What if you have already had a stroke?


Immediate care

Ideally, you will be assessed quickly by a doctor. Commonly, a scan of the brain is organised as soon as possible. The aim of the scan is to confirm the diagnosis and to tell whether the stroke is an ischaemic or haemorrhagic stroke. This is very important to know, as the initial treatment of the two is very different.

If an ischaemic stroke is diagnosed and it has been less than four and a half hours since symptoms started, you may be given a medicine directly into a vein, called alteplase. This is a clot-busting medicine which aims to dissolve the blood clot. The medical word for this is thrombolysis. If the blood clot that caused the stoke can be dissolved shortly after symptoms begin, it can improve the eventual outcome. This is because brain cells that would have died are able to survive.

A plan for any other treatments should be devised and started as soon as possible. Treatments should be tailored to the particular need of the individual. The treatment plan can depend on factors such as the severity of the stroke, the effects it has, the cause of the stroke, and other diseases that may be present. Treatments that may be considered include the following:

Antiplatelet medication. Platelets are tiny particles in the blood which help blood to clot. Antiplatelet medication is usually advised if you have had an ischaemic stroke (due to a blood clot). Antiplatelet medication reduces the stickiness of platelets. This helps to prevent blood clots forming inside arteries, which helps to prevent a further stroke. Aspirin (low-dose) is the most commonly used antiplatelet medicine when the stroke has just happened. Another antiplatelet medicine, clopidogrel, is usually given long-term after the initial treatment.

If you are unable to swallow, you will be given food and fluids via a tube that is passed into your stomach. As mentioned earlier, a swallowing test is usually done early after being admitted to hospital.

Medication may be advised to reduce any risk factors for having a further stroke (as discussed later in this leaflet). For example, medication to lower a raised blood pressure, sugar level or cholesterol level.

If you have atrial fibrillation, you have an increased risk of a blood clot forming in a heart chamber and travelling to the brain to cause a stroke. If you have atrial fibrillation (or certain other heart conditions), a medicine called warfarin may be prescribed. Warfarin helps to prevent blood clots forming. Warfarin is an anticoagulant.

If you have carotid stenosis then you have an increased risk of having a stroke. Carotid stenosis means a narrowing of one of your carotid arteries, due to atheroma. If the narrowing is severe, you may be advised to have surgery to strip out the atheroma. Your doctor will advise if this is an option.

If you have a bleeding (haemorrhagic) stroke and are taking an anticoagulant medicine such as warfarin, treatment to reverse the effect of the anticoagulation is given.

If a subarachnoid haemorrhage is the cause of the stroke, an operation to fix the leaking blood vessel (artery) is sometimes an option.

Other operations are occasionally done. For example, sometimes surgery is considered to ease the pressure within the skull if the pressure becomes high following certain types of stroke.

As soon as possible after having a stroke you should be helped to sit up in bed and to get out of bed and move around if you are able to do so. This is to start the process of rehabilitation as soon as possible. Also, this reduces the risk of having a deep vein thrombosis (DVT) in a leg vein, which is a risk if you are inactive in bed for long periods.


Rehabilitation

The aim of rehabilitation is to maximise activity and quality of life following a stroke. Hospitals which deal with stroke patients have various specialists who help in rehabilitation. These include physiotherapists, occupational therapists, speech therapists, dieticians, psychologists, specialist nurses and doctors. One or more of these may be required, depending on how the stroke has affected you. Good-quality rehabilitation is vital following a stroke and can make a big difference to your eventual outcome.

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