Frequently asked questions
Having a stroke can be a confusing and upsetting time, our frequently asked questions can help patients and their family and friends understand what has happened and what comes next.
• What is a sub-arachnoid stroke?
• What is stroke?
• What is a Transient Ischaemic Attack?
• What are the symptoms of stroke?
• What causes a stroke?
• What do I do if I experience worsening function or new symptoms after my stroke?
• Is the brain affected by stroke?
• What are the risk factors for stroke?
• Is stroke due to overwork or stress?
• Is the heart affected by stroke?
• When can I start driving after my stroke?
• How can I reduce my risk of a stroke?
• What are the risks of a second stroke?
• Will recovery occur and how long will it take?
• How is movement affected?
• How is speech affected?
• What can you do to help your loved one recover?
• How is vision affected?
What is a sub-arachnoid stroke?
I heard this said by one of the doctors in the hospital and was told it was to do with a bleed on the brain. Would you be able to explain what it means?
Most strokes are caused by a blockage in an artery leading to the brain – an ischaemic stroke. However, about 15 per cent are due to bleeding in or around the brain. These are called haemorrhagic strokes.
Blood from the heart is pumped around the body through a network of blood vessels (called arteries). This blood contains vital oxygen and nutrients. If a blood vessel in or around the brain bursts it can cause bleeding, which is called a haemorrhagic stroke.
There are two main types:
- Bleeding within the brain (called an intra-cerebral haemorrhage).
- Bleeding on the surface of the brain (called a subarachnoid haemorrhage).
The brain itself sits inside a cushion of membranes that protects it from the skull. Between two of the layers of membranes is a space called the subarachnoid space that is filled with cerebrospinal fluid (CSF). If blood vessels near the surface of the brain burst and blood leaks into the subarachnoid space, this is called a subarachnoid haemorrhage (SAH). This accounts for five per cent of all strokes. Often the only symptom is a sudden, severe headache. This is sometimes described as like ‘being hit over the head with a hammer’ resulting in a blinding pain unlike anything you have experienced before. Other symptoms can include altered, or loss of, consciousness, seizures, nausea and vomiting, sensitivity to light, neck stiffness (takes three to twelve hours to develop), confusion and fever. These symptoms may also be accompanied by speech problems and weakness on one side of the body (Source of all previous information: Stroke Association UK).
There is a Stroke Association factsheet that explains the different types of stroke caused by bleeding and how they are diagnosed and treated. It also lists sources of further information and support and a glossary. It can be found by clicking here.
What is stroke?
A stroke, sometimes called brain attack, happens when blood supply to specific areas or parts of the brain is interrupted due to blocked or ruptured blood vessels. This prevents vital nutrients and oxygen reaching the brain causing severe damage to brain cells. This results in loss of function in the areas directly affected by the stroke due to tissue death; as well as the surrounding areas due to swelling and inflammation. For more information click here:
What is a Transient Ischaemic Attack?
A transient ischaemic attack or TIA is sometimes called a mini-stroke because symptoms resemble those of stroke except that it last for shorter time (no longer than 24 hours). There is usually a temporary brief obstruction of the blood flow to the brain causing loss of function, for instance, weakness, tingling or disturbed vision or speech. A TIA is a warning of possible stroke risk and therefore should be treated as an emergency in order to prevent the development of a stroke in the future. For more information click here:
What are the symptoms of stroke?
Stroke usually results in:
- Sudden paralysis or weakness of the face, arm or leg.
- Numbness and loss or reduced sensation.
- Eyesight problems, for example problems with visual field.
- Problems with speech and disturbed ability to communicate or understand others.
- Sudden headaches and/or dizziness.
- Disturbed coordination and/or balance and difficulty walking.
For more information click here:
What causes a stroke?
There is no single cause for stroke but certain factors increase the risk of a stroke. Most strokes occur in the second half of life and are caused by damage to the blood vessels – and sometimes to the heart – which has been building up slowly over time. This damage usually happens as a result of prolonged exposure to high blood pressure. If in addition the patient is overweight, smokes, drinks heavily or has a sedentary lifestyle, the risk of stroke is increased.
A stroke happens when blood supply to the brain is interrupted due to blocked or ruptured blood vessels. When a blood vessel is blocked, it results in a type of stroke called ischemic stroke (usually caused by a blood clot or fatty deposits building up on the walls of blood vessels), whereas haemorrhagic stroke occurs when a blood vessel bursts in the brain causing bleeding and pressure on specific brain tissue.
Unfortunately, stroke can affect anyone at any time, regardless of their age; however the risks can substantially be minimised by a healthy lifestyle anyone can suffer a stroke at any time, although the risks can be substantially reduced by a healthy lifestyle.
For more information click here:
What do I do if I experience worsening function or new symptoms after my stroke?
This should be treated as medical emergency; you need to call 999 immediately. If you are not sure and you feel you need to discuss mild new or worsening symptoms, call your GP to seek medical advice.
