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Strokes affect people in different ways. If you have a stroke you may not be able to move one side of your body, or you may have difficulty speaking or swallowing.

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:

• Feel weak on one side of your body. If you can't move one side at all, doctors say you have a right-sided paralysis or a left-sided paralysis.
• Can't feel anything on one side of your body. One side may feel numb.
• Have trouble speaking or understanding what is being said.
• Can't see out of one or both eyes. You may have gaps in what you can see or you may see double.
• Feel dizzy, feel unsteady and have trouble walking.
• Have difficulty swallowing.
• Have a severe headache, either on its own or together with some of the symptoms mentioned above. Many patients describe these headaches as the worst headaches of their lives.

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:

• Your left arm or leg may be paralyzed
• You may have problems getting washed and dressed or understanding directions.

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:

• Your right arm or leg may be paralyzed
• You may have problems with reading, writing or speaking
• You may have problems understanding what is being said.

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:

• You may have difficulty speaking and swallowing
• You may see double and feel nauseated
• You may not be able to breathe automatically or keep your heart beating automatically.

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:

• You may have problems with coordination
• You may have problems with your balance
• You'll probably feel dizzy and nauseated.

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).

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 100.¹

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.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.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.³

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

• If you have had a severe stroke and there's swelling in your brain, your symptoms are more likely to get worse before they get better.⁴
• If you have high blood pressure, diabetes, signs of brain damage or you're older, your symptoms are also likely to get worse before they get better.⁵

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.^{5 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:

• How severe your stroke was
• Where in the brain it happened
• What treatment you've had
• How much of the brain has been damaged.

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

• Paralysis can disrupt your life, making even the most basic activities a problem. You may have difficulty eating, dressing, washing and using the bathroom.
• Nearly half of all people who have a stroke develop weakness in the muscles of their face, making eating and sometimes speaking difficult.
• Nearly half of those people who've had a stroke have weakness in the muscles of their legs, which may make walking difficult or even impossible.
• About half of all patients lose some functioning in their hand or arm, which can affect their ability to feed themselves, write or drive an automobile.⁵

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.^{8 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.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.¹⁰ Problems that don't get better will almost always improve, at least to some extent, with speech therapy.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.⁷

About half of all patients who are treated in the hospital for a stroke have difficulty swallowing.⁵ In one study, only 1 person out of 357 had swallowing difficulties that lasted more than six months after their stroke.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.⁶

There are three types of problem:

• Blindness in one eye (caused by a blood clot interrupting the blood flow)
• A blind spot in your vision. This happens when part of the brain that receives information from the eyes is affected. This means you may not be able to see all of something you're looking at. The blind spot is usually on either the left or right side of your field of vision and affects the sight in both eyes. This can cause problems in your daily activities, and you may not be able to drive an automobile.
• Seeing double (caused by a stroke in the brainstem).

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.^{8 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.

• About half of all patients who have a stroke have problems controlling their bladder at some time.¹⁰
• It's more common in older patients, in those with diabetes, and in those who have had a severe stroke.¹²
• But most people regain control of their bladder and bowels after a few weeks.¹³
• If you aren't able to control your bladder after a few days, it's often a sign that your recovery may not be good.¹²
• Incontinence can be very distressing for you, as well as your family. There are things that can help you if you are incontinent, so don't suffer in silence. If there's a problem, talk with your doctor.

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.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 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.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.^{14 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.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.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.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.