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Encyclopaedia


Stroke

Introduction

A stroke is a serious, life-threatening medical condition that occurs when the blood supply to part of the brain is cut off.

Strokes are a medical emergency and urgent treatment is essential.

The sooner a person receives treatment for a stroke, the less damage is likely to happen.

If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.

Signs and symptoms

The main symptoms of stroke can be remembered with the word FAST: Face-Arms-Speech-Time.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have dropped.
  • Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm.
  • Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake.
  • Time – it is time to dial 999 immediately if you see any of these signs or symptoms.

Read more about the symptoms of a stroke.

Why do strokes happen?

Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain injury, disability and possibly death.

There are two main causes of strokes:

  • ischaemic – where the blood supply is stopped due to a blood clot (this accounts for 85% of all cases)
  • haemorrhagic – where a weakened blood vessel supplying the brain bursts

There is also a related condition known as a transient ischaemic attack (TIA), where the supply of blood to the brain is temporarily interrupted.

This causes what is known as  a mini-stroke, often lasting between a few minutes and several hours.

TIAs should be treated urgently, as they're often a warning sign you're at risk of having a full stroke in the near future. Seek medical advice as soon as possible, even if your symptoms resolve.

Certain conditions increase the risk of having a stroke, including:

Read more about the causes of strokes.

How strokes are treated

Treatment depends on the type of stroke you have, including which part of the brain was affected and what caused it.

Strokes are usually treated with medication. This includes medicines to prevent and dissolve blood clots, reduce blood pressure and reduce cholesterol levels.

In some cases, procedures may be required to remove blood clots. Surgery may also be required to treat brain swelling and reduce the risk of further bleeding in cases of haemorrhagic strokes.

Read more about diagnosing strokes and treating strokes.

Life after a stroke

People who survive a stroke are often left with long-term problems caused by injury to their brain.

Some people need a long period of rehabilitation before they can recover their former independence, while many never fully recover and need support adjusting to living with the effects of their stroke.

Local authorities should provide free reablement services for anyone assessed as needing them. These services help the person recovering from a stroke to learn or relearn the skills necessary for independent daily living at home.

Some people will be dependent on some form of care for help with their daily activities. For example, a care worker could come to the person's home to help with washing and dressing, or to provide companionship.

Read more about recovering from a stroke.

Can strokes be prevented?

You can significantly reduce your risk of having a stroke through a healthy lifestyle by:

If you have a condition that increases your risk of a stroke, it's important to manage it effectively – for example, by lowering high blood pressure or cholesterol levels with medication.

If you have had a stroke or TIA in the past, these measures are particularly important because your risk of having another stroke in the future is greatly increased.

Read more about preventing strokes.

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Symptoms

If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.

Even if the symptoms of a stroke disappear while you are waiting for the ambulance, it's still important tp go to hospital for an assessment.

After an initial assessment, you may need to be admitted to hospital for a more in-depth assessment. Specialist treatment may also begin if this is necessary.

Symptoms of a stroke that disappear quickly and in less than 24 hours may mean you have had a transient ischaemic attack (TIA). These symptoms should also be treated as a medical emergency to reduce the chances of having another stroke.

Recognising the signs and symptoms of a stroke

The signs and symptoms of a stroke vary from person to person but usually begin suddenly.

As different parts of your brain control different parts of your body, your symptoms will depend upon the part of your brain affected and the extent of the damage.

The main stroke symptoms can be remembered with the word FAST: Face-Arms-Speech-Time.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
  • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness in one arm
  • Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
  • Time – it is time to dial 999 immediately if you see any of these signs or symptoms

It is important for everyone to be aware of these signs and symptoms, particularly if you live with or care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure.

Other possible symptoms

Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause different symptoms.

Other signs and symptoms may include:

  • complete paralysis of one side of the body
  • sudden loss or blurring of vision
  • dizziness
  • confusion
  • difficulty understanding what others are saying
  • problems with balance and coordination
  • difficulty swallowing (dysphagia)
  • a sudden and very severe headache resulting in a blinding pain unlike anything experienced before
  • loss of consciousness

However, there are usually other causes for these symptoms.

