Stroke: symptoms, causes, treatment and recovery

The NHS and the Stroke Association both use the FAST test. Face: can the person smile, or has one side drooped? Arms: can they raise both arms and keep them there? Speech: is it slurred, or are they confused or unable to find words? Time: if any of these is present, call 999.

Other signs listed by the NHS include weakness or numbness down one side of the body, blurred vision or loss of sight in one or both eyes, difficulty finding words, confusion and memory loss, dizziness or falling over, a severe headache, and feeling or being sick.

Symptoms can stop after a short time. The NHS says to get medical help straight away even then, because it may be a TIA, which is a warning that a full stroke could follow.

The Stroke Association describes a stroke as the blood supply to part of the brain being cut off, which kills brain cells. Because the brain controls movement, speech, vision, thinking and feelings, the effects depend on where in the brain it happens and how large the damaged area is.

NICE Clinical Knowledge Summaries define stroke as a sudden-onset deficit in brain function that lasts longer than 24 hours or leads to death. A transient ischaemic attack, by contrast, is a similar episode that settles within 24 hours.

Stroke is not the same as a heart attack, although both are caused by problems with blood vessels. A stroke affects the brain, and treatment is time-critical.

The NHS describes an ischaemic stroke as the most common type, where a blood clot blocks blood flow to the brain. A haemorrhagic stroke happens when a blood vessel in or around the brain bursts. NICE puts the split at about 86% ischaemic and about 14% haemorrhagic.

A TIA is caused by a temporary disruption of blood supply. The NHS says its effects last from a few minutes to a few hours and resolve fully within 24 hours, but it still needs urgent assessment.

The NHS says a stroke can happen to anyone at any age, but risk may increase if you are over 50, are from a Black or South Asian background, have sickle cell disease, have an unhealthy lifestyle, have migraines, take the combined contraceptive pill, have pre-eclampsia in pregnancy, or have just had a baby.

Certain conditions also raise the risk. The NHS lists high blood pressure, diabetes, atrial fibrillation (an irregular and fast heartbeat), high cholesterol and a previous TIA. The Stroke Association also lists family history and age, and notes that arteries become harder and narrower as we get older.

Having had a stroke or TIA raises the chance of another. The NHS suggests stopping smoking, eating a balanced diet, exercising, cutting down on alcohol, and keeping to medicines for conditions such as high blood pressure or diabetes.

Treatment depends on the type of stroke. The NHS says that in the first 24 hours it may include medicine to dissolve blood clots in the brain (thrombolysis), surgery to remove a clot (thrombectomy) or to drain fluid, or a procedure to relieve pressure inside the skull.

Longer-term medicines, often taken for life, may include anticoagulants to stop clots forming, medicines to lower blood pressure, and statins to lower cholesterol. Carotid endarterectomy, an operation to clear a narrowed neck artery, may be used in some TIA cases, according to the NHS.

A team of doctors, nurses and therapists begins rehabilitation while you are still in hospital. The Stroke Association says you will be checked for swallowing, mobility, continence, communication, thinking skills and nutrition.

In hospital, doctors use blood tests, CT, MRI and ultrasound scans to look in and around the brain, and an ECG to check the heart. The NHS says these tests show what type of stroke has happened, which decides the treatment.

NICE guidance for primary care includes checking a finger-prick blood glucose, because low blood sugar can cause similar symptoms, and arranging emergency transfer to a hyperacute stroke centre with a pre-alert to the stroke team.

For a suspected TIA, NICE says to offer aspirin 300 mg immediately unless it is not suitable, and to arrange assessment by a stroke specialist within 24 hours. It also advises not driving until seen by a specialist.

Recovery varies widely. The NHS says some people recover over days or weeks with little effect on life, while for others it takes months or years and may mean adapting the home or stopping work for a time.

After you leave hospital, the NHS says your team creates a home recovery plan. It may include physiotherapy, cognitive behavioural therapy for anxiety, low mood and tiredness, memory and concentration exercises, speech and swallowing therapy, and help with bladder or bowel problems. Rehabilitation can be done in person or online.

The NHS says you should get a review of progress after about six months, and to ask your team if you do not. Common after-effects covered by the Stroke Association include communication problems (aphasia), memory and concentration difficulties, vision problems, and emotional changes. Carers also need support.

The NHS says that in the early stages of a TIA it is not possible to tell whether you are having a TIA or a full stroke, so it is important to call 999 immediately and ask for an ambulance. Even if the symptoms disappear while you are waiting for the ambulance, you still need to be assessed in hospital and should be referred to see a specialist within 24 hours of the onset of symptoms.

If you think you may have had a TIA previously, but the symptoms passed and you did not seek medical advice at the time, the NHS says to make an urgent appointment with a GP, who can determine whether to refer you for a hospital assessment. NICE advises not driving until seen by a stroke specialist.

Emergency stroke care is delivered through 999 and NHS hyperacute stroke units. This is not something to arrange privately, because time matters and the ambulance team will take you to the right hospital.

Private care is more relevant in the weeks and months afterwards: for private neurology review, tests to find the cause of a TIA or stroke, or additional therapy sessions. Rehabilitation and secondary prevention are shared with your GP and stroke team whichever route you use.