Stroke, What Is It, Life After A Stroke

A stroke or "brain attack" occurs when a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a blood vessel (a tube through which the blood moves through the body) breaks, interrupting blood flow to an area of the brain.  When either of these things happen, brain cells begin to die and brain damage occurs.

When brain cells die during a stroke, abilities controlled by that area of the brain are lost.  These abilities include speech, movement and memory.  How a stroke patient is affected depends on where the stroke occurs in the brain and how much the brain is damaged.

For example, someone who has a small stroke may experience only minor problems such as weakness of an arm or leg.  People who have larger strokes may be paralyzed on one side or lose their ability to speak.  Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.

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 damage and possibly death.

Types of stroke

There are two main causes of strokes:

• ischaemic (accounting for over 80% of all cases) – the blood supply is stopped due to a blood clot 
• haemorrhagic – a weakened blood vessel supplying the brain bursts and causes brain damage

There is also a related condition known as a transient ischaemic attack (TIA), where the supply of blood to the brain is temporarily interrupted, causing a 'mini-stroke'. TIAs should be treated seriously as they are often a warning sign that a stroke is coming.

Who is at risk from stroke?

In England, strokes are a major health problem. Every year over 150,000 people have a stroke and it is the third largest cause of death, after heart disease and cancer. The brain damage caused by strokes means that they are the largest cause of adult disability in the UK.

People over 65 years of age are most at risk from having strokes, although 25% of strokes occur in people who are under 65. It is also possible for children to have strokes.

If you are south Asian, African or Caribbean, your risk of stroke is higher. This is partly because of a predisposition (a natural tendency) to developing diabetes and heart disease, which are two conditions that can cause strokes.

Smoking, being overweight, lack of exercise and a poor diet are also risk factors for stroke. Also, conditions that affect the circulation of the blood, such as high blood pressure, high cholesterol atrial fibrillation (an irregular heartbeat) and diabetes, increase your risk of having a stroke.

Treating a stroke

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

Most often, strokes are treated with medicines. This generally includes drugs to prevent and remove blood clots, reduce blood pressure and reduce cholesterol levels.

In some cases, surgery may be required. This is to clear fatty deposits in your arteries or to repair the damage caused by a haemorrhagic stroke.

Life after a stroke

The damage caused by a stroke can be widespread and long-lasting. Some people need to have a long period of rehabilitation before they can recover their former independence, while many will never fully recover.

The process of rehabilitation will be specific to you, and will depend on your symptoms and how severe they are. A team of specialists are available to help, including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors.

The damage that a stroke causes to your brain can impact on many aspects of your life and wellbeing, and depending on your individual circumstances, you may require a number of different treatment and rehabilitation methods.

Your disabilities and your ability to get better after a stroke depend on:

• Which side of the brain was affected (whether it is your dominant side).
• Which part of the brain was damaged by the stroke.
• How much of the brain was damaged.
• Your general health before the stroke.

Impairments after a stroke may include problems with muscles and movement. These include:

• Weakness on one side of the body. This may cause you to have trouble walking, grasping objects, or doing other tasks. The side of the body that is affected is opposite from the side of the brain that was damaged by the stroke.
• Joint pain and rigidity. A person with a very weak arm may have shoulder pain caused by a tight or locked-up joint. Movement of the joint is essential to keep it from "freezing" and to make sure that you can move it easily when your strength returns.
• Muscle stiffness or spasms (spasticity). If you have spacticity, you may need certain medicines or injections of substances that block nerve reactions.
• Problems with your sense of touch or your ability to feel hot and cold. You may also have problems judging the position of parts of your body.
• Pain, numbness, or tingling in your limbs.
• Trouble with walking and coordinating body movements.
• Problems swallowing and eating (dysphagia). 

• Urinary or bowel problems. You may have trouble holding your urine (urinary incontinence) or trouble emptying your bladder(urinary retention). Or you may have constipation or problems controlling bowel movements. Although this can make you feel embarrassed or discouraged, these issues are usually not permanent. 

Other problems involve how you process information and your emotions. These include:

• Speech and language problems (aphasia). Aphasia usually results from damage to the left side of the brain, which is the area responsible for language. Some people who have aphasia may not be able to understand written or spoken language, read or write, or express their own thoughts. 

• Memory and cognitive problems. You may have damage to parts of your brain that control awareness, learning, and memory. You may have trouble focusing or remembering. It may be difficult to make plans, learn new activities, or do other complex tasks. You may not be able to acknowledge the physical impairments caused by your stroke. 

• Problems with perception. You may have trouble judging distance, size, position, rate of movement, form, and how parts relate to the whole. Some people have trouble recognizing body parts on the affected side. This is especially true for people who do not have feeling in the affected arm or leg. 

• Problems with vision. You may have problems seeing in some or all of the normal areas of vision. 

• Emotional problems. Fear, anxiety, anger, sadness, frustration, and grief are common after a stroke. About one-third of people older than 65 who have had a stroke have symptoms of depression 1Depression is a serious condition that requires treatment. 

Can strokes be prevented?

Strokes can usually be prevented through a healthy lifestyle. Eating a healthy diet taking regular exercise, drinking alcohol in moderation and not smoking, will dramatically reduce your risk of having a stroke. Lowering high blood pressure and cholesterol levels with medication also lowers the risk of stroke substantially.