Transient ischaemic attack (TIA)

The symptoms of a TIA, also known as a mini-stroke, are the same as a stroke, but tend to only last between a few minutes and a few hours before disappearing completely.

Although the symptoms do improve, a TIA should never be ignored as it is a serious warning sign of a problem with the blood supply to your brain and means you are at an increased risk of having a stroke in the near future.

If you have had a TIA, you should contact your GP, local hospital or out-of-hours service, as soon as possible.

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Causes

There are two main types of stroke – ischaemic strokes and haemorrhagic strokes. They affect the brain in different ways and can have different causes.

Ischaemic strokes

Ischaemic strokes are the most common type of stroke. They occur when a blood clot blocks the flow of blood and oxygen to the brain.

These blood clots typically form in areas where the arteries have been narrowed or blocked over time by fatty deposits known as plaques. This process is known as atherosclerosis.

As you get older, the arteries can naturally narrow, but certain things can dangerously accelerate the process. These include:

Another possible cause of ischaemic stroke is a type of irregular heartbeat called atrial fibrillation, which can cause blood clots in the heart that break up and escape from the heart and become lodged in the blood vessels supplying the brain.

Haemorrhagic strokes

Haemorrhagic strokes (also known as cerebral haemorrhages or intracranial haemorrhages) are less common than ischaemic strokes. They occur when a blood vessel within the skull bursts and bleeds into and around the brain.

The main cause of haemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain and make them prone to split or rupture.

Things that increase the risk of high blood pressure include:

  • being overweight or obese
  • drinking excessive amounts of alcohol
  • smoking
  • a lack of exercise
  • stress, which may cause a temporary rise in blood pressure

Haemorrhagic strokes can also occur as the result of the rupture of a balloon-like expansion of a blood vessel (brain aneurysm) and badly-formed blood vessels in the brain.

Can I reduce my risk?

It's not possible to completely prevent strokes because some things that increase your risk of the condition cannot be changed, including:

  • age – you are more likely to have a stroke if you are over 65 years old, although about a quarter of strokes happen in younger people
  • family history – if a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher
  • ethnicity – if you are south Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups
  • your medical history – if you have previously had a stroke, transient ischaemic attack (TIA) or heart attack, your risk of stroke is higher

However, it's possible to significantly reduce your risk of having a stroke by making lifestyle changes to avoid problems such as atherosclerosis and high blood pressure.

You should also seek medical advice if you think you may have an irregular heartbeat. This can be a sign of atrial fibrillation, which increases the risk of a stroke.

Read more about preventing strokes.

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Diagnosis

Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan.

When you first arrive at hospital with a suspected stroke, a doctor will usually want to find out as much as they can about your symptoms.

A number of tests can then be carried out to help confirm the diagnosis and determine the cause of the stroke.

This may include:

  • blood tests to determine your cholesterol and blood sugar levels
  • checking your pulse for an irregular heartbeat
  • taking a blood pressure measurement.

Brain scans

Even if the physical symptoms of a stroke are obvious, brain scans should also be carried out to determine:

  • if the stroke has been caused by a blocked artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke)
  • which part of the brain has been affected
  • how severe the stroke is

Everyone with suspected stroke should receive a brain scan within an hour of arriving at hospital.

An early brain scan is especially important in those who:

  • might benefit from clot-busting drugs (thrombolysis) such as alteplase or early anticoagulant treatment
  • are already on anticoagulant treatments
  • have a lower level of consciousness

This is why a stroke is a medical emergency and why 999 should be dialled when a stroke is suspected – there isn’t time to wait for a GP appointment.

The two main types of scan used to assess the brain in people who have had a suspected stroke are:

CT scans

A CT scan is like an X-ray, but uses multiple images to build up a more detailed, three-dimensional picture of your brain to help your doctor identify any problem areas.

