Stroke refers to a sudden interruption of the blood supply to your brain, which can cause permanent damage. There are different types of stroke, described by the Stroke Foundation NZ as follows:
Ischaemic stroke: This is the most common type of stroke. An ischaemic stroke occurs when a clot blocks an artery in the brain. Some strokes are caused when a clot forms in a small blood vessel inside the brain that has become narrowed through high blood pressure, high cholesterol, diabetes or smoking (lacunar stroke). Some strokes are caused when a clot forms outside the brain (eg, the carotid artery or the heart) then breaks off and travels in the bloodstream to block an artery to the brain itself (embolic stroke). A common cause for carotid artery clot is atherosclerosis (build up of cholesterol and calcium deposits). A clot in the heart can be caused by some heart conditions such as atrial fibrillation.
Embolic stroke: This occurs when a blood clot or piece of plaque (cholesterol or calcium deposits) on the wall of an artery breaks loose and travels to the brain. When this happens, the flow of oxygen-rich blood to the brain is blocked and tissue is damaged or dies.
Haemorrhagic stroke: This occurs when an artery in the brain ruptures (bursts) and leaks blood into the brain (cerebral haemorrhage). This break in the blood pipeline means parts of the brain are deprived of blood and a stroke occurs. Blood irritates brain tissue, causing swelling and pressure, which cause further damage and loss of function. Subarachnoid haemorrhage (SAH) is when blood leaks into the surface of the brain. Intracranial haemorrhage (ICH) is when there is bleeding into the brain tissue itself.
Each year about 9,000 people in New Zealand have a stroke. Strokes are more common as you get older, with 76% of strokes occurring in people over the age of 65 years. However, they can occur in younger adults and even children on rare occasions.
About 80% of strokes are preventable, so check with your doctor, nurse or pharmacist as to what your risk is and what you can do to reduce it.
Check your risk with the Stroke Riskometer app developed by the Auckland University of Technology, NZ, 2015.
To diagnose a stroke, ambulance and medical teams will ask you a series of questions. These will be about your symptoms, when they started, whether you have any other health conditions, etc. They will also use some standard assessment tools to help assess how urgently you need treatment.
If a stroke is suspected, further tests will be done, such as:
blood tests to check your full blood count, electrolytes, renal function tests, fasting lipids, erythrocyte sedimentation rate and/or C-reactive protein and glucose
These tests should be performed as soon as possible after a stroke. In some cases they may need to be performed as an emergency procedure.
The symptoms you have in the first few days after a stroke may not last forever. If your symptoms are going to improve, they usually do so in the first 2 months after you have a stroke. In many cases, if treatment is received early enough, full recovery is possible.
Early treatment is critical
Time is brain – meaning every minute counts and the longer brain cells are without oxygen, the more damage that is done. If treatment is started within a few hours, more brain cells can be saved.
Where possible, stroke patients are now treated within specialist stroke units. In most cases, treatment includes medication, rehabilitation and lifestyle changes.
In the acute phase:
Medicine may be given intravenously to help dissolve blood clots (acute stroke thrombolysis).
Sometimes surgery is needed to treat brain swelling or help reduce further bleeding in cases of haemorrhagic strokes.
In the recovery phase:
Medication is given to lower blood pressure and reduce cholesterol levels.
Depending on the type of stroke and parts of the body affected, a range of rehabilitation support may be needed for weeks to months.
Rehabilitation support can range from speech and language therapy to physical therapy and work retraining.
Lifestyle changes are also needed as above to improve diet and exercise levels, support quitting smoking, managing stress and more.
If you are at higher risk of having a stroke or have had one, talk with your doctor, nurse or pharmacist about what you can do to lower this risk.
Fatigue (excessive tiredness) affects up to 92% of people who have had a stroke. It's normal to get tired after a busy day or not sleeping well the night before. This usually gets better after a good night's rest.
However, fatigue after stroke is an excessive tiredness that will not go away even after a good rest or sleep. You may feel constantly worn out, or have no energy to carry out usual daily activities.
