Stroke

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  1. About stroke
  2. Symptoms and signs of a stroke
  3. Causes of a stroke
  4. Diagnosing a stroke
  5. Treating a stroke
  6. Recovering after a stroke
  7. Caring for someone who has had a stroke
  8. Preventing a stroke
  9. Stroke research

About stroke

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.

Treating and preventing stroke continues to be a national clinical priority for Scotland. 

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 may have dropped, and their eyelid may droop.
  • 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). This is when the supply of blood to the brain is temporarily interrupted, causing a "mini-stroke". TIAs often last between 30 minutes and several hours (but fewer than 24 hours). TIAs should be treated seriously, as they're often a warning sign that you're at risk of having a full stroke in the near future.

Read more about the causes of strokes

Who is at risk?

In the Scottish Health Survey (2017), 3.2% of men and 2.8% of women reported that they had experienced a stroke.

Treating and preventing stroke continues to be a national clinical priority for Scotland. Smoking, being overweight, lack of exercise, drinking alcohol above recommended limits and a poor diet are also risk factors for stroke. Having high cholesterol, atrial fibrillation and diabetes

Older people are most at risk of having strokes, although they can happen at any age – including in children.

Some risk factors can't be changed. These include:

  • age
  • family history
  • ethnicity
  • your medical history

Read more about causes of a stroke and who's at risk

How strokes are treated

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

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 usually involves taking one or more different medications. Some people may also need surgery. It’s important to seek treatment as soon as possible to improve the chances of a good recovery.

Read more about diagnosing a stroke and treating a stroke

Life after a stroke

Often individuals who survive a stroke are left with long-term problems resulting from the injury to their brain.

Some people need to have a long period of rehabilitation before they can recover their former independence. Others may never fully recover and will 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 living at home.

Read more about recovering from a stroke

Caring for someone who has had a stroke

Around half the people who have a stroke 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 even just to provide companionship. Read more about care services in your home on Care Information Scotland.

Read more about caring for someone who has had a stroke

Can strokes be prevented?

You can significantly reduce your risk of having a stroke through a healthy lifestyle, such as:

Lowering high blood pressure and cholesterol levels with medication also lowers the risk of stroke. Taking anticoagulant medication if you have an irregular heartbeat due to atrial fibrillation will also help prevent stroke.

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

Read more about preventing strokes and stroke research

Symptoms and signs of a stroke

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 to arrive, you or the person having the stroke should still go to hospital for an assessment.

Symptoms that disappear quickly (and in less than 24 hours) may mean you've had a transient ischaemic attack (TIA) and you could be at risk of having a full stroke in the near future.

After an initial assessment, you may need to be admitted to hospital to receive a more in-depth assessment and, if necessary, for specialist treatment to begin.

Recognising the signs 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 on 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 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 notice any of these signs or symptoms.

It is important for everyone to be aware of these signs and symptoms. 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, being aware of the symptoms is even more important.

Other possible symptoms

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

Other symptoms and signs may include:

  • complete paralysis of one side of the body
  • sudden loss or blurring of vision
  • difficulty understanding what others are saying
  • problems with balance and co-ordination
  • a sudden and very severe headache
  • loss of feeling in one side of the body

However, there are usually other causes for these symptoms.

'Mini-stroke' or transient ischaemic attack (TIA)

The symptoms of a TIA are the same as a stroke, but they 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's a serious warning sign there is a problem with the blood supply to your brain and means you're at an increased risk of having a stroke in the near future.

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

Causes of a stroke

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 speed up the process. These include:

Another possible cause of ischaemic stroke is a type of irregular heartbeat called atrial fibrillation. This 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.

Atrial fibrillation can have many different causes, including:

Read more about the causes of atrial fibrillation.

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

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 can't be changed. These include:

  • 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, in most cases 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. This includes things such as:

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

As atrial fibrillation can also significantly increase your risk of having a stroke, it's important to seek medical advice if you think you may have an irregular heartbeat. If you're diagnosed with the condition, you should talk to your doctor about the option of taking anticoagulant medications to lower your stroke risk.

Read more about preventing strokes

Diagnosing a stroke

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.

Some tests can then be carried out to help confirm the diagnosis and determine the cause of the stroke. This may include:

  • blood tests to check your cholesterol and blood sugar levels
  • checking your pulse for an irregular heartbeat
  • measuring your blood pressure

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

Different treatment is required for the different types of stroke, so a fast diagnosis will make treatment easier.

Everyone with suspected stroke should receive a brain scan within 24 hours and some people should be scanned urgently when they are admitted to hospital, especially 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:

The type of scan you may have largely depends on your symptoms.

CT scans

A CT scan is like an X-ray, but uses multiple images to build up a more detailed, 3D (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. This will help improve the clarity of the CT image and look at the blood vessels that supply the brain.