During the scan, you may be given an injection of a special dye into one of the veins in your arm to help improve the clarity of the CT image and look at the blood vessels that supply the brain.

If it is suspected you are experiencing a major stroke, a CT scan is usually able to show whether you have had an ischaemic stroke or a haemorrhagic stroke. It's generally quicker than an MRI scan and can mean you are able to receive appropriate treatment sooner.

MRI scans

An MRI scan uses a strong magnetic field and radio waves to produce a detailed picture of the inside of your body.

It's usually used in people with more complex symptoms, where the extent or location of the damage is unknown. It's also used in people who have recovered from a transient ischaemic attack (TIA).

This type of scan provides greater detail of brain tissue, allowing smaller, or more unusually located areas, affected by a stroke to be identified.

As with a CT scan, special dye can be used to improve MRI scan images.

Swallow tests

A swallow test is essential for anybody who has had a stroke, as swallowing ability is commonly affected early after a stroke.

When a person cannot swallow properly, there is a risk that food and drink may get into the windpipe and lungs, which can lead to chest infections such as pneumonia. This is called aspiration.

The test is simple. The person is given a few teaspoons of water to drink. If they can swallow this without choking and coughing they will be asked to swallow half a glass of water.

If they have any difficulty swallowing, they will be referred to the speech and language therapist for a more detailed assessment.

They will usually not be allowed to eat or drink normally until they have seen the therapist and may therefore need to have fluids or food given directly into an arm vein (intravenously) or through a tube inserted into their stomach via their nose.

Heart and blood vessel tests 

Further tests on the heart and blood vessels might be carried out later to confirm what caused your stroke. Some of the tests that may be carried out are described below.

Carotid ultrasound

A carotid ultrasound scan can help show if there is any narrowing or blockages in the neck arteries leading to your brain.

An ultrasound scan involves using a small probe (transducer) to send high-frequency sound waves into your body. When these sound waves bounce back, they can be used to create an image of the inside of your body.

When carotid ultrasonography is needed, it should happen within 48 hours.

Echocardiography

An echocardiogram may be carried out to produce images of your heart and check for any problems that could be related to your stroke.

This normally involves moving an ultrasound probe across your chest (transthoracic echocardiogram).

An alternative type of echocardiogram called transoesophageal echocardiography (TOE) may sometimes be used.

An ultrasound probe is passed down your gullet (oesophagus), usually under sedation.

As this allows the probe to be placed directly behind the heart, it produces a clear image of blood clots and other abnormalities that may not get picked up by a transthoracic echocardiogram.

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Treatment

Effective treatment of stroke can prevent long-term disability and save lives.

The Welsh Government has published a plan titled 'Together for Health,  Stroke Delivery: our vision'. The plan sets out the vision for the population of Wales and what this means for NHS stroke services.  Stroke remains a top priority for Wales and is a leading cause of death and adult disability in Wales. Each year around 7,400 people will have a stroke in Wales and it  is estimated that there are almost 66,000 stroke survivors living in Wales. The plan can be found on the Welsh Government website.

The specific treatments recommended depend on whether a stroke is caused by

  • a blood clot obstructing the flow of blood to the brain (ischaemic stroke)
  • bleeding in or around the brain (haemorrhagic stroke).

Treatment will usually involve taking one or more different medications, although some people may also need surgery.

The main treatment strategies for the two types of stroke are outlined below.

Treating ischaemic strokes

If you have had an ischaemic stroke, a combination of medications to treat the condition and prevent it from happening again will usually be recommended.

Some of these medications will need to be taken immediately and only for a short time, while others may only be started once the stroke has been treated and may need to be taken in the long-term.

Thrombolysis

Ischaemic strokes can often be treated using injections of a medication called alteplase that dissolves blood clots and restores the flow of blood to the brain. This use of 'clot-busting' medication is known as thrombolysis.

Alteplase is most effective if started as soon as possible after the stroke occurs and is not generally recommended if more than four and a half hours have passed because it's not clear how beneficial it is when used after this time.

