Health A to Z
A stroke is a serious life-threatening medical condition that occurs when the blood supply to part of the brain is cut off.
Strokes are a medical emergency and urgent treatment is essential.
The sooner a person receives treatment for a stroke, the less damage is likely to happen.
If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.
The main symptoms of stroke can be remembered with the word F.A.S.T.:
Read about the symptoms of a stroke.
Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain injury, disability and possibly death.
There are two main causes of strokes:
There's also a related condition known as a transient ischaemic attack (TIA), where the blood supply to the brain is temporarily interrupted.
This causes what's known as a mini-stroke, often lasting between a few minutes and several hours.
TIAs should be treated urgently, as they're often a warning sign you're at risk of having a full stroke in the near future. Seek medical advice as soon as possible, even if your symptoms resolve.
Certain conditions increase the risk of having a stroke, including:
Read about the causes of strokes.
Treatment depends on the type of stroke you have, including which part of the brain was affected and what caused it.
Strokes are usually treated with medication. This includes medicines to prevent and dissolve blood clots, reduce blood pressure and reduce cholesterol levels.
In some cases, procedures may be required to remove blood clots. Surgery may also be required to treat brain swelling and reduce the risk of further bleeding in cases of haemorrhagic strokes.
People who survive a stroke are often left with long-term problems caused by injury to their brain.
Some people need a long period of rehabilitation before they can recover their former independence, while many never fully recover and need support adjusting to living with the effects of their stroke.
Local authorities should provide free reablement services for anyone assessed as needing them. These services help the person recovering from a stroke to learn or relearn the skills necessary for independent daily living at home.
Some people will be dependent on some form of care for help with their daily activities. For example, a care worker could come to the person's home to help with washing and dressing, or to provide companionship.
If you're recovering from a stroke or caring for someone who is, it may be useful to read your guide to care and support. This is written for people with care and support needs, as well as their carers and relatives.
You can significantly reduce your risk of having a stroke through leading a healthy lifestyle by:
If you have a condition that increases your risk of a stroke, it's important to manage it effectively – for example, by lowering high blood pressure or cholesterol levels with medication.
If you've had a stroke or TIA in the past, these measures are particularly important because your risk of having another stroke is greatly increased.
Read more about preventing strokes.
Stroke doesn't just affect adults. Every year around 400 children in the UK will have a stroke, according to the Stroke Association.
Read more about childhood stroke on the Stroke Association website.
If you suspect you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.
Even if the symptoms disappear while you're waiting for the ambulance, it's still important to go to hospital for an assessment.
After an initial assessment, you may need to be admitted to hospital for a more in-depth assessment. Specialist treatment may also begin if this is necessary.
Symptoms of a stroke that disappear quickly and in less than 24 hours may mean you had a transient ischaemic attack (TIA). These symptoms should also be treated as a medical emergency to reduce the chances of having another stroke.
The signs and symptoms of a stroke vary from person to person, but usually begin suddenly.
As different parts of your brain control different parts of your body, your symptoms will depend on the part of your brain affected and the extent of the damage.
The main stroke symptoms can be remembered with the word F.A.S.T.:
It's important for everyone to be aware of these signs and symptoms, particularly if you live with or care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure.
Symptoms in the F.A.S.T. test identify most strokes, but occasionally a stroke can cause different symptoms.
Other symptoms and signs may include:
However, there may be other causes for these symptoms.
The symptoms of a TIA, also known as a mini-stroke, are the same as a stroke, but tend to only last between a few minutes and a few hours before disappearing completely.
Although the symptoms do improve, a TIA should never be ignored as it's a serious warning sign of a problem with the blood supply to your brain. It means you're at an increased risk of having a stroke in the near future.
If you've had a TIA, contact your GP, local hospital or out-of-hours service as soon as possible.
There are two main types of stroke – ischaemic strokes and haemorrhagic strokes. They affect the brain in different ways and can have different causes.
Ischaemic strokes are the most common type of stroke. They occur when a blood clot blocks the flow of blood and oxygen to the brain.
