. If you have atrial fibrillation, taking anticoagulant medication reduces stroke risk.

The BHF suggests eating healthily, being physically active, keeping to a healthy weight, not smoking, cutting down on alcohol, having regular check-ups to pick up high blood pressure, high cholesterol or diabetes (the BHF mentions a regular check-up with your GP if you are over 40), and controlling high blood pressure, cholesterol, blood sugar and atrial fibrillation.

Suspected stroke is a 999 emergency. Ambulance crews take you to a hospital that treats stroke, scans are done as quickly as possible and emergency treatment follows on the NHS regardless of insurance. Rehabilitation continues in hospital, in community stroke teams and sometimes at home, with GP follow-up for secondary prevention.

Private care becomes relevant for longer-term rehabilitation, therapy and specialist review after discharge. If considering private neurorehabilitation, ask about the team, the expected hours of therapy and how progress is measured, and how it fits with NHS follow-up.