However, before alteplase can be used, it is very important that a brain scan to confirm a diagnosis of an ischaemic stroke is carried out because the medication can make the bleeding that occurs in haemorrhagic strokes worse.

Thrombectomy

A small proportion of severe ischaemic strokes can be treated by an emergency procedure known as thrombectomy. This removes blood clots and helps restore blood flow to the brain.

Thrombectomy is only effective at treating ischaemic strokes caused by a blood clot in a large artery in the brain. It's most effective when started as soon as possible after a stroke.

The procedure involves inserting a catheter into an artery, often in the groin. A small device is passed through the catheter into the artery in the brain.

The blood clot can then be removed using the device, or through suction. The procedure can be carried out under local or general anaesthetic.

Antiplatelets

Most people will also be offered a regular dose of aspirin which – as well as being a painkiller – makes the cells in your blood called platelets less sticky, reducing the chances of another clot forming.

In addition to aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.

Anticoagulants

Some people may also be offered an anticoagulant to help reduce their risk of developing further blood clots in the future.

Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants for long-term use.

There are also a number of anticoagulants called heparins that can only be given by injection and are used in the short-term.

Anticoagulants may be offered if you:

  • have a type of irregular heartbeat called atrial fibrillation that can cause blood clots
  • have a history of blood clots
  • are at risk of developing clots in your leg veins – known as deep vein thrombosis (DVT) – because a stroke has left you unable to move one of your legs

Antihypertensives

If your blood pressure is too high, you may be offered medicines to lower it. Medicines that are commonly used include:

  • thiazide diuretics
  • angiotensin-converting enzyme (ACE) inhibitors
  • calcium channel blockers
  • beta-blockers
  • alpha-blockers

Read more about treating high blood pressure.

Statins

If the level of cholesterol in your blood is too high, you will be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.

You may be offered a statin even if your cholesterol level is not particularly high, because a statin may help reduce your risk of stroke whatever your cholesterol level is.

Carotid endarterectomy

Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.

If the carotid stenosis is particularly severe, surgery may be offered to unblock the artery. This is done using a surgical technique called a carotid endarterectomy. It involves the surgeon making an incision in your neck to open up the carotid artery and remove the fatty deposits.

Treating haemorrhagic strokes

As with ischaemic strokes, some people who have had a haemorrhagic stroke will also be offered medication, to lower their blood pressure and prevent further strokes.

If you were previously taking anticoagulants before you had your stroke, you may also need treatment to reverse the effects of the medication and reduce your risk of further bleeding.

Surgery

Occasionally, emergency surgery may be needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.

During a craniotomy, a section of the skull is cut away to allow the surgeon access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain.

After the bleeding has been stopped, the piece of bone removed from the skull is replaced, often by an artificial metal plate.

Surgery for hydrocephalus

Surgery can also be carried out to treat a complication of haemorrhagic strokes called hydrocephalus.

This is where damage resulting from a stroke causes cerebrospinal fluid to build up in the cavities (ventricles) of the brain, causing symptoms such as headaches, sickness, vomiting and loss of balance.

Hydrocephalus can be treated by surgically placing an artificial tube called a shunt into the brain to allow the fluid to drain properly.

Read more about treating hydrocephalus.

Supportive treatments

As well as the treatments mentioned above, you may also need further short-term treatment to help manage some of the problems that can affect people who have had a stroke.

For example, you may require:

  • a feeding tube inserted into your stomach through your nose (nasogastric tube) to provide nutrition if you have difficulty swallowing (dysphagia)
  • nutritional supplements if you are malnourished
  • fluids given directly into a vein (intravenously) if you are at risk of dehydration
  • oxygen through a nasal tube or face mask if you have low levels of oxygen in your blood
  • compression stockings to prevent blood clots in the leg (deep vein thrombosis, or DVT)
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Recovery

The injury to the brain caused by a stroke can lead to widespread and long-lasting problems.

