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Ischaemic stroke

Published by Bupa's health information team, March 2009.

This factsheet is for people who have had an ischaemic stroke, or who would like more information about it.

A stroke is what happens when the normal flow of blood to your brain is suddenly cut off. In an ischaemic stroke, the blood supply is blocked by a blood clot or clump of fat. It is the most common type of stroke.

About ischaemic stroke
Symptoms of ischaemic stroke
Causes of ischaemic stroke
Diagnosis of ischaemic stroke
Treatment of ischaemic stroke
Further information
Questions and answers
Related topics
Sources

About ischaemic stroke

Blood vessels called arteries carry blood to different parts of your body, including your brain.

In an ischaemic stroke, parts of the brain are starved of oxygen and nutrients as the blood supply to the brain becomes blocked. This damages brain cells and they begin to die. Your brain controls everything your body does, including your movement, speech, vision and emotions. So damage to your brain can affect any of these functions.

Ischaemic strokes are most common in people over the age of 65, although they can happen at any age.

Symptoms of ischaemic stroke

Stroke symptoms usually come on suddenly, within seconds or minutes. They may include:

numbness, weakness or inability to move your face, arm or leg on one side of your body
difficulty speaking
sudden loss of sight in one eye or blurred vision
confusion or difficulty understanding
loss of balance or coordination
severe headache

A good way to recognise if someone has had a stroke is to use the face-arm-speech test (abbreviated to FAST). This involves checking for three of the main symptoms of stroke - facial weakness, arm weakness and speech problems. If you notice someone has any of these symptoms, you should call for emergency help.

Long-term problems

Some strokes may be quite mild and the effects only temporary, while others may be more severe and cause more lasting damage. How much damage a stroke will cause depends on where in the brain the stroke happened and how many brain cells were affected. Common problems after a stroke include:

weakness or paralysis, usually on one side of the body
difficulty swallowing (called dysphagia)
extreme tiredness
problems with speech, reading and writing
problems with vision - such as double vision, or partial blindness
memory and concentration difficulties
difficulty in controlling your bladder and bowel movements (incontinence)
anxiety and depression

These problems can often improve as you recover.

Causes of ischaemic stroke

An ischaemic stroke occurs when the flow of blood to your brain is blocked, usually by a blood clot. The blood clot may develop in one of the arteries leading to your brain, or it may develop somewhere else in your body and travel to your brain in your blood.

You are at greater risk of getting a blood clot if your arteries have become narrowed and 'furred up' with fatty deposits - a process known as atherosclerosis. This often happens as people age. However, the following risk factors can also speed up the process:

smoking
uncontrolled high blood pressure
high cholesterol
being overweight or obese
diabetes
a family history of stroke/heart disease

You're also at risk of an ischaemic stroke if you have a type of abnormal heart beat (arrhythmia) called atrial fibrillation. In atrial fibrillation, your heart doesn't pump blood as efficiently, which can cause a blood clot to form in your heart. This can then travel to your brain, causing a stroke. Regular, heavy drinking can put you at risk of developing an abnormal heart rhythm. It can also raise your blood pressure.

Diagnosis of ischaemic stroke

If you have symptoms of a stroke, you will usually be taken to your nearest accident and emergency department or directly to a specialist stroke unit, if available in your hospital. Here, doctors will carry out a physical assessment to check whether your symptoms are due to a stroke or something else.

You will have a brain scan as soon as possible after the stroke to work out what type of stroke you have had and which part of your brain is affected. This will be either a CT scan or an MRI scan. You may also need to have blood tests and other scans of your heart and blood vessels.

Your doctor will try to find out why the stroke happened so you can have treatment to prevent further strokes in the future. This includes tests for raised blood pressure, cholesterol, diabetes and irregular heart rhythms. The doctor may also check for blood clotting abnormalities and rare conditions that can sometimes be the cause of stroke.

Treatment of ischaemic stroke

You may be treated in a specialist stroke unit or on a general ward while in hospital for stroke. You will be cared for by a team of doctors, nurses and other health professionals.

If you're unable to swallow, you will be given fluid through a drip in your arm and all the nutrients you need though a tube in your nose. You may be given oxygen through a face mask, if you need it, to help you breathe.

You will be helped to sit up and move around as soon as you are able. If you're unable to move, you will be helped to regularly turn in your bed, to reduce your chance of getting pressure ulcers (bed sores) and blood clots in the veins in your legs (deep vein thrombosis).

Medicines

You may be prescribed the following medicines for ischaemic stroke.

Alteplase - this is given through a drip in your arm. It works by breaking down the blood clot in your brain, helping to restore the blood flow to your brain. It can only be given in certain centres and within a time limit of three hours of your symptoms starting. So it's vital that you get help quickly, as soon as the symptoms of stroke start.
Aspirin or similar alternative. This helps to stop your blood from clotting. You may be given aspirin as tablets, via a feeding tube placed in your nose, or as a suppository or enema (tablets or liquid placed directly into your back passage. You will usually need to keep taking aspirin for at least two weeks after you had your stroke.
Warfarin and heparin - for the longer-term prevention of strokes.
Medicines to control your blood pressure and cholesterol.

Surgery

For some types of stroke, you may be advised to have a procedure called a carotid endarterectomy. This is to reduce your risk of getting another stroke. The procedure involves removing the fatty deposits in one of the main arteries supplying your head and neck. It will usually be carried out within two weeks of your stroke happening. The procedure is only suitable for some people - your doctor will advise you if it's suitable for you.

Stroke rehabilitation

Rehabilitation is a crucial part of stroke treatment - it's the process of overcoming or learning to cope with the damage a stroke has caused. After a stroke, you may need to re-learn skills and abilities, learn new skills or adapt to the damage a stroke has caused.

Stroke recovery can be difficult to predict; most people will make most of their recovery in the early weeks and months following the stroke. However, recovery can continue after this time.

The stroke team at the hospital will work out a rehabilitation programme for you (sometimes called a care pathway), designed around your particular needs. This will continue after you leave the hospital. Your rehabilitation programme may involve physiotherapists, speech and language therapists, occupational therapists, ophthalmologists and psychologists, as well as doctors and nurses.

Further information

The Stroke Association
0845 3033100
www.stroke.org.uk