These blood clots typically form in areas where the arteries have been narrowed or blocked over time by fatty deposits known as plaques. This process is known as atherosclerosis.
As you get older, the arteries can naturally narrow, but certain things can dangerously accelerate the process.
Another possible cause of ischaemic stroke is a type of irregular heartbeat called atrial fibrillation. This can cause blood clots in the heart that break up and escape from the heart, and become lodged in the blood vessels supplying the brain.
Haemorrhagic strokes – also known as cerebral haemorrhages or intracranial haemorrhages – are less common than ischaemic strokes. They occur when a blood vessel within the skull bursts and bleeds into and around the brain.
The main cause of haemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain and make them prone to split or rupture.
Things that increase the risk of high blood pressure include:
Haemorrhagic strokes can also occur as the result of the rupture of a balloon-like expansion of a blood vessel (brain aneurysm) or abnormally formed blood vessels in the brain.
It's not possible to completely prevent strokes because some things that increase your risk of the condition can't be changed, including:
However, it's possible to significantly reduce your risk of having a stroke by making lifestyle changes to avoid problems such as atherosclerosis and high blood pressure.
Read about preventing strokes.
Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan.
When you first arrive at hospital with a suspected stroke, the doctor will want to find out as much as they can about your symptoms.
A number of tests can be carried out to help confirm the diagnosis and determine the cause of the stroke.
This may include:
Even if the physical symptoms of a stroke are obvious, brain scans should also be carried out to determine:
Everyone with suspected stroke should receive a brain scan within an hour of arriving at hospital.
An early brain scan is especially important in those who:
This is why a stroke is a medical emergency and 999 should be dialled when a stroke is suspected – there isn't time to wait for a GP appointment.
The two main types of scan used to assess the brain in people who have had a suspected stroke are:
A CT scan is like an X-ray, but uses multiple images to build up a more detailed, three-dimensional picture of your brain to help your doctor identify any problem areas.
During the scan, you may be given an injection of a special dye into one of the veins in your arm to help improve the clarity of the CT image and look at the blood vessels that supply the brain.
If it's suspected you're experiencing a major stroke, a CT scan is usually able to show whether you've had an ischaemic stroke or a haemorrhagic stroke. It's generally quicker than an MRI scan and can mean you're able to receive appropriate treatment sooner.
An MRI scan uses a strong magnetic field and radio waves to produce a detailed picture of the inside of your body.
It's usually used in people with more complex symptoms, where the extent or location of the damage is unknown. It's also used in people who have recovered from a transient ischaemic attack (TIA).
This type of scan provides greater detail of brain tissue, allowing smaller, or more unusually located areas, affected by a stroke to be identified.
As with a CT scan, special dye can be used to improve MRI scan images.
A swallow test is essential for anybody who has had a stroke, as swallowing ability is commonly affected early after having a stroke.
The test is simple. The person is given a few teaspoons of water to drink. If they can swallow this without choking and coughing, they'll be asked to swallow half a glass of water.
If they have any difficulty swallowing, they'll be referred to the speech and language therapist for a more detailed assessment.
They usually won't be allowed to eat or drink normally until they've seen the therapist. Fluids or food may need to be given directly into a vein in the arm (intravenously) or through a tube inserted into their stomach via their nose.
Further tests on the heart and blood vessels might be carried out later to confirm what caused your stroke. Some of the tests that may be carried out are described below.
A carotid ultrasound scan can help show if there's any narrowing or blockages in the neck arteries leading to your brain.
An ultrasound scan involves using a small probe (transducer) to send high-frequency sound waves into your body. When these sound waves bounce back, they can be used to create an image of the inside of your body.
When carotid ultrasonography is needed, it should happen within 48 hours.
An echocardiogram may be carried out to produce images of your heart and check for any problems that could be related to your stroke.
This normally involves moving an ultrasound probe across your chest (transthoracic echocardiogram).
