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Diagnosis

What is a stroke?  What does TIA mean and how is it different?

The brain needs a constant blood supply to provide oxygen and nutrients to brain cells. A stroke happens when the blood supply to part of the brain is cut off and brain cells are damaged or die.  This is usually because of a blockage in the blood supply, but sometimes it can be because of a bleed in the brain.  Strokes can happen suddenly and have an immediate effect.  They affect people in different ways, depending on the part of the brain that is involved, how widespread the damage is and how healthy the person was before the stroke.  Some people become numb, weak or paralysed on one side of the body, slur their speech or have difficulty finding words or understanding speech. Some people lose their sight or have blurred vision, and others become confused or unsteady. Stroke may also affect bodily functions, thought processes, the ability to learn, personality and ability to communicate.  TIA stands for Transient Ischaemic Attack.  It has the same causes as a stroke, but symptoms do not last more than 24 hours. Someone who has had a TIA or stroke is at increased risk of having another event.   

Investigations

Will I have any tests?  What tests might I have?  Why am I being asked to have them?

In order to investigate your symptoms and know how best to treat them, some routine tests will be required.  Some are done when we first meet you, others may be done over the following weeks.  Different tests are needed in different people but common ones include:

  • Blood Pressure (BP).  This will be checked in hospital and you may be asked to use a blood pressure monitor at home, or wear a monitor to check your blood pressure overnight. 
  • An electrocardiogram (ECG).  This can be done as a short test in a few minutes or as a longer test over several days.  It looks for any irregularities in your heart beat.
  • Blood tests, including a check of your cholesterol, and general health.
  • Scans of your brain (CT or MRI) and of the blood vessels in your neck (Doppler or MRA) or of your heart (Echo). 

Each test is done in a different part of the hospital. Some departments may contact you directly to arrange an appointment, explaining when and where it will be and providing their contact details if you have any questions.  Sometimes the results of investigations are normal, particularly after a TIA, but treatment is still required. 

Medication

Why have I been given medication?  How long will I have to take it?

Medications play an important role in treating stroke and TIA and in preventing further events.  Where a stroke or TIA has been diagnosed or suspected it is normal to take preventative medications for life. 

What are the medications for?

Different people may need different medications, but there are 3 common types of treatment. 

  • Some tablets reduce the ‘stickiness’ of the blood.  These antiplatelet or anticoagulant medications make blood less sticky to reduce the risk of blood clots which can cause a stroke.  The most common is Aspirin.  Others include Clopidogrel, Dipyridamole, or in some cases Warfarin.  Dipyridamole is taken once a day for 1 week and then twice a day after.
  • Some tablets reduce blood pressure which is the biggest risk factor for stroke. There are 5 main types of blood pressure medication.  Most people will need to take more than one.
  • Some tablets reduce cholesterol.  This is important because fatty deposits can narrow blood vessels and increase the risk of stroke.  Statins are the most common. 

Treatment for blood pressure and cholesterol has been found to be beneficial after TIA or stroke even if your levels are normal. 

I was prescribed some medication by you.  How do I get more in future?

After we see you we inform your GP of any changes recommended or made to your medications.  Your GP can add these to your repeat prescription.  If you have to pay prescription charges, and you need to take regular medications, you could save money by buying a Prescription Pre-payment Certificate (PPC).  Forms are available from GP surgeries, online at www.ppa.org.uk/ppc or by telephoning 0845 850 0030.

Appointments

Will I be seen again?  If so, what will happen at the next appointment?

After your initial visit we will ask to see you again after 1 month, and up to 3 more times over the next 5 years.  Each appointment is designed to check your recovery, identify any new symptoms, check your medicines and blood pressures, and discuss any outstanding test results.  We may ask you questions to test your memory.  These appointments are usually with a specialist nurse.  If your appointment is in clinic, this is held in the Neurosciences Outpatient Department, Level 3, West Wing, John Radcliffe Hospital.  These appointments are for your clinical care, and we write to your GP afterwards.  If you are asked to participate in any other studies, this should be in addition to the follow up appointments described above.

Lifestyle

Why am I being told I cannot drive?

The Driver and Vehicle Licensing Agency (DVLA) sets guidelines for doctors to follow to make sure people are fit to drive.  Further information is available at www.direct.gov.uk/en/Motoring. If this is your first TIA or stroke you must not drive for at least 1 month.  You may resume driving after this period if your recovery is satisfactory. However there are exceptions, for example if you still have symptoms after 1 month, or more than 1 TIA or stroke in a period of 3 months, when you need to tell the DVLA. 

What can I do to help prevent a future stroke?

Stop smoking, drink sensibly (for women 2-3 and men 3-4 units of alcohol a day at most), eat healthily (eat 5 portions of fruit and vegetables a day, reduce your salt and fat intake), be a healthy weight, and try some regular exercise.  Gentle exercise is safe after TIA or minor stroke as long as you feel comfortable. 

Further information

Further information is available, in different languages, from the Stroke Association.