Is the brain affected by stroke?
Yes. A stroke causes obstruction to the brain circulation, depriving the brain from essential nutrients and oxygen, which can result in brain cell damage. All stroke symptoms are related to disruption of various brain functions and the presenting deficits are usually linked to damage of specific brain areas. For example, the main deficit following a stroke might be related to speech because the area affected in the brain is the communication control center.
What are the risk factors for stroke?
Anyone can have a stroke although some risk factors increase your chance of suffering a stroke. Stroke can happen at any age but it is more common in people over age of 65 (three in four strokes in UK happen in people above 65 years old). Certain health conditions and lifestyle choices can increase your risk of a stroke.
Risk factors fall into two main categories:
1. Risks factors that you cannot change:
- Age – stroke risk generally increases as we get older.
- Family history – if you have a close relative who suffered a stroke, your risk is likely to be higher.
- Ethnic origin – specific ethnic origins have increased risk of stroke.
- Genetic conditions – certain conditions, for example, Sickle cell disease, can increase risk of a stroke.
2. Risks factors that you can change (modifiable risk factors):
- High blood pressure
- Heart disease
- High Cholesterol
- Excessive alcohol intake
- Cigarette smoking
- Poor diet
- Lack of physical activity
- Prior stroke
For more information click here:
Is stroke due to overwork or stress?
Stress is not directly related to increased stroke risks but stress affects your physiological functions and can therefore increase your blood pressure (thus increasing risks of a stroke).
Is the heart affected by stroke?
No. The stroke itself has no effect on the heart, but patients who suffer from a heart condition have a higher risk of stroke.
When can I start driving after my stroke?
After your stroke, you have to wait at least 1 month from the date of hospital discharge before you are allowed to drive. After this time, you must see your GP who will give you advice on whether it is safe for you to return to driving, depending on how you have been affected by the stroke, any residual problems you might have and the type of vehicle you drive. If your GP advice that you are able and it is safe to drive again, you usually don’t need to inform the DVLA but you need to let your car insurance provider know.
For more information click here:
How can I reduce my risk of a stroke?
Risk factors fall into two main categories; (1) modifiable and (2) non-modifiable risks. Although you cannot do much about the non-modifiable risks, for example, your age or family history, most strokes can be prevented by changing certain other factors (modifiable risks). Example of these changes:
- Reduce your alcohol intake.
- Stop smoking.
- Eat a healthy diet (less fat and salt and more fruit and vegetables).
- Engage in regular physical activities.
- Manage any underlying medical problems, for instance, high cholesterol or high blood pressure. Discuss with your GP if certain medications are needed to control your risk factors.
- In addition to your GP, a number of organisations and people can help you tackle the above changes. For more information on how to get help click here:
What are the risks of a second stroke?
Certain risks that might have contributed to your stroke, for example, high blood pressure or damaged blood vessel wall, can sometimes not be reversed and therefore the risk can still persist. Although your risk of having a second stroke is higher if you have already suffered a stroke, the above changes (see post above about ‘how to reduce risks of a stroke’) should still have positive impact on reducing your risk of a second stroke. In addition, you need to make sure you do the following:
You might be prescribed certain medication after your stroke to address specific underlying medical conditions, for example, high blood pressure. You need to make sure you take the medication as prescribed.
Monitor your general health and do regular check-ups to make sure your risk factors are controlled and that the medication is working well for you.
Identify lifestyle changes that could help reduce your risks and talk to your GP on how to get help and support to achieve these (for example, stopping smoking or losing weight).
In addition to your GP, a number of organisations and people can help you tackle the above changes. For more information on how to get help click here:
Will recovery occur and how long will it take?
Recovery after stroke varies depending on which areas have been affected and the extent by which they have been affected. The brain tries to fix, repair and heal following a stroke; therefore it is not surprising that you might feel confused or mentally and/or physically tired.
Recovery takes time and requires motivation and determination, and is usually reinforced by practice and repetition of movements and activities. Patience is very important in order to allow the brain to heal and the body to get over effects of stroke. Although you should never assume things would not get better, it is also important to have realistic expectations of your recovery and work with your therapists to set achievable goals for each stage of your recovery.
Most of the recovery happens in the early months after a stroke, although improvement and changes can still happen later on (many months or even years after your stroke). After a stroke, the pace of recovery is usually fairly speedy but it tends to slow down to a more gradual pace thereafter. Recovery is usually defined in terms of 4 common changes:
Brain cells which were badly damaged by the stroke die and never recover.
Neighbouring brain cells which were only partially damaged (due to brain swelling) recover and regain their function in the first few weeks following a stroke. This is called Spontaneous Recovery.
Other parts of the brain start to take over the lost functions in order to compensate for the permanently damaged brain cells. This is called Neuroplasticity.