Although some people may recover quite quickly, many people who have a stroke will need long-term support to help them manage any difficulties they have and regain as much independence as possible.

This process of rehabilitation will be specific to you, and will depend on your symptoms and their severity. It will often start while you are still in hospital and will continue at home or at a local clinic in your community once you are well enough to leave.

A team of specialists are available to help with your rehabilitation, including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors.

You will be encouraged to actively participate in the rehabilitation process and will work with your care team to set goals you want to achieve during your recovery.

The different treatment and rehabilitation methods for some of the main problems caused by strokes are outlined below.

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Psychological impact

Two of the most common psychological problems that can affect people after a stroke are:

  • depression – many people experience intense bouts of crying and feel hopeless and withdrawn from social activities
  • anxiety – where people experience general feelings of fear and anxiety, sometimes punctuated by intense, uncontrolled feelings of anxiety (anxiety attacks)

Feelings of anger, frustration and bewilderment are also common.

You will receive a psychological assessment from a member of your healthcare team soon after your stroke to check if you are experiencing any emotional problems.

Advice should be given to help deal with the psychological impact of stroke. This includes the impact on relationships with other family members and any sexual relationship.

There should also be a regular review of any problems of depression and anxiety, and psychological and emotional symptoms generally.

These problems may settle down over time but if they are severe or last a long time, GPs can refer people for expert healthcare from a psychiatrist or clinical psychologist.

For some people, medicines and psychological therapies, such as counselling or cognitive behavioural therapy (CBT) can help. CBT is a therapy that aims to change the way you think about things to produce a more positive state of mind.

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Cognitive impact

'Cognitive' is a term used by scientists to refer to the many processes and functions our brain uses to process information.

One or more cognitive functions can be disrupted by a stroke, including:

  • communication – both verbal and written
  • spatial awareness – having a natural awareness of where your body is in relation to your immediate environment
  • memory
  • concentration
  • executive function – the ability to plan, solve problems and reason about situations
  • praxis – the ability to carry out skilled physical activities, such as getting dressed or making a cup of tea

As part of your treatment, each one of your cognitive functions will be assessed and a treatment and rehabilitation plan will be created.

You can be taught a wide range of techniques that can help you relearn disrupted cognitive functions, such as recovering your communication skills through speech and language therapy.

There are many ways to compensate for any loss of cognitive function, such as using memory aids, diaries and routines to help plan daily tasks.

Most cognitive functions will return after time and rehabilitation but you may find that they do not return to their former levels.

The damage that a stroke causes to your brain also increases the risk of developing vascular dementia. The dementia may happen immediately after a stroke or may develop some time after the stroke occurred.

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Movement problems

Strokes can cause weakness or paralysis in one side of the body and can result in problems with co-ordination and balance.

Many people also experience extreme tiredness (fatigue) in the first few weeks after a stroke, and may also have difficulty sleeping, making them even more tired.

As part of your rehabilitation you should be seen by a physiotherapist, who will assess the extent of any physical disability before drawing up a treatment plan.

Physiotherapy will often involve several sessions a week, focusing on areas such as exercises to improve your muscle strength and overcome any walking difficulties.

The physiotherapist will work with you by setting goals. At first, these may be simple goals such as picking up an object. As your condition improves, more demanding long-term goals, such as standing or walking, will be set.

A careworker or carer, such as a member of your family, will be encouraged to become involved in your physiotherapy. The physiotherapist can teach you both simple exercises you can carry out at home.

If you have problems with movement, you may also receive help from an occupational therapist, who can assess your ability to carry out everyday tasks and help find ways to manage any difficulties.

Occupational therapy may involve adapting your home or using equipment to make everyday activities easier, as well as trying to find alternative ways of carrying out tasks you have problems with.

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Communication problems

After having a stroke, many people experience problems with speaking and understanding, as well as with reading and writing.

This is called aphasia, or dysphasia, when it is caused by injury to the parts of the brain responsible for language. If the problems are caused by muscles involved in speech being affected, this is known as dysarthria.

