Stroke | He mate ikura roro

The signs and symptoms of stroke usually come on suddenly. The type of signs experienced will depend on what area of the brain is affected.

Common first signs of stroke include 1 or more of the following:

• Face: sudden drooping, weakness and/or numbness of face
• Arm: sudden weakness of the arm (and/or leg)
• Speech: difficulty speaking, words jumbled or lost voice.

The T in F.A.S.T. represents the need to take action – if you think somebody might be having a stroke, call 111 immediately.

These symptoms are present in 85% of strokes.

Image credit: Stroke Foundation of New Zealand

Video: FAST campaign: Stroke Foundation of New Zealand 

(Stroke Foundation of NZ, 2018)

Watch this video in te Reo Māori.(external link)

Stroke Foundation NZ training on what a stroke is, how to recognise the key signs of stroke and how to give someone the best chance of recovery after a stroke is available through the F.A.S.T. Training and Workplace Toolkit.(external link)

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.
• 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.

Video: What is a stroke? 

(Health Sketch, UK, 2015)

Each year about 9,500 people in Aotearoa 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 are increasingly happening in younger adults. Māori and Pacific Peoples experience stroke about  10 to 15 years earlier than Europeans/pakeha. Strokes can even occur in children on rare occasions. 

About 75% of strokes are preventable, so check with your healthcare provider or pharmacist as to what your risk is and what you can do to reduce it.

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, lipids and glucose
• electrocardiogram and cardiac monitor or Holter monitor to check your heart rhythm
• possibly additional investigations, eg, MRI scan and additional blood tests for common causes of stroke..

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. In many cases, if treatment is received early enough, full recovery is possible. In most cases, some improvements occur with time and rehabilitation, particularly in the first 3 months – but even over a longer period

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. This is called acute stroke thrombolysis.
• A stroke clot retrieval procedure may be performed to remove a blood clot from an artery in your brain using a device put into the blood vessel by an interventional radiologist. This is called an endovascular thrombectomy. 
• Sometimes surgery is needed to treat brain swelling or help reduce further bleeding in cases of haemorrhagic strokes.

In the recovery phase:

• Medicine 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 healthcare provider or pharmacist about what you can do to lower this risk.

Key steps include:

• lowering cardiovascular risk factors such as high blood pressure or high cholesterol
• quitting smoking and/or avoiding second-hand smoke
• keeping your weight at a healthy level or reducing it if you are overweight
• increasing physical activity levels
• reducing your salt intake 
• reducing stress
• managing any anxiety or depression.

Read more about how to reduce your risk of stroke.

Fatigue (excessive tiredness) affects up to 92% of people who've 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:

• diabetes
• anaemia
• insomnia
• sleep apnoea
• thyroid problems
• depression
• medications that have fatigue as a side effect
• poor diet.

Talk to your healthcare provider

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:

• exercise regularly
• eat well
• drink plenty of water 
• sleep well
• avoid alcohol
• keep a diary on how much you are doing and discuss this with your healthcare provider
• 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.

Videos

Video: Know the Signs of a Stroke Think FAST – Dianna’s story

"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)

Video: Know the signs of a stroke think FAST – Kaumolangi’s story

"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." This video may take a few moments to load.

(Ministry of Health, NZ, 2017)

Video: Living well after stroke with Jacqui & Murray 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. 

(Health Navigator Charitable Trust, NZ, 2015)

Relearning Life – Jacqui Hynd's story(external link) Able Magazine, UK
Jacqui's website(external link) has more about her experiences, and videos on how she has learned to do things differently and maintain her independence after her stroke.
Videos: 1995 AVM Stroke survivor rise above the challenge(external link) Part 1 – Jacqui Hynd and Part 2(external link) 

Read

Read some personal stories(external link) on the Stroke Foundation New Zealand site.

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. Their community help(external link) page has many useful links to information, support and services. 

Community stroke navigators(external link) are available throughout most of Aotearoa 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.

Communicating after stroke(external link) Resources for Māori whānau affected by communication difficulties after stroke.

Family and stroke(external link) A new online support platform to help tamariki who have whānau who have experienced a stroke. This website is part of Stroke Foundation NZ.

New Zealand Sign Language videos about stroke, produced by Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, NZ.

These videos are NZSL translations of Healthify pages on stroke.

Stroke – overview

(Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, 2022)
Visit our stroke key points information.

What are the symptoms of a stroke?

(Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, 2022)
Visit our what are the symptoms of stroke information.

Who is at risk of having a stroke?

(Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, 2022)
Visit our who is at risk of having a stroke information.

How is a stroke diagnosed?

(Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, 2022)
Visit our how a stroke is diagnosed information.

What is the treatment for stroke?

(Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, 2022)
Visit our what is the treatment for stroke information.

How can I reduce my risk of stroke?

(Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, 2022)

Clinical pathways

The Australian and New Zealand clinical guidelines for stroke management(external link) Stroke Foundation, NZ, 2022

Other resources

Time is brain – emergency treatment of stroke – early assessment and management(external link) BPAC, NZ, 2010
Carotid stenting – a stroke of genius?(external link) IME Video Library – University of Wisconsin School of Medicine and Public Health, US, 2015   
The use of antithrombotic medicines in general practice(external link) BPAC, NZ, 2011
F.A.S.T. training and workplace toolkit(external link) Stroke Foundation NZ, 2022
New Zealand out-of-hospital acute stroke destination policy Northland and Auckland Areas(external link) 
He toto rere pai he tohu ora – Lower blood, pressure lower stroke risk and he tohu o te mate ikura roro – Signs of stroke(external link) This resource was adapted from Stroke Foundation NZ resources ‘Blood pressure’, ‘He toto rere pai’ (an old publication) and ‘See a stroke – FAST’ (to share with patients). 

Continuing professional development

Video: MHH – Strokes in the wild

You can watch the video, answer questions and claim hours with a certificate. 

Other

• Acute stroke management(external link) (Mobile Health, NZ, 2020)
• Stroke and TIA clinical update(external link) (Goodfellow Unit Webinar, NZ, 2020)
• Managing common neurological conundrums(external link) (Goodfellow Unit Webinar, 2020)
• Neurology updates(external link) Interactive cases, including neuromuscular and stroke – Dr Anna Ranta (36 minutes) (PHARMAC Seminars, NZ, 2019)
• Heart attack & stroke – getting the blood flowing again (external link)(University of Auckland, NZ, 2018)
• Stroke – devastating but preventable(external link) Goodfellow Unit Webinar, 2022