Your body adapts to the loss or change in specific functions by means of learning new or adapted ways of carrying out activities
For more information click here:
How is movement affected?
Stroke can affect the muscles in your face, trunk upper and lower limbs on one or both sides. It can also affect the sensation and the ability of the brain to coordinate different muscle groups to produce accurate movement. This will significantly affect the way you maintain your balance or walk. The nature of movement and balance problems following a stroke depends on the specific area of the brain that was and the extent of damage to brain cells. In most cases spontaneous recovery takes place and muscle power and movement gradually return. This usually happens to the lower limb first and then followed by the upper limb, which can sometimes take significantly longer to show improvement. It is very important to maintain good limb positioning at all times following a stroke to prevent joint stiffness and muscle tightness. This will make sure when you regain your muscle power, all joints and muscles will be in a good condition to resume function.
For more information on general movement difficulties following a stroke and if you are looking into information on why your balance have been affected please click here:
How is speech affected?
Your speech can be affected in various ways after a stroke, ranging from a difficulty formulating or articulating speech to having difficulty with understanding others or findings your words. The range of communication problems depends on the specific area of the brain that was affected by the stroke and the extent of damage to brain cells.
For more information on different speech problems following a stroke click here.
What can you do to help your loved one recover?
After a stroke the brain makes new connections to replace the connections that have been damaged. Conversations with other people can help people with aphasia to make connections as they work hard to get their message across. Using the strategies suggested by the Speech and Language Therapist (SLT) will help your loved one to join in as much as they are able to. Using their communication in conversations will help it improve.
You can support your loved one to resume their usual routines or establish new ones. Think about how you can both get back to your usual activities- perhaps by doing things in a different way. Doing things together will give you more to talk about which will help communication.
Speech and Language Therapy (SLT) is one part of your loved one’s recovery. The time they spend having conversations with you, friends and family members is equally valuable in their recovery. If your loved one agrees they can be referred for more SLT from another team. We will let you know which team they have been referred to, and give you the team’s contact details. (You can contact them to find out how long the waiting time is likely to be.) If your loved one decides that they do not want further SLT we will provide you with contact details so that if they change their mind they/you can contact Community SLT in the future.
Both you and your loved one can access support from The Stroke Association’s Communication Support service alongside further SLT. Relatives are often concerned that progress will slow or be lost while their loved one is not receiving SLT. Generally after a stroke, patients with aphasia make gradual improvements and setbacks can usually be explained by other factors e.g. another illness, a period of significant stress or fatigue. If your loved one’s aphasia becomes suddenly worse you should phone 999 as they may be having another stroke.
People with aphasia can benefit from a time of intensive therapy such as that offered by Early Supported Discharge. Lower intensity forms of SLT and breaks from SLT to allow consolidation of what has been learnt are also important elements of rehabilitation for people with aphasia. Different input is needed at different stages of recovery and the next Speech and Language Therapist will do their best to offer what your loved one needs.
In the early days after a stroke we do not usually ask close relatives to complete SLT exercises with their loved one. It is more important to focus on re-establishing helpful communication patterns. Doing exercises together can put yourself and your partner into different roles which can be problematic for your relationship especially in the early days after a stroke. Some people with aphasia can benefit from exercises to complete on their own on a computer, tablet or with a pen and paper at some point in their rehabilitation. The SLTs providing care for your loved one will let you know if this is the case. They will also advise you if the time is right to do exercises together or with another supportive friend or family member.
- Support your loved one to get their message across using any method they can such as pointing to pictures, words or objects, writing words, drawing, using gesture and facial expression.
- Turn off the TV or radio when you are talking together. It is easier to talk and listen with no background noise.
- Wear glasses, hearing aids and dentures if you need to. Support your loved one to wear their aids too.
- If you have tried and could not understand your loved one then come back to it later.
- Show friends, family and the wider community how to use communication strategies and supporting them so they can include your loved one too.
- Have conversations one to one and gradually build up to joining small and larger groups. People with aphasia usually find it difficult having conversations in larger groups. It can be helpful to invite fewer friends over at once until your loved one is ready to communicate in larger groups.
- Fatigue is common after a stroke. It will improve with time. Communication will be better when your loved one is rested. Try to plan times of rest into your day. Try to have important conversations at times when your loved one has most energy.
How is vision affected?
In general, stroke does not affect your eye sight but it does affect the way the brain interprets what the eye sees. If areas of your brain that receive, control and process information from your eyes are affected by your stroke, then this can result in problems with your vision. Normally, when our eyes receive an image, the two sides of the brain each form a separate picture of half of this image. Specific areas in the brain will then process, join and interpret those two pictures to give a total view. Visual problems occur when a stroke affects this part of the brain forming one of those half pictures; patients will therefore see only one half of the image laid in front of them. Visual difficulty following a stroke can range from problems with your visual field, visual neglect, eye movement problems as well as problems processing visual information.
For more information click here: