Treatment after a stroke: What can you expect?

A stroke occurs every five minutes in the UK. Post-stroke treatment is critical to treating the lasting impact, but it’s also vital for reducing your odds of having a second stroke, as around 30% of stroke survivors will go on to have another one.

But what does treatment after a stroke look like, and what can you expect?

What causes a stroke?

There are two types of stroke: ischaemic and haemorrhagic, which affect the brain in different ways.

Ischaemic stroke: The most common type of stroke, ischaemic strokes happen when a blood clot blocks the flow of blood and oxygen to the brain. These clots can form when the arteries become narrowed or blocked by fatty deposits in a process called atherosclerosis.

Haemorrhagic stroke: Also known as cerebral or intracranial haemorrhages, these are less common than ischaemic strokes. They occur when a blood vessel inside the skull bursts, causing bleeding in and around the brain. They’re most commonly caused by high blood pressure, which makes the arteries in the brain more likely to rupture.s

What happens after a stroke?

Immediately after a stroke, you can expect to have several tests to confirm the diagnosis and identify the cause. These will include blood pressure tests, blood tests to check your cholesterol, brain scans and a swallow test.

A swallow test is simple but vital because if you can’t swallow properly, food and drink may get trapped in the windpipe and lungs. You’ll be given a few teaspoons of water to drink. If you can swallow without coughing or choking, you’ll be given a half-glass of water. If you struggle to swallow (dysphagia), you’ll be referred to a speech and language therapist, and you may need to be given nutrients intravenously or through a tube inserted in your stomach until you’ve been assessed.

You will also need immediate treatment after a stroke to restore blood flow to the brain and lower your blood pressure.

Treatment after a stroke

The exact treatment you will need after your stroke will depend on which type of stroke you’ve had.

Treatment for ischaemic strokes

The immediate priority after an ischaemic stroke is to dissolve the blood clots that caused it.

The procedure is called thrombolysis, which involves injecting a medicine called alteplase. It’s most effective if started no later than four-and-a-half hours after the stroke occurred.

You may also be offered other antiplatelet medication, such as aspirin, statins to reduce your cholesterol or an anticoagulant to reduce your risk of developing further blood clots and suffering a second stroke. Anticoagulants are commonly known as “blood thinners”, and whilst they don’t actually thin the blood, they do change its composition so that it doesn’t clot as easily.

Surgery is rarely needed after an ischaemic stroke, but in severe cases, a procedure called a carotid endarterectomy may be needed. The carotid artery is in the neck and carries blood to the brain. If this artery is narrowed by plaque build-up, it can cause a stroke, and surgery may be required to unblock it.

Treatment for haemorrhagic strokes

As with an ischaemic stroke, the immediate priority after a haemorrhagic stroke is to reduce the risk of another stroke, so you will be given medication to reduce your blood pressure.

If you’ve had this type of stroke and have previously taken anticoagulants, it’s vital that you get treatment to reverse the effects, as anticoagulants can worsen the bleeding.

Emergency surgery may be needed to relieve pressure on the brain and repair any burst blood vessels. Called a craniotomy, it involves removing a section of the skull to allow access to the brain. A surgeon will also check for blood clots that may be restricting blood flow. Once the bleeding has been stopped, the removed piece of skull is replaced by a metal plate.

There is a complication with this type of stroke called hydrocephalus, which is when fluid builds up in the brain and causes headaches, sickness, vomiting and balance issues. This can be treated by inserting a shunt (a tube) into the brain to drain the fluid.

Long-term stroke treatment and rehabilitation

A stroke can affect you in many ways. It can cause weakness or paralysis on one side of the body, preventing you from smiling, closing one eye or using an arm, and it may cause problems with your coordination and balance.

You might feel extremely fatigued and find it hard to sleep, making you even more tired.

Then there’s the psychological impact of a stroke. It’s not uncommon for people to experience intense feelings of hopelessness and anxiety, withdraw from social activities and feel anger and frustration at their situation.

Goal-oriented, patient-centred care is crucial for recovery, and it can take many forms.

Speech and language therapy after a stroke

After a stroke, it’s common for people to struggle with swallowing (dysphagia) or with communication.

Communication problems take two forms:

Aphasia: Where the parts of the brain responsible for language are damaged. People with aphasia often struggle to understand language and may have difficulty reading, writing and remembering the meanings of words.

Dysarthria: Where brain damage weakens the muscles involved in speech. People with dysarthria have no trouble determining what they want to communicate internally but struggle to convey what they want to say.

If you have dysphagia, aphasia or dysarthria after a stroke, speech and language therapy is vital. This may include:

• Modifying the texture of foods to enable safe intake orally
• Practising safe swallow strategies
• Strengthening the muscles in the face used to communicate
• Learning alternative methods of communicating (such as using aids or body language)

When you have this treatment after your stroke, you’ll usually see rapid improvements in the immediate weeks and months, but ongoing rehabilitation can yield results even years after the stroke.

Physiotherapy treatment after a stroke

Physiotherapy treatment is also a crucial part of your treatment plan. You can expect several sessions a week, focusing on exercises to improve your muscle strength. These are goal-oriented and will progressively become more challenging. For example, your first goal might be to pick up an object before gradually working towards standing and walking independently.

If you have problems with certain daily activities, such as getting dressed, working with an occupational therapist may be recommended to help you manage your difficulties and regain your independence.

Treatment after a stroke at St John & St Elizabeth Hospital

At St John & St Elizabeth Hospital in London, we work with patients, families and the wider multi-disciplinary team to support your rehabilitation.

Not only can you expect short-term respite care in our homely, 5-star accommodation, but you will also receive round-the-clock care, with daily visits and support from Consultants in multiple disciplines, including Ophthalmologists (eye), Urologists (kidneys and urinary function), Cardiologists (heart) and more.

Our goal is to get you back home as quickly as possible whilst providing the highest quality personalised treatment after a stroke.
If you’ve had a stroke and need treatment, the dedicated Consultants at our stroke rehabilitation facility can help you achieve a speedy recovery. Get in touch today to see how we can help.