A stroke happens when the blood supply to part of your brain is cut off. You will have symptoms almost immediately, which is why a stroke happens without warning.

Without a supply of blood, your brain cells won't get enough food and oxygen. Because your brain has so many different functions, having a stroke can cause lots of different symptoms. The symptoms you get depend on which part of your brain is affected.

You may find that you suddenly:

If you or someone you know have any of these symptoms, treat it as an emergency and get medical help right away. The sooner you are treated for a stroke, the better your chances of making a good recovery.

Doctors may talk to you about where in the brain you've had a stroke. A stroke in the front of your brain (the cerebral hemispheres) will have different symptoms from a stroke in the base of your brain (the brainstem or the cerebellum). Here is a description of what each part does and the symptoms that you may get when these parts of the brain are suddenly starved of blood.

The two sides of the cerebrum are called the right cerebral hemisphere and the left cerebral hemisphere. They do slightly different jobs.

The right cerebral hemisphere controls movement on the left side of your body. And it organizes complicated movements, such as getting dressed. If you have a stroke in this part of your brain:

The left cerebral hemisphere controls movement on the right side of your body and controls speaking. If you have a stroke in this part of your brain:

This part of your brain keeps your heart beating and your lungs working. It also controls the muscles that move your tongue and voicebox. These are the muscles that allow you to swallow food and to talk. And the brainstem also controls your eye muscles.

If you have a stroke in this part of your brain:

A stroke in the brainstem can be fatal.

Your cerebellum helps coordinate your body's movements. If you have a stroke in this part of your brain:

If your symptoms go away within a few minutes and you recover completely, you have had a transient ischemic attack (TIA) or mini-stroke. A TIA happens when an artery supplying blood to the brain gets blocked and the blood supply is cut off temporarily. This usually happens if the artery is blocked by a blood clot or has been narrowed by hardening of the arteries (

 

 

 

 

 

atherosclerosis
Atherosclerosis is also called "hardening of the arteries." It happens when fatty material attaches to the inner wall of the arteries. Over time, cholesterol, fats and other blood components stick to the same area and the artery wall becomes thick and narrow, making it progressively more difficult for blood to flow through the affected vessels.

 

 

 

 

 

atherosclerosis).

In a transient ischemic attack, the blockage corrects itself (usually after a few minutes or after a few hours at the most). And once the blood flow is restored, the brain cells begin to work normally again. Usually all your symptoms disappear.

But this type of attack should always be taken seriously because it can mean you have a high chance of having a full-scale stroke, which could leave you with permanent brain damage. About 10 in 100 people who have a TIA will have a full-scale stroke within a week. Having treatment quickly (within 24 hours of having symptoms) can reduce this risk to 2 in 100.

 

 

 

 

 

Source:
Rothwell, Giles, Chandratheva, et al.
Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison.
Lancet. 2007; 370: 1432-1442.

 

 

 

 

 

¹

If you think you have had a transient ischemic attack, or are having one, you should seek medical help right away.

It's difficult to say what will happen to you if you've had a stroke. Every stroke is different. It's especially difficult for doctors to predict what will happen to your symptoms in the first few weeks after a stroke. Once these symptoms have settled down, your doctor will probably have a better idea of what kind of progress you will make. But even then there's a lot of guesswork involved. You may find that you are still getting better months and even years after your stroke. So there's always hope that things will improve, even if they only improve slightly.

Doctors aren't exactly sure what happens in the brain just after a stroke.

 

 

 

 

 

Source:
Rudd A, Irwin P, Penhale B.
Stroke at your fingertips.
Class Publishing, London, UK; 2000.

 

 

 

 

 

² The part of the brain where the stroke has happened may become swollen. Part of your recovery may have to do with this swelling going down. As the swelling goes down, brain cells that are still alive start working again.

 

 

 

 

 

Source:
Rudd A, Irwin P, Penhale B.
Stroke at your fingertips.
Class Publishing, London, UK; 2000.

 

 

 

 

 

²

In the first few days after you have a stroke you may get worse before you start to get better. In fact, researchers have estimated that symptoms get worse in up to 4 in 10 people who have a stroke and have gone into the hospital.

 

 

 

 

 

Source:
Davalos A, Castillo J, Pumar JM, et al.
Body temperature and fibrinogen are related to early neurological deterioration on acute ischemic stroke.
Cerebrovascular Diseases. 1997; 7: 64-69.

 

 

 

 

 

³

Why this happens is still not fully understood, although certain things make it more likely.

If your symptoms do get worse, you will probably do less well in the long term than if you recover quickly or remain the same.

You may lose consciousness during or after a stroke.

Researchers aren't sure how many people become unconscious during or after a stroke. Studies have shown between 1 in 6 and 1 in 3 people may become unconscious.

 

 

 

 

 

Source:
Warlow CP, Dennis MS, van Gijn J, et al.
Treatment of primary intracerebral haemorrhage.
In: Warlow CP, Dennis MS, van Gijn J, et al (editors). Stroke: a practical guide to management. Blackwell Science, London, UK; 1996.

 

 

 

 

 

⁵

 

 

 

 

 

Source:
Turney TM, Garraway WM, Whisnant JP.
The natural history of hemispheric and brainstem infarction in Rochester, Minnesota.
Stroke. 1984; 15: 790-794.

 

 

 

 

 

⁶ No one knows why some people become unconscious, but it may be because they have had severe strokes before and have more swelling in their brain.

How you are affected after a stroke will depend on:

It's difficult to say how your symptoms will change in the first few weeks and months. But there's a lot to be hopeful about. Research shows that being treated by a team of stroke specialists can help you recover, even if you have this treatment months or years after your stroke. A stroke team might include a physical therapist (someone who uses massage, exercises, or hot and cold compresses to help you regain control over your muscles) or a speech therapist, as well as doctors and nurses who specialize in treating strokes.

Although brain cells that have died never work again, the cells that are left can form new links with each other. There's also evidence that when nerves in the brain have been damaged, other brain cells may take over their job.

As a result of these things, you may find that gradually you can do some of the things you used to do before you had a stroke.

 

 

 

 

 

Source:
Yatsu FM, Grotta JC, Pettigrew LC.
Stroke: 100 maxims in neurology.
Hodder Arnold, UK; 1995.

 

 

 

 

 

⁷ Doctors call this neuroplasticity, and there is still a lot of debate about how much this influences recovery, and whether treatments such as physical therapy help.

Doing special exercises may help speed this process up.

 

 

 

 

 

Source:
Yatsu FM, Grotta JC, Pettigrew LC.
Stroke: 100 maxims in neurology.
Hodder Arnold, UK; 1995.

 

 

 

 

 

⁷ So even if your stroke happened months ago, it's worth asking about special treatments that could help you get back to normal.

One of the main problems that you can be left with after a stroke is weakness or paralysis on one side of your body. Doctors call this

 

 

 

 

 

hemiplegia
Hemiplegia is paralysis that occurs on one side of the body. This means that a person can't move their arm and leg on one side. If a person has a stroke, hemiplegia can happen in the arm and leg on the other side of their body, but this doesn't always occur. For example, if a person had a stroke in a particular part of the right side of their brain, the body is wired in such a way that they may have hemiplegia on the left side of their body.

 

 

 

 

 

hemiplegia, and it happens when the brain cells controlling the movement of the muscles have died.

Physical therapy can help you get the use of your muscles back if they have been left weak after a stroke. For example, special exercises may be used to improve your balance and walking, and can help you become more independent. Ideally, physical therapy should start soon after a stroke, but even if it's given a year later you should be able to recover some function.

 

 

 

 

 

Source:
Ernst E.
A review of stroke rehabilitation and physiotherapy.
Stroke. 1990; 21: 1081-1085.

 

 

 

 

 

⁸

 

 

 

 

 

Source:
Tangeman PT, Banaitis DA, Williams AK.
Rehabilitation of chronic stroke patients: changes in functional performance.
Archives of Physical Medicine and Rehabilitation. 1990; 71: 876-880.

 

 

 

 

 

⁹ Occupational therapy can help you develop new ways to carry out daily activities such as dressing, washing and driving.

Your muscles and joints may become stiff after you have had a stroke. Doctors call this spasticity, and it's a natural reaction of the body after a stroke if the nerve cells controlling the movement of the muscles have died. If it isn't treated it can eventually cause your arm and leg to be held in strange positions. For example, your arm may stay close to your body and your hand may curl up into a fist.

This combination of weakness from the stroke and the stiffness that develops afterwards can make your movements awkward and clumsy. It often gets better on its own, but if it doesn't, physical therapy or splinting (where the muscles are put in plaster casts or bandaged) may help you gain some control over your movement. Injections of botulinum toxin (Botox) or two other drugs called baclofen and tizanidine may also help relieve stiffness.

You may have problems speaking or understanding what people are saying, reading or writing. Doctors call these kinds of problems aphasia, and they are most common in people who have had a stroke involving the left cerebral hemisphere. This is the part of the brain that is most strongly involved in language.

Up to 4 in 10 people who have a stroke have some language problems.

 

 

 

 

 

Source:
Scottish Intercollegiate Guidelines Network.
Management of patients with stroke: Identification and management of dysphagia. Clinical guideline 78.
September 2004. Available at http://www.sign.ac.uk (accessed on 13 August 2008).

 

 

 

 

 

¹⁰ Many people have slurred speech after a stroke. If you have problems speaking, you may also have problems swallowing since the parts of the brain that control speaking and swallowing are close together.

Problems with speaking and swallowing sometimes clear up on their own in the first few months after a stroke as blood flow to the brain is restored. Only 1 in 5 people who have language problems still have them six months later.

 

 

 

 

 

Source:
Scottish Intercollegiate Guidelines Network.
Management of patients with stroke: Identification and management of dysphagia. Clinical guideline 78.
September 2004. Available at http://www.sign.ac.uk (accessed on 13 August 2008).

 

 

 

 

 

¹⁰ Problems that don't get better will almost always improve, at least to some extent, with speech therapy.

 

 

 

 

 

Source:
Scottish Intercollegiate Guidelines Network.
Management of patients with stroke: Identification and management of dysphagia. Clinical guideline 78.
September 2004. Available at http://www.sign.ac.uk (accessed on 13 August 2008).

 

 

 

 

 

¹⁰ It's thought that the nerve cells in the brain can adapt to injury. They may do this by rearranging themselves so they take over the job that used to be done by the cells that were killed by the stroke. This process can be helped by stimulating the nerves with speech therapy.

 

 

 

 

 

Source:
Yatsu FM, Grotta JC, Pettigrew LC.
Stroke: 100 maxims in neurology.
Hodder Arnold, UK; 1995.

 

 

 

 

 

⁷

About half of all patients who are treated in the hospital for a stroke have difficulty swallowing.

 

 

 

 

 

Source:
Warlow CP, Dennis MS, van Gijn J, et al.
Treatment of primary intracerebral haemorrhage.
In: Warlow CP, Dennis MS, van Gijn J, et al (editors). Stroke: a practical guide to management. Blackwell Science, London, UK; 1996.

 

 

 

 

 

⁵ In one study, only 1 person out of 357 had swallowing difficulties that lasted more than six months after their stroke.

 

 

 

 

 

Source:
Barer DH.
The natural history and functional consequences of dysphagia after hemispheric stroke.
Journal of Neurology, Neurosurgery and Psychiatry. 1989; 52: 236-241.

 

 

 

 

 

¹¹ Speech therapists and dietitians may be able to teach you how to cope with swallowing problems, but it's not clear whether this speeds up your recovery.

About 1 in 5 people have problems seeing after a stroke.

 

 

 

 

 

Source:
Turney TM, Garraway WM, Whisnant JP.
The natural history of hemispheric and brainstem infarction in Rochester, Minnesota.
Stroke. 1984; 15: 790-794.

 

 

 

 

 

⁶

There are three types of problem:

Again, physical therapy may help. The sooner it starts the better. Although even if you have it later, it's still likely to be good for you.

 

 

 

 

 

Source:
Ernst E.
A review of stroke rehabilitation and physiotherapy.
Stroke. 1990; 21: 1081-1085.

 

 

 

 

 

⁸

 

 

 

 

 

Source:
Tangeman PT, Banaitis DA, Williams AK.
Rehabilitation of chronic stroke patients: changes in functional performance.
Archives of Physical Medicine and Rehabilitation. 1990; 71: 876-880.

 

 

 

 

 

⁹

Incontinence is the term doctors use when a person can't always control when they go to the bathroom, either to urinate or have a bowel movement.

As many as 1 in 6 people will have problems remembering things after a stroke. You may have problems concentrating, learning new information, making decisions and solving everyday problems.

For example, you may not be able to remember why you went out to the store or you may not be able to work out simple addition. Some of these problems may get better on their own or you may learn to cope with them. For example, you may have to use lists or carry a diary with you to remind you what you're doing that day.