An alternative type of echocardiogram called transoesophageal echocardiography (TOE) may sometimes be used.
An ultrasound probe is passed down your gullet (oesophagus), usually under sedation. As this allows the probe to be placed directly behind the heart, it produces a clear image of blood clots and other abnormalities that may not get picked up by a transthoracic echocardiogram.
If you've had an ischaemic stroke, a combination of medications to treat the condition and prevent it happening again is usually recommended.
Some of these medications need to be taken immediately and only for a short time, while others may only be started once the stroke has been treated and may need to be taken long term.
Ischaemic strokes can often be treated using injections of a medication called alteplase, which dissolves blood clots and restores blood flow to the brain. This use of "clot-busting" medication is known as thrombolysis.
Alteplase is most effective if started as soon as possible after the stroke occurs. It isn't generally recommended if more than 4.5 hours have passed, as it's not clear how beneficial it is when used after this time.
Before alteplase can be used, it's very important that a brain scan is carried out to confirm a diagnosis of an ischaemic stroke. This is because the medication can make the bleeding that occurs in haemorrhagic strokes worse.
A small proportion of severe ischaemic strokes can be treated by an emergency procedure known as thrombectomy. This removes blood clots and helps restore blood flow to the brain.
Thrombectomy is only effective at treating ischaemic strokes caused by a blood clot in a large artery in the brain. It's most effective when started as soon as possible after a stroke.
The procedure involves inserting a catheter into an artery, often in the groin. A small device is passed through the catheter into the artery in the brain.
The blood clot can then be removed using the device, or through suction. The procedure can be carried out under local or general anaesthetic.
Most people will be offered a regular dose of aspirin. As well as being a painkiller, aspirin is an antiplatelet, which reduces the chances of another clot forming.
In addition to aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.
Some people may be offered an anticoagulant to help reduce their risk of developing further blood clots in the future.
Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots occurring.
Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants for long-term use.
There are also a number of anticoagulants called heparins that can only be given by injection and are used short term.
Anticoagulants may be offered if you:
If your blood pressure is too high, you may be offered medicines to lower it.
Medicines that are commonly used include:
Read more about treating high blood pressure.
If the level of cholesterol in your blood is too high, you'll be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking a chemical (enzyme) in the liver that produces cholesterol.
You may be offered a statin even if your cholesterol level isn't particularly high, as it may help reduce your risk of stroke whatever your cholesterol level is.
Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.
If the carotid stenosis is particularly severe, surgery may be offered to unblock the artery. This is done using a surgical technique called a carotid endarterectomy. It involves the surgeon making a cut (incision) in your neck to open up the carotid artery and remove the fatty deposits.
As with ischaemic strokes, some people who have had a haemorrhagic stroke will also be offered medication to lower their blood pressure and prevent further strokes.
If you were taking anticoagulants before you had your stroke, you may also need treatment to reverse the effects of the medication and reduce your risk of further bleeding.
Occasionally, emergency surgery may be needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.
During a craniotomy, a section of the skull is cut away to allow the surgeon access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain.
After the bleeding has been stopped, the piece of bone removed from the skull is replaced, often by an artificial metal plate.
Surgery can also be carried out to treat a complication of haemorrhagic strokes called hydrocephalus.
This is where damage resulting from a stroke causes cerebrospinal fluid to build up in the cavities (ventricles) of the brain, causing symptoms such as headaches, sickness, drowsiness, vomiting and loss of balance.
Hydrocephalus can be treated by surgically placing an artificial tube called a shunt into the brain to allow the fluid to drain properly.
Read more about treating hydrocephalus.
As well as the treatments mentioned above, you may also need further short-term treatment to help manage some of the problems that can affect people who have had a stroke.
For example, you may require:
Read more about recovering from a stroke.
The National Stroke Strategy, published in December 2007, provides a guide to high-quality health and social care for those affected by stroke.
Stroke experts have set out standards that define good stroke care, including:
The National Institute for Health and Care Excellence (NICE) has also produced guidelines on the diagnosis and management of stroke and a quality standard for stroke that describes the level of care the NHS is working towards.
If you're concerned about the standard of care provided, speak to your stroke specialist or a member of the stroke team.
Two of the most common psychological problems that can affect people after a stroke are:
Feelings of anger, frustration and bewilderment are also common.
You'll receive a psychological assessment from a member of your healthcare team soon after your stroke to check if you're experiencing any emotional problems.
Advice should be given to help deal with the psychological impact of stroke. This includes the impact on relationships with other family members and any sexual relationship.
There should also be a regular review of any problems of depression and anxiety, and psychological and emotional symptoms generally.
These problems may settle down over time, but if they are severe or last a long time, GPs can refer people for expert healthcare from a psychiatrist or clinical psychologist.
For some people, medicines and psychological therapies, such as counselling or cognitive behavioural therapy (CBT), can help. CBT is a therapy that aims to change the way you think about things to produce a more positive state of mind.
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Cognitive is a term used by scientists to refer to the many processes and functions our brain uses to process information.
One or more cognitive functions can be disrupted by a stroke, including:
As part of your treatment, each one of your cognitive functions will be assessed and a treatment and rehabilitation plan will be created.
You can be taught a wide range of techniques that can help you relearn disrupted cognitive functions, such as recovering your communication skills through speech and language therapy.
There are many ways to compensate for any loss of cognitive function, such as using memory aids, diaries and routines to help plan daily tasks.
Most cognitive functions will return after time and rehabilitation, but you may find they don't return to the way they were before.
The damage a stroke causes to your brain also increases the risk of developing vascular dementia. This may happen immediately after a stroke or may develop some time after the stroke occurred.
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Strokes can cause weakness or paralysis on one side of the body, and can result in problems with co-ordination and balance.
Many people also experience extreme tiredness (fatigue) in the first few weeks after a stroke, and may also have difficulty sleeping, making them even more tired.
As part of your rehabilitation, you should be seen by a physiotherapist, who will assess the extent of any physical disability before drawing up a treatment plan.
Physiotherapy will often involve several sessions a week, focusing on areas such as exercises to improve your muscle strength and overcome any walking difficulties.
The physiotherapist will work with you by setting goals. At first, these may be simple goals, such as picking up an object. As your condition improves, more demanding long-term goals, such as standing or walking, will be set.
A careworker or carer, such as a member of your family, will be encouraged to become involved in your physiotherapy. The physiotherapist can teach you both simple exercises you can carry out at home.
If you have problems with movement and certain activities, such as getting washed and dressed, you may also receive help from an occupational therapist. They can find ways to manage any difficulties.
Occupational therapy may involve adapting your home or using equipment to make everyday activities easier, and finding alternative ways of carrying out tasks you have problems with.
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After having a stroke, many people experience problems with speaking and understanding, as well as reading and writing.
If the parts of the brain responsible for language are damaged, this is called aphasia, or dysphasia. If there is weakness in the muscles involved in speech as a result of brain damage, this is known as dysarthria.
You should see a speech and language therapist as soon as possible for an assessment and to start therapy to help you with your communication.
This may involve:
Read more about treating aphasia.
You can also read our guide on caring and communication difficulties.
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The damage caused by a stroke can interrupt your normal swallowing reflex, making it possible for small particles of food to enter your windpipe.
You may need to be fed using a feeding tube during the initial phases of your recovery to prevent any complications from dysphagia.
The tube is usually put into your nose and passed into your stomach (nasogastric tube), or it may be directly connected to your stomach in a minor surgical procedure carried out using local anaesthetic (percutaneous endoscopic gastrostomy, or PEG).
In the long term, you'll usually see a speech and language therapist several times a week for treatment to manage your swallowing problems.
Treatment may involve tips to make swallowing easier, such as taking smaller bites of food and advice on posture, and exercises to improve control of the muscles involved in swallowing.
Read more about treating dysphagia.
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Stroke can sometimes damage the parts of the brain that receive, process and interpret information sent by the eyes.
This can result in losing half the field of vision – for example, only being able to see the left- or righthand side of what's in front of you.
Strokes can also affect the control of the movement of the eye muscles. This can cause double vision.
If you have any problems with your vision after a stroke, you'll be referred to an eye specialist called an orthoptist, who can assess your vision and suggest possible treatments.
For example, if you've lost part of your field of vision, you may be offered eye movement therapy. This involves exercises to help you look to the side with the reduced vision.
You may also be given advice about particular ways to perform tasks that can be difficult if your vision is reduced on one side, such as getting dressed.
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Some strokes damage the part of the brain that controls bladder and bowel movements. This can result in urinary incontinence and difficulty with bowel control.
Some people may regain bladder and bowel control quite quickly, but if you still have problems after leaving hospital, help is available from the hospital, your GP, and specialist continence advisers.
Don't be embarrassed – seek advice if you have a problem, as there are lots of treatments that can help.
Read more about treating urinary incontinence.
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Having sex won't put you at higher risk of having a stroke. There's no guarantee you won't have another stroke, but there's no reason why it should happen while you're having sex.
Even if you've been left with a severe disability, you can experiment with different positions and find new ways of being intimate with your partner.
Be aware that some medications can reduce your sex drive (libido), so make sure your doctor knows if you have a problem – there may be other medicines that can help.
Some men may experience erectile dysfunction after having a stroke. Speak to your GP or rehabilitation team if this is the case, as there are a number of treatments available that can help.
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If you've had a stroke or TIA, you can't drive for one month. Whether you can return to driving depends on what long-term disabilities you may have and the type of vehicle you drive.
It's often not physical problems that can make driving dangerous, but problems with concentration, vision, reaction time and awareness that can develop after a stroke.
Your GP can advise you on whether you can start driving again a month after your stroke, or whether you need further assessment at a mobility centre.
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If you've had a stroke, your chances of having another one are significantly increased.
You'll usually require long-term treatment with medications aimed at improving the underlying risk factors for your stroke.
You'll also be encouraged to make lifestyle changes to improve your general health and lower your stroke risk, such as:
Read more about preventing strokes.
There are many ways you can provide support to a friend or relative who's had a stroke to speed up their rehabilitation process.
Caring for somebody after a stroke can be a frustrating and lonely experience. The advice outlined below may help.
Someone who's had a stroke can often seem as though they've had a change in personality and appear to act irrationally at times. This is the result of the psychological and cognitive impact of a stroke.
They may become angry or resentful towards you. Upsetting as it may be, try not to take it personally.
It's important to remember they'll often start to return to their old self as their rehabilitation and recovery progresses.
Rehabilitation can be a slow and frustrating process, and there will be periods of time when it appears little progress has been made.
Encouraging and praising any progress, no matter how small it may appear, can help motivate someone who's had a stroke to achieve their long-term goals.
If you're caring for someone who's had a stroke, it's important not to neglect your own physical and psychological wellbeing. Socialising with friends or pursuing leisure interests will help you cope better with the situation.
There are a wide range of support services and resources available for people recovering from strokes, and their families and carers. This ranges from equipment that can help with mobility, to psychological support for carers and families.
The hospital staff involved with the rehabilitation process can provide advice and relevant contact information.
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The best way to help prevent a stroke is to eat a healthy diet, exercise regularly, and avoid smoking and drinking too much alcohol.
These lifestyle changes can reduce your risk of problems like:
If you've already had a stroke, making these changes can help reduce your risk of having another one in the future.
An unhealthy diet can increase your chances of having a stroke because it may lead to an increase in your blood pressure and cholesterol levels.
A low-fat, high-fibre diet is usually recommended, including plenty of fresh fruit and vegetables (5 A DAY) and wholegrains.
Ensuring a balance in your diet is important. Don't eat too much of any single food, particularly foods high in salt and processed foods.
You should limit the amount of salt you eat to no more than 6g (0.2oz) a day as too much salt will increase your blood pressure. Six grams of salt is about one teaspoonful.
Combining a healthy diet with regular exercise is the best way to maintain a healthy weight. Regular exercise can also help lower your cholesterol and keep your blood pressure healthy.
For most people, at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week is recommended.
If you're recovering from a stroke, you should discuss possible exercise plans with the members of your rehabilitation team.
Regular exercise may not be possible in the first weeks or months after a stroke, but you should be able to begin exercising once your rehabilitation has progressed.
Read more about health and fitness.
Smoking significantly increases your risk of having a stroke. This is because it narrows your arteries and makes your blood more likely to clot.
You can reduce your risk of having a stroke by stopping smoking. Not smoking will also improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease.
The NHS Smoking Helpline can offer advice and encouragement to help you quit smoking. Call 0300 123 1044, or visit NHS Smokefree.
Read more about stopping smoking.
Excessive alcohol consumption can lead to high blood pressure and trigger an irregular heartbeat (atrial fibrillation), both of which can increase your risk of having a stroke.
Because alcoholic drinks are high in calories, they also cause weight gain. Heavy drinking multiplies the risk of stroke by more than three times.
If you choose to drink alcohol and have fully recovered, you should aim not to exceed the recommended limits:
If you haven't fully recovered from your stroke, you may find you've become particularly sensitive to alcohol and even the recommended safe limits may be too much for you.
Read more about drinking and alcohol.
If you've been diagnosed with a condition known to increase your risk of stroke, ensuring the condition is well controlled is also important in helping prevent strokes.
The lifestyle changes mentioned above can help control these conditions to a large degree, but you may also need to take regular medication.
For more information, see:
Jim Whyte was forced to give up work after having a stroke, but he's proved there is life after stroke.
Jim was getting out of a van when he suddenly felt his left leg turn to jelly. "I fell down, and my workmates got me a chair," he says.
"They brought me a cup of tea, but I couldn't work out where the handle was to grasp it. Somehow I knew I'd had a stroke, and asked them to take me to hospital.
"By the time I got there, I didn't have any feeling in the left side of me. I felt like a lump of meat. I could hardly get out of the car."
Doctors confirmed Jim was right, he'd had a stroke. He spent the next 27 weeks in hospital undergoing rehabilitation and physiotherapy.
"Luckily, my speech was still all right, though I'm sure my kids and grandchildren sometimes wish I'd be quiet!" he says. "During my time in hospital I regained around 85% use of my hand and arm. I'm actually very lucky."
Jim had high blood pressure and was diabetic, which are both risk factors for stroke. But he'd never smoked and, because of his diabetes, was already following the healthy diet recommended for stroke survivors. "My wife was a chef and she made sure we ate properly," he says.
He was put on tablets for high blood pressure and now has regular checks. "When I had the stroke, I had no idea I had high blood pressure," he says.
Jim had his stroke more than 10 years ago. Although it forced him to give up work, he makes a point of leading an active, healthy lifestyle. He attends his local stroke survivors club every week, which includes exercise sessions, talks from experts and a blood pressure check.
"It's also a great place to share advice and make friends," says Jim. "It's good to talk about any problems you're having with people who have been through the same thing.
"I'd recommend any stroke survivors to contact the Stroke Association to get information on their nearest club." He also visits stroke survivors in hospital.
Jim believes there is life after stroke. "We call ourselves stroke survivors, not patients – that's very important.
"When you've had a stroke, the most important thing to do is accept it. Unless you do that, it's difficult to move forward. But once you do, you'll realise that you can live a very happy, active life. I certainly do!"
Having a stroke on the first day of his summer holiday was the last thing Stephen Harnet expected, especially as he was a healthy 32-year-old at the time.
"I'd taken my wife and baby boy for a week in Spain. We'd been there less than 12 hours when I collapsed on the street. I was rushed to a hospital in Barcelona and I lay there in a coma for 72 hours.