If it's suspected you are experiencing a major stroke, a CT scan is usually able to show which type of stoke you've had. CT's are generally quicker than an MRI scan which can allow you 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.

For people with more complex symptoms (where the extent or location of the damage is unknown) and in people who have recovered from a transient ischaemic attack (TIA) – an MRI scan is more appropriate. An MRI will provide greater detail of brain tissue. This will allow smaller, or unusually located areas affected by a stroke to be idenified.

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 can't swallow properly, there's a risk that food and drink may get into the windpipe and then into the lungs (called aspiration). This can lead to chest infections such as pneumonia.

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

If you have any difficulty swallowing, you will be referred to the speech and language therapist for an assessment.

You will usually not be allowed to eat or drink until you have seen the therapist. This means you may need to have fluids or food given directly into an arm vein (intravenously) or through a feeding tube.

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's 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 as soon as possible.

Echocardiography

Another type of ultrasound scan called an echocardiogram may be carried out to produce images of your heart. This can check for any problem with it that could be related to your stroke. This involves having an ultrasound probe moved across your chest (transthoracic echocardiogram).

In some cases, an alternative type of echocardiogram called transoesophageal echocardiography (TOE) may also be used. A TOE involves passing an ultrasound probe down your gullet (oesophagus), usually under sedation. This allows the probe to be placed directly behind the heart. The TOE produces a clear image of blood clots and other abnormalities that may not be picked up by a transthoracic echocardiogram.

Cardiac Monitoring

While you're in a stroke unit, the team may put a heart monitor on you to look for abnormal heart rhythms such as atrial fibrillation.

This may be done again after you go home by having you wear a device which looks like a small pager for two to three days.

Treating a stroke

Treating ischemic strokes

If you have had an ischaemic stroke, you may benefit from urgent treatment. A combination of medications to treat the condition and prevent it from happening again is usually recommended. In some cases, surgery may be necessary.

Some of these medications need to be taken immediately and only for a short time. Others may only be started once the stroke has been treated and may need to be taken long term.

Thrombolysis

Ischaemic strokes can often be treated using injections of a medication called alteplase. Aleplase 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. It's not generally recommended if more than four-and-a-half hours have passed, as it's not clear how beneficial it is after this time.

Before alteplase can be used, it's very important that a brain scan to confirm a diagnosis of an ischaemic stroke is carried out. This is because alteplase can make the bleeding in haemorrhagic strokes worse.

Thrombectomy

A 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. A few people may be treated later after a stroke if they have a particular type of stoke.

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

People who have had an ischaemic stroke will usually be given aspirin to start their treatment. This may then be changed to a different antiplatelet medication called clopidogrel for longterm use.

Sometimes both aspirin and clopidogrel are given at the start of treatment. If a patient can’t take either of these medicines, there is another medication called dipyridamole which can be used.

Anticoagulants

Some people may also be offered an additional medication called an anticoagulant. These help reduce the 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. Examples of anticoagulants for long term use are:

  • warfarin
  • edoxaban
  • rivaroxaban
  • dabigatran
  • apixaban

There are also some 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
  • 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.

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 a cut (incision) in your neck to open up the carotid artery and remove the fatty deposits.

This reduces the risk of further strokes if done soon after a stroke (or TIA) but is not usually recommended if a long time has passed since the stroke.

Treating haemorrhagic strokes

As with ischaemic strokes, some people who have had a haemorrhagic stroke will also be offered medication, such as ACE inhibitors. These lower blood pressure and prevent further strokes from occurring.

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

Craniotomy

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.

Hemicraniectomy

If you or your relative has had a large stroke caused by a blockage in an artery this can lead to swelling in the brain.

If this happens in the few days immediately following a stroke, your medical team may consider performing an operation to remove part of the skull which can help with the swelling (decompressive hemicraniectomy).

This is a complicated surgery that is highly risky.

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've 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're malnourished
  • fluids given directly into a vein (intravenously) if you're 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)

For more information about the supportive treatments, see recovering from a stroke.

What is good stroke care?

The Stroke Improvement Plan (2014), provides a guide to high-quality health and social care for those affected by stroke. Stroke experts have set out standards which define good stroke care, including:

  • a rapid response to a 999 call for suspected stroke
  • prompt transfer to a hospital providing specialist care
  • an urgent brain scan – for example, (CT) scan or (MRI) scan undertaken as soon as possible
  • immediate access to a high-quality stroke unit
  • early multidisciplinary assessment, including swallowing screening
  • specialised stroke rehabilitation
  • planned transfer of care from hospital to community and longer-term support

The National Institute for Health and Care Excellence (NICE) has also produced guidelines on the diagnosis and management of stroke.

If you're concerned about the standard of care provided, speak to your stroke specialist or a member of the stroke team.

Recovering after a stroke

The brain injury caused by a stroke can lead to long lasting problems.

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

This process of rehabilitation depends on the symptoms and their severity. It often starts in hospital and continues at home or at a local clinic in your community. A team of specialists are available to help with you're rehabilitation, including:

  • physiotherapists
  • psychologists
  • occupational therapists
  • speech and language therapists
  • dietitians
  • specialist nurses and doctors

You'll be encouraged to actively participate in the rehabilitation process and 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.

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're 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 psychological symptoms.

These problems may settle down over time but if they're severe or long lasting. GPs can refer you 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.

Want to know more?

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 re-learn disrupted cognitive functions. For example, you can recover communication skills through speech therapy (see below).

There are also many methods to compensate for any loss of cognitive function. These include using memory aids, diaries and routines to help plan daily tasks.

Most cognitive functions will return after time and rehabilitation, but you may find 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.

Want to know more?

Movement problems

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

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

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

Physiotherapy will often involve several sessions a week. It should include exercises to improve your muscle strength to 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 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. They can assess your ability to carry out everyday tasks and find ways to manage any difficulties. Occupational therapy may involve adapting your home or using equipment to make tasks easier.

Want to know more?

Communication problems

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

This is called aphasia, or dysphasia, when it's 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. This may involve:

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

Read more about aphasia

Want to know more?

Swallowing problems

The damage caused by a stroke can interrupt your normal swallowing reflex. This makes 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). 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
  • advice on posture
  • exercises to improve control of the muscles involved in swallowing

Read more about treating dysphagia

Want to know more?

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 of the field of vision – for example only being able to see the left or right hand 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 will be referred to an eye specialist called an orthoptist. They 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.

Want to know more?

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. If you still have problems after leaving hospital, help is available from 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:

Read more about treating urinary incontinence.

Want to know more?

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're having sex.

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

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

Want to know more?

Driving after a stroke

If you've had a stroke or TIA, you can't 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's often not the physical problems that can make driving dangerous (such as pressing the pedals or holding the steering wheel). Problems with concentration, reaction time and awareness that can develop after a stroke are the most concerning.

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.

Want to know more?

Preventing further strokes

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

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

You'll 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
  • drinking alcohol within the recommended limits

Read more about preventing strokes

Further information

For more information and further support when recovering from a stroke you can visit The Stroke Association's 'My Stroke Guide'.

My Stroke Guide has further information about different types of stroke, risk factors and advice on stroke prevention. You can also find tools and over 200 videos, to help you to understand stroke and manage its effects.

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 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's 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're 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.

Preventing a stroke

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 such as:

If you have already had a stroke, making these changes can help reduce your risk of having another stroke 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, vegetables and whole grains.

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. 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. 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're recovering from a stroke, you should discuss possible exercise plans with 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.

Read more about keeping active

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.

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

Quit Your Way Scotland can offer advice and encouragement to help you quit smoking on 0800 84 84 84.

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've not fully recovered from your stroke, you may find that you will have become particularly sensitive to alcohol. 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 strokes, it's important to ensure it is well controlled. These conditions include: 

  • high cholesterol
  • high blood pressure
  • atrial fibrillation
  • diabetes
  • transient ischaemic attack (TIA)

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

For more information, see:

Stroke research

New Stroke treatments are being developed all the time. Before we start using new treatments in the NHS, research needs to show if the treatment works.

Scotland has a tradition of world-class stroke research. Many of the treatments we use in daily stroke care were first developed and tested in Scotland.

Across Scotland we still have lots of important stroke research happening. Research is looking at all stages of the stroke journey. This includes the very early treatments of stroke, through to the longer term issues that people living with stroke face.

Participating in stroke research studies

There are many opportunities to get involved in stroke research. You may be approached about stroke research by the clinical team looking after you or by members of the NHS stroke research team.

The NHS are interested in improving care at every point of the stroke pathway. You may be asked about helping with research through your GP, during your hospital stay or as part of your follow-up appointments.

Helping with research is voluntary. If you are asked about research you will be given information to read and have the opportunity to discuss the research with the team. If you decide that you don’t want to help with a project this is not a problem. This will not change the treatment you receive.

If you would like to be informed about stroke research projects, you can share your details with the NHS Research Scotland SHARE register.

The best research is performed in partnership with the people who know most about stroke – stroke survivors and their care-givers. Across Scotland, researchers are working with people who have lived experience of stroke to shape the future of research.

If you would be interested in helping with stroke research, the NHS Research Scotland Stroke group can help put you in touch with a research group. 

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Source: Stroke Association

Last updated:
16 April 2020

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