It's common to feel depressed after a stroke. It's thought that as many as 1 in 5 people develop severe depression one month after their stroke.

 

 

 

 

 

Source:
Warlow CP, Dennis MS, van Gijn J, et al.
Treatment of primary intracerebral haemorrhage.
In: Warlow CP, Dennis MS, van Gijn J, et al (editors). Stroke: a practical guide to management. Blackwell Science, London, UK; 1996.

 

 

 

 

 

⁵

You may be particularly likely to get depressed if you have had a bout of depression before your stroke, or if your stroke was severe and it is difficult adjusting to a new lifestyle afterwards. But you have a good chance of getting over these feelings with treatment (usually with

 

 

 

 

 

antidepressant
Antidepressants are medicines used to treat depression and sometimes other conditions. They work by changing the levels of chemicals in your brain called neurotransmitters. There are three main types of antidepressants, which work in different ways: selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).

 

 

 

 

 

antidepressants).

Most people recover from depression within a year after their stroke.

To learn more about depression and how to recover from it, see our section on depression.

Not surprisingly, it's also common to feel very emotional in the year after a stroke. About 1 in 5 people find it hard to control their emotions and may burst out crying or may laugh uncontrollably for no reason.

 

 

 

 

 

Source:
Warlow CP, Dennis MS, van Gijn J, et al.
Treatment of primary intracerebral haemorrhage.
In: Warlow CP, Dennis MS, van Gijn J, et al (editors). Stroke: a practical guide to management. Blackwell Science, London, UK; 1996.

 

 

 

 

 

⁵ Very often these outbursts are triggered by other people, for example, if someone asks how things are going. You may want to ask your doctor about treatment if this happens to you.

It's quite safe to have sex after a stroke. But, understandably, many people who have had a stroke and their spouses feel less like having sex, and many stop having sex altogether.

 

 

 

 

 

Source:
Korpelainen JT, Nieminen P, Myllyla W.
Sexual functioning among stroke patients and their spouses.
Stroke. 1999; 30: 715-719.

 

 

 

 

 

¹⁴

 

 

 

 

 

Source:
Korpelainen JT, Kauhanen ML, Kemola H, et al.
Sexual dysfunction in stroke patients.
Acta Neurologica Scandinavica. 1998; 98: 400-405.

 

 

 

 

 

¹⁵ Part of the problem may be due to loss of feeling in one half of the body, although a stroke may simply turn some people off talking about and having sex. Sexual therapy may help you find ways of enjoying sex again.

If you have had a stroke, you are at risk of developing a number of health problems. These are not caused by the stroke itself, but may happen because the stroke has left you vulnerable in some way. Many of these complications can be prevented if you get good care in the hospital and afterward, but it is still a good idea to be aware of the health problems that could come up. To learn more, see Possible health problems after a stroke.

A stroke affects many people, not just the person who's had the stroke. Husbands and wives of people who have had a stroke are especially affected, but other relatives may also feel the strain.

Caring for someone who has had a stroke can be physically and emotionally draining.

 

 

 

 

 

Source:
Kerr SM, Smith LN.
Stroke: an exploration of the experience of informal caregiving.
Clinical Rehabilitation. 2001; 15: 428-436.

 

 

 

 

 

¹⁶ Caregivers may have to help with dressing, feeding and washing, and they will have to change their own lifestyles to be able to do all these things. Many caregivers choose to stop working and very often what they do is not appreciated by the patient. This is because patients are often not aware of what the caregiver is doing or because they are depressed as a result of the stroke.

Caregivers most often complain about not getting enough sleep and feeling isolated.

 

 

 

 

 

Source:
Greveson GC, Gray CS, French JM, et al.
Long-term outcome for patients and carers following hospital admission for stroke.
Age and Ageing. 1991; 20: 337-344.

 

 

 

 

 

¹⁷ To avoid becoming ill themselves it's important for caregivers to recognize they may not be able to do everything themselves. They may need to get extra help at home or arrange respite care (this is when someone else takes over looking after the patient so that the caregivers can have a break).

Support groups for caregivers can help make them feel less isolated. Support groups may also be able to put caregivers in touch with organizations that can help them out at home. Ask your doctor for help if you are having difficulties as a caregiver. Don't let your own health be damaged.

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