"It turned out that the stroke was due to a condition I was born with called arteriovenous malformation [AVM], which is a tangle of abnormal blood vessels [arteries and veins], and can affect the brain and lead to a stroke.
"Hospital staff didn't think I was going to make it during those critical hours. They kept saying to my wife, 'No good, no good'. I don't know how she kept it together.
"Luckily, I did pull through. I had a life-saving operation on my brain and was then air-ambulanced home to the Queen Elizabeth Hospital in Birmingham, where I spent the next three months.
"I don't remember much about that time, but I do recall a lot of people saying I might not walk or talk again. But those words of doubt spurred me on – I was determined to lead a normal life.
"Every day I faced a new challenge, but as the weeks went by I accomplished so much. The more I succeeded, the more I wanted to do. I even shocked medical staff by becoming a dad again, which they had said I wouldn't be able to do.
"Before the stroke I was a technical manager working 12-hour days, seven days a week. I knew I wouldn't be able to do that again. I took a computer course and applied for administrative jobs. Now I have a paid part-time job as a medical records assistant at my rehabilitation centre.
"I also do voluntary work with other stroke victims. When I was really poorly, it gave me so much hope when I met people who'd had the same experience but had turned their lives around. I wanted to do the same for others. I truly believe that positivity is the best medicine – there's only so much that medicine can do.
"I've been through a hard time, but I really believe that, in some ways, my stroke made me a better person. I now know what's important in life, and try to enjoy every minute."
David Diston had a major stroke that left him paralysed down his right side and unable to speak. Now, he's made a near total recovery, and has even run a marathon.
When David crossed the finishing line of the London Marathon after a gruelling eight hours, 23 minutes and 15 seconds, he was entitled to feel proud. It was just 2.5 years since he suffered a major stroke.
"I'm sure the doctors thought I wouldn't get better, let alone run a marathon," says David.
David was overweight, had high blood pressure, and had begun to have symptoms of stroke, such as episodes of blurred vision, as long as 10 years earlier.
His daughter, cousin, father and aunt have all had strokes, yet he was never diagnosed as being at high risk. Indeed, he was feeling well when he suddenly dropped to the floor in what must have looked like a dead faint.
He woke up in an assessment ward at Swindon's Princess Margaret Hospital. He had no feeling or movement down his right side, and he couldn't speak.
"I wanted to ask for a coffee and I could read the word on the hospital menu, but I couldn't say it. I couldn't walk, I couldn't go to the loo on my own, or even do up my trousers. Worst of all, I couldn't tell anyone how embarrassed I felt.
"After a few days, I was moved to a specialist stroke unit, where the doctors explained that I would have to learn to speak, write and walk again from scratch.
"The lessons began quickly, and I was soon having daily physiotherapy to strengthen my right arm and leg. I also had speech therapy a few times a week."
After four weeks, David was allowed home. "I had to make a cup of tea, walk up four stairs and do some clearing up, otherwise they wouldn't have let me leave.
"Although I still couldn't write more than two or three letters of the alphabet, I could read, and this helped me relearn how to write letters and numbers.
"A speech therapist and physiotherapist came to the house two or three times a week for three months. After that, I continued to go to the hospital for physio and speech therapy.
"The doctors explained that my family history of strokes and being so overweight meant I had to change my diet and start exercising. I was 127kg (20st) and only 1.73m (5ft 8in).
"I follow a low-fat diet and eat far more fruit and veg, and have lost five stone. I run up to 10 miles several times a week. I also go to the gym and use weight machines to carry on strengthening my right arm and leg.
"Now, no-one knows I've had a stroke, unless I choose to tell them."
Manjit Bains was just 26 when he had a stroke. Determination, support from his family and friends, and rehabilitation helped him get his life back.
"'I've had a stroke'. This may be quite a common thing to hear. But not for me. I was just 26 and had my whole life ahead of me.
"I also worked as a senior staff nurse in a hospital and remember asking the rehabilitation nurse where my emboli, thrombosis or even my haemorrhage was!