You should see a speech and language therapist as soon as possible for an assessment, and to start therapy to help you with communication skills.

This may involve:

  • exercises to improve your control over your speech muscles
  • using communication aids (such as letter charts and electronic aids)
  • alternative methods of communication (such as gestures or writing).

Read more about treating aphasia.

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Swallowing problems

The damage caused by a stroke can interrupt your normal swallowing reflex, making it possible for small particles of food to enter your windpipe.

Problems with swallowing are known as dysphagia. Dysphagia can lead to damage to your lungs, which can trigger a lung infection (pneumonia).

You may need to be fed using a feeding tube during the initial phases of your recovery to prevent any complications from dysphagia.

The tube is usually put into your nose and passed into your stomach (nasogastric tube), or it may be directly connected to your stomach in a minor surgical procedure carried out using local anaesthetic (percutaneous endoscopic gastrostomy, or PEG).

In the long term, you'll usually see a speech and language therapist several times a week for treatment to manage your swallowing problems.

Treatment may involve tips to make swallowing easier, such as taking smaller bites of food and advice on posture, and exercises to improve control of the muscles involved in swallowing.

Read more about treating dysphagia.

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Visual Problems

Stroke can sometimes damage the parts of the brain that receive, process and interpret information sent by the eyes.

This can result in losing half the field of vision – for example, only being able to see the left- or righthand side of what's in front of you.

Strokes can also affect the control of the movement of the eye muscles. This can cause double vision. 

If you have any problems with your vision after a stroke, you'll be referred to an eye specialist called an orthoptist, who can assess your vision and suggest possible treatments.

For example, if you've lost part of your field of vision, you may be offered eye movement therapy. This involves exercises to help you look to the side with the reduced vision.

You may also be given advice about particular ways to perform tasks that can be difficult if your vision is reduced on one side, such as getting dressed.

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Bladder and bowel control

Some strokes damage the part of the brain that controls bladder and bowel movements. This can result in urinary incontinence and difficulty with bowel control.

Some people who have had a stroke may regain bladder and bowel control quite quickly, but if you still have problems after leaving hospital, help is available from the hospital, your GP and specialist continence advisors.

Don’t be embarrassed – seek advice if you have a problem as there are lots of treatments that can help. These include bladder retraining exercises, medications, pelvic floor exercises and the use of incontinence products.

Read more about treating urinary incontinence.

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Sex after a stroke

Having sex will not put you at higher risk of having a stroke.

There's no guarantee you won't have another stroke, but there's no reason why it should happen while you are having sex.

Even if you have been left with a severe disability, you can experiment with different positions and find new ways of being intimate with your partner.

Be aware that some medications can reduce your sex drive (libido), so make sure your doctor knows if you have a problem, there may be other medicines which can help.

Some men may experience erectile dysfunction after having a stroke. Speak to your GP or rehabilitation team if this is the case, as there are a number of treatments available that can help.

Read more about treating erectile dysfunction.

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Driving after a stroke

If you have had a stroke, you cannot drive for one month. Whether you can return to driving depends on what long-term disabilities you may have and the type of vehicle you drive.

It is often not the physical problems that can make driving dangerous (such as pressing the pedals or holding the steering wheel) but the problems with concentration, reaction time and awareness that can develop after a stroke.

Your GP can advise about whether you can start driving again a month after your stroke or whether you need further assessment at a mobility centre.

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Preventing further strokes

If you have had a stroke, your chances of having another one are significantly increased.

You will usually require long-term treatment with medications aimed at improving the underlying risk factors for your stroke.

For example:

  • medication to help lower your blood pressure
  • anticoagulants or antiplatelets to reduce your risk of blood clots
  • statins to lower your cholesterol levels.

You will also be encouraged to make lifestyle changes to improve your general health and lower your stroke risk, such as:

  • eating a healthy diet
  • exercising regularly
  • stopping smoking if you smoke
  • cutting down on the amount of alcohol you drink.

Read more about preventing strokes.

Caring for someone who has had a stroke

There are many ways you can provide support to a friend or relative who has had a stroke to speed up their rehabilitation process. These include:

  • helping to practice physiotherapy exercises in between their sessions with the physiotherapist
  • providing emotional support and reassurance their condition will improve with time
  • helping motivate the person to reach their long-term goals
  • adapting to any needs they may have, such as speaking slowly if they have communication problems

Caring for somebody after a stroke can be a frustrating and sometimes a lonely experience. The advice outlined below may help.

Be prepared for changed behaviour

Someone who has had a stroke can often seem as though they have had a change in personality and appear to act irrationally at times. This is due to the psychological and cognitive impact of a stroke.

They may become angry or resentful towards you. Upsetting as it may be, try not to take it personally.

It is important to remember that a person will often start to return to their old self as their rehabilitation and recovery progresses.

Try to remain patient and positive

Rehabilitation can be a slow and frustrating process, and there will be periods of time when it appears little progress has been made.

Encouraging and praising any progress, no matter how small it may appear, can help motivate someone who has had a stroke to achieve their long-term goals.

Make time for yourself

If you are caring for someone who has had a stroke, it is important not to neglect your own physical and psychological wellbeing. Socialising with friends or pursuing leisure interests will help you cope better with the situation.

Ask for help

There are a wide range of support services and resources available for people recovering from strokes, and their families and carers. This ranges from equipment that can help with mobility, to psychological support for carers and families.

The hospital staff involved with the rehabilitation process can provide advice and relevant contact information.

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Prevention

The best way to help prevent a stroke is to eat a healthy diet, exercise regularly and avoid smoking and drinking too much alcohol.

These lifestyle changes can reduce your risk of problems like:

If you have already had a stroke, making these changes can help reduce your risk of having another one in the future.

Diet

An unhealthy diet can increase your chances of having a stroke because it may lead to an increase in your blood pressure and cholesterol levels.

A low-fat, high-fibre diet is usually recommended, including plenty of fresh fruit and vegetables (five portions a day) and wholegrains.

Ensuring a balance in your diet is important. Don’t eat too much of any single food – particularly foods that are high in salt and processed foods.

You should limit the amount of salt you eat to no more than 6g (0.2oz) a day because too much salt will increase your blood pressure. Six grams of salt is about one teaspoonful.

Read more about healthy eating and losing weight.

Exercise

Combining a healthy diet with regular exercise is the best way to maintain a healthy weight, and regular exercise can also help lower your cholesterol level and keep your blood pressure at a healthy level.

For most people, at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week is recommended.

If you are recovering from a stroke, you should discuss possible exercise plans with the members of your rehabilitation team.

Regular exercise may not be possible in the first weeks or months following a stroke but you should be able to begin exercising once your rehabilitation has progressed.

Stop smoking

Smoking significantly increases your risk of having a stroke. This is because it narrows your arteries and makes your blood more likely to clot.

You can reduce your risk of having a stroke by stopping smoking. Not smoking will also improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease.

You can call Stop Smoking Wales on 0800 085 2219 for advice

Read more about stopping smoking.

Cut down on alcohol

Excessive alcohol consumption can lead to high blood pressure and trigger irregular heartbeat (atrial fibrillation), both of which can increase your risk of having a stroke.

Because alcoholic drinks are high in calories they also cause weight gain. Heavy drinking multiplies the risk of stroke by more than three times.

If you choose to drink alcohol and have fully recovered, you should aim not to exceed the recommended limits:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

If you have not fully recovered from your stroke, you may find that you will have become particularly sensitive to alcohol and even the recommended safe limits as above for the general population may be too much for you.

Read more about drinking and alcohol.

Managing underlying conditions

If you have been diagnosed with a condition known to increase your risk of stroke – ensuring the condition is well controlled is also important in helping prevent strokes.

The lifestyle changes mentioned above can help control these conditions to a large degree, but you may also need to take regular medication.

For more information, see:

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 23/03/2017 13:38:15

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