Causes of fatigue after stroke
It is unclear why you get excessive tiredness after experiencing a stroke. It could be caused by a combination of factors, such as:
brain damage due to stroke
stress after having a stroke
difficulty adjusting to your new life situation.
There are also a number of medical problems that could contribute to excessive tiredness after stroke. These include:
medications that have fatigue as a side effect
See your doctor if you have excessive tiredness after stroke so that they can check if you have any of these medical problems.
Top tips to cope with fatigue after stroke
There are a number of things you can do to help cope with excessive tiredness after a stroke. These include to:
drink plenty of water
keep a diary on how much you are doing and discuss this with your doctor
do regular activities in a day
ask for help when you need it.
Here are a few personal stories about individuals who have been through stroke. Despite the mountain of troubles and problems caused by stroke, these courageous people continue to live joyful and productive lives.
"Dianna, a health worker who is Ngāpuhi, experienced a stroke one morning. Fortunately she knew the signs and got help fast. Because of this she has recovered well. Dianna knew she was at risk, given she was a long time smoker and overweight. She has made some changes now, and that day she had her last cigarette."
(Ministry of Health, NZ, 2018)
"Father of five children and just 29 years old, Kaumolangi had a stroke. Thanks to his mother in law, who knew the signs of a stroke and acted fast, he has fully recovered. Think FAST - FACE drooping, ARM weakness. SPEECH difficulty, TIME to call 111."
(Ministry of Health, NZ, 2017)
Daphne suffered a stroke and was in hospital for nine weeks. She was determined to go home and with the support of Southern DHB, she was able to. Watch Daphne’s story to find out more about her patient journey through Southern DHB.
(Southern DHB, NZ, 2018)
Viewpoint of a stroke survivor
Stroke survivor Rob provides a quick insight into his life and his use of Stroke Foundation of New Zealand services.
(Stroke Foundation of NZ, 2015)
My stroke, my inspiration – Jacqui Hynd
Murray and Jacqui Hynd's lives changed dramatically after Jacqui had a severe stroke in 1995. They talk about their new approach and outlook toward life, the importance of a sense of humour, maintaining new and exciting challenges and more.
Like many of us, Rukingi worked 24/7, pushing himself at the expense of his health. Unfortunately, Rukingi’s experience reinforces the horrifying statistics that pin the average age of stroke occurrence in Maori to 56 years old – a conspicuous 15 years earlier than Pakeha.
(Faultline Films, NZ, 2010)
(Faultline Films, NZ, 2010)
(Faultline Films & Te Mangai Paho, NZ, 2010)
Inspire – Rise above the challenge – Jacqui Hynd
"Rehab participation: Jacqui turns disability into capability."
If you or someone you know has had a stroke, visit Stroke Foundation of NZ(external link) 0800 STROKE (0800 78 76 53). The Stroke Foundation provides a wide range of support, including support groups and educational resources.
Community Stroke Advisors(external link) are available throughout most of New Zealand to work with stroke survivors, their family, whānau and carers. Their role ensures people achieve the best possible outcome after stroke. This service is free.
Many resources below are from the Stroke Foundation of NZ. Most of them can be downloaded as pdf files. To order paper copies, email email@example.com or phone 0800 78 76 53. They will be delivered free within New Zealand.
Life after stroke – book(external link) The essential information resource for people with a stroke, their families and caregivers. (Available as a 208 page spiral bound paperback or as an ePub download.)
Slash the salt(external link) Information on the risks of eating too much salt and ways of cutting back on it. Contains a detachable wallet card to help you choose lower-salt foods.
Intimacy after stroke(external link) A stroke may slightly change this side of your relationship, but try to be positive about it. Here are some tips about how a stroke can actually reignite the spark between you and your partner.
Coping with stress(external link) Information about the signs and symptoms of stress. Tips about how to cope with stress and maintain a positive outlook on life after a stroke.
Stroke and medication(external link)This 4-page fact sheet is about medication prescribed to reduce your risk of stroke, and after a stroke or TIA (transient ischaemic attack, ‘mini-stroke’, warning stroke).
Driving after stroke(external link) Information about driving assessment and starting to drive again after a stroke. Some people may not be able to drive again, but there are plenty of transport alternatives.