"I had heart problems from birth and developed complications as I got older, which led to my stroke. Apparently, I'd had a respiratory arrest and ended up in intensive care.
"But I guess luck was on my side, even though my life changed as a result. I had to battle to overcome a speech problem and gain control of my right hand, but thankfully the rest of me was in working order.
"Depression soon followed. I couldn't believe that I'd suffered a stroke at such a young age, and I suppose I went through a kind of grieving process of anger, bitterness and finally acceptance.
"Although I was improving every week (my speech was getting clearer and my hand much stronger) I discovered that patience was not one of my strongest points. I was determined to go back to my nursing career and I had to learn to write left-handed.
"With a lot of support from my family and my rehabilitation and occupational health team, I had an assessment at work and was given a staff nurse post on a medical ward.
"As the years have gone by, I've become more confident and my speech and manual dexterity have improved. I've also nursed elderly and physically disabled clients.
"This hasn't been a solo journey. I've had a lot of support, including psychologists and counselling.
"After intensive care, I was nursed on a medical ward at the hospital where I'd been working. I remember asking my consultant how long it would take for me to get better. I had no idea I'd been at death's door.
"I was walking a lot, and my speech therapist assessed my swallowing ability and said I could have soft food. My hand was slowly improving but still weak, and I couldn't comb my hair or tie it up – thankfully hair bands had come into fashion! My colleague from work tied my shoelaces for me, but I was determined to get back to normal.
"I was finally discharged from hospital and referred to a rehabilitation team. For one week I was assessed on my ability to cope with daily activities.
"At home I started to practise manual dexterity skills, from opening cans to striking matches. My speech was improving, my slur had completely gone, and all the while I had fantastic support from my extended family.
"Eventually, I began attending the rehabilitation centre on an outpatient basis. And every day I get stronger and stronger."
Before June 17 2000, Jane Stokes CBE was a successful lawyer with a 25-year career in the civil service.
She was highly driven and passionate, working up to 15 hours a day as a legal adviser in the Treasury Solicitor's Department. That stopped suddenly one Monday morning.
Jane, 52 at the time, was getting ready for work when she collapsed in her bathroom in Dulwich, south London.
She might not have been here today if two concerned colleagues hadn't travelled to her house when she didn't turn up for work.
"I was on the bathroom floor, going in and out of consciousness and unable to move," she says. "I lived alone, so there was no-one I could call out to for help."
By the time Jane reached King's College Hospital, it had been more than three hours since the stroke, a delay that may have increased the brain damage.
Jane had had an ischaemic stroke, a blood clot in the brain. She was given statins and aspirin to thin the blood. Once her condition was stable, she began rehabilitation and spent seven months in hospital.
"I was devastated," she says. "I thought, 'The career is finished'. But I tried to remain positive and take one day at a time."
Her parents, who lived in Bournemouth, came up to visit her three days a week. Jane says the support from her family and close friends was vital for helping her recovery. "They were fantastic," she says.
In hospital, Jane received physiotherapy, occupational therapy, including relearning everyday tasks in the home, and speech and language therapy. She'd lost the movement down her right side and had a severe speech disability.
"Doctors said I'd had a massive stroke," says Jane. "I was almost dead. It was more than three hours before I received any treatment."
She says her lifestyle may have raised her risk of a stroke. As a smoker, she had developed a two-pack-a-day habit. She drank moderately and neglected her fitness when her career began to take over.
"I was working up to 15 hours a day, seven days a week," she says. "I was driven and I enjoyed the challenge."
Recovery is a long process. Jane's speech was severely affected, and she found it frustrating when she couldn't find the words to express what she was thinking.
Jane now dedicates her time to volunteering for Connect, a charity that provides support services and information for people recovering from a stroke. "I've stopped smoking. That was no problem. I drink moderately and keep fit, mainly through walking."
Keeping her spirits up isn't always easy. "I try to stay positive, but sometimes I feel down in the dumps," she says. "I don't know what keeps me going, but I just think it's good to be here."