Stroke

A stroke is an emergency. If you suddenly notice any of the following signs in yourself or someone else, call 112 immediately. Do not wait for it to pass and do not drive yourself to hospital.

Face. Ask the person to smile. Is one corner of the mouth drooping, is the smile uneven?

Arm. Ask them to raise both arms and hold them there. Does one drift downwards, or can they not raise it at all?

Speech. Ask them to repeat a simple sentence. Is their speech slurred, are they mixing up words, do they not understand you?

Time. Remember the time the signs began, or the time you last saw the person well, and tell it to 112. This information decides which treatment is still possible.

Even one of these signs is enough to call. The signs of a stroke are sudden and usually painless, so people often put them down to tiredness or stress and wait until morning. It is precisely this waiting that is the biggest cause of permanent damage.

Other sudden signs that mean the same

Sudden numbness or weakness of a leg or of one whole half of the body, even if speech is not affected.

Sudden loss of vision in one eye, loss of half of the field of vision or double vision.

Sudden loss of balance, unsteadiness when walking or severe dizziness with vomiting that comes out of nowhere.

A sudden, very severe headache with no known cause, especially if accompanied by confusion or vomiting.

Each of these signs is a reason to call 112, not to wait and watch.

Why time is decisive

In the most common form of stroke, a blood clot blocks a blood vessel and part of the brain is left without oxygen. Nerve cells in this area begin to die immediately, and the extent of permanent damage depends on how quickly blood flow is restored.

Treatment that dissolves the clot or removes it mechanically is time-limited and is carried out in hospital. It is measured in hours from the onset of signs, which is why the time of onset is so important.

Arriving by ambulance is quicker, because the crew assesses the situation on the way and the hospital knows who is coming.

What to do until the ambulance arrives

Stay with the person and reassure them. If they are conscious, place them in a comfortable half-sitting position with the head raised. If they are unconscious and breathing normally, turn them into the recovery position.

Do not give them food, drink or medicines, not even aspirin. Swallowing is often affected in a stroke, and the type of stroke is not known on the spot, so a blood-thinning medicine can be harmful.

Prepare a list of medicines and information about illnesses, and unlock the front door.

If the person is not breathing normally, tell 112 immediately. The dispatcher will guide you through resuscitation.

When the signs pass within a few minutes

When the signs disappear completely within a few minutes or hours, it may be a transient ischaemic attack. This is not a reassuring outcome but a warning. The risk of a full stroke is highest precisely in the first days after such an event, so signs that have passed also require immediate care.

If the signs linger and the person refuses help, insist. The absence of pain in a stroke convinces many people that it was nothing serious.

Risk factors

The greatest risk comes from high blood pressure, heart rhythm disorders, especially atrial fibrillation, diabetes, raised blood fats, smoking, excess body weight and physical inactivity. These factors can mostly be controlled.

Part of the risk also lies in the neck arteries. Blood flows through them to the brain, and plaque on their walls narrows the vessel or a fragment breaks off it and blocks a vessel in the brain.

Ultrasound of the neck vessels and where you can book

An ultrasound examination of the neck arteries, also known as a carotid Doppler, shows the walls of these vessels and the blood flow through them. It is non-invasive, involves no radiation and no needles.

It makes sense with the risk factors listed, with a murmur that the doctor hears over a neck artery, and as part of wider care after a stroke.

No preparation is needed and you do not have to fast. The examination is done lying down, with a probe and gel on the side of the neck. The report describes the state of the vessel walls and the measured flows; what they mean for you is judged by the doctor in the light of the overall picture of your health.

Ultrasound examinations at Medicinski center Ljubljana are self-pay; you do not need a referral. Appointments are booked with the clinic that runs the service. Bring your results and a list of medicines.

This examination is intended to assess risk before or after an event. It does not treat an acute stroke and does not rule one out. With signs of a stroke, one rule applies: 112.