Stroke: Symptoms, Types, Diagnosis & NHS Treatment

A stroke is a medical emergency that occurs when the blood supply to part of the brain is cut off, causing brain cells to die. In the UK, around 100,000 people have a stroke each year — that’s one every five minutes. Stroke is the fourth largest cause of death in the UK and the leading cause of complex adult disability. However, with fast treatment, many strokes are survivable and recovery is possible.

Recognising a Stroke: The FAST Test

The NHS uses the FAST acronym to help people recognise stroke symptoms quickly:

  • F — Face drooping: Has their face fallen on one side? Can they smile?
  • A — Arm weakness: Can they raise both arms and keep them raised?
  • S — Speech problems: Is their speech slurred or garbled? Can they understand what you say?
  • T — Time to call 999: Call 999 immediately if you notice any of these signs

Additional symptoms include sudden severe headache, vision loss or double vision, sudden dizziness or loss of balance, confusion, or sudden numbness on one side of the body.

“Time is brain” — every minute without treatment, approximately 1.9 million brain cells die. Do not wait to see if symptoms improve. Call 999 immediately.

Types of Stroke

Ischaemic Stroke (85% of cases)

Caused by a blood clot blocking an artery supplying the brain. The clot may form in the brain’s arteries (thrombotic stroke) or travel from elsewhere, such as the heart in atrial fibrillation (embolic stroke — see our AF guide).

Haemorrhagic Stroke (15% of cases)

Caused by a blood vessel bursting in or around the brain. Subtypes include intracerebral haemorrhage (bleeding within the brain tissue) and subarachnoid haemorrhage (bleeding between the brain and skull, often from a ruptured aneurysm). Haemorrhagic strokes are more often fatal than ischaemic strokes.

Transient Ischaemic Attack (TIA) — “Mini Stroke”

A TIA has the same symptoms as a stroke but resolves completely within 24 hours (usually within minutes). It must be treated as a medical emergency because the risk of a full stroke in the days following a TIA is very high — approximately 10% within 7 days if untreated. The ABCD2 score is used to assess TIA risk. NICE recommends all TIAs be assessed by a specialist within 24 hours.

UK Stroke Statistics

  • Around 1.3 million people in the UK are living with the effects of stroke
  • 100,000 people have a stroke in the UK each year
  • 38,000 people die from stroke in the UK each year
  • Stroke is the leading cause of serious long-term adult disability in the UK
  • 55,000 of strokes each year are first strokes
  • Around 25% of strokes occur in people under 65
  • The NHS spends over £3 billion per year on stroke care

Risk Factors for Stroke

  • High blood pressure — the single biggest risk factor; responsible for over 50% of strokes; see our hypertension guide
  • Atrial fibrillation (AF) — irregular heart rhythm causing blood clots in the heart; increases stroke risk 5-fold; see our AF guide
  • Smoking — doubles stroke risk
  • High cholesterol — see our high cholesterol guide
  • Type 2 diabetes — doubles stroke risk; see our diabetes guide
  • Heart disease — see our heart attack guide
  • Obesity
  • Physical inactivity
  • Excessive alcohol
  • Age — risk doubles every decade after 55
  • Family history
  • Ethnicity — Black African and Caribbean people in the UK have stroke rates 2–3 times higher than the general population, often at younger ages
  • Previous TIA or stroke
  • Carotid artery disease (narrowing of the carotid arteries in the neck)

NHS Emergency Treatment for Stroke

Hyperacute Stroke Units (HASUs)

Most UK cities have designated Hyperacute Stroke Units (HASUs) — specialised centres staffed 24/7 with stroke consultants, nurses, and imaging facilities. Evidence shows patients treated in dedicated stroke units have better outcomes than those treated in general wards. If you call 999, the ambulance will take you directly to the nearest appropriate centre.

Thrombolysis (Clot-Busting Drug)

For ischaemic strokes, alteplase (tPA) — an intravenous clot-dissolving drug — can be given within 4.5 hours of symptom onset if CT scanning confirms no haemorrhage and the patient meets eligibility criteria. This is why calling 999 immediately is critical — every minute of delay narrows the treatment window.

Mechanical Thrombectomy

Thrombectomy is a revolutionary treatment where a catheter is threaded to the blocked brain artery to mechanically remove the clot. NICE TA524 recommends thrombectomy for eligible patients within 24 hours of symptom onset if imaging confirms a large vessel occlusion. The UK has been rapidly expanding thrombectomy services — NHS England aims for universal access by 2025. It can reverse severe stroke deficits that thrombolysis cannot reach.

Treatment for Haemorrhagic Stroke

Clot-busting drugs are not used for haemorrhagic strokes (they would worsen bleeding). Treatment focuses on controlling blood pressure, reversing any anticoagulant medications, and in some cases surgery to drain blood or clip aneurysms.

Stroke Recovery and Rehabilitation

Early Supported Discharge (ESD)

NICE recommends Early Supported Discharge (ESD) for stroke patients who are medically stable — specialist community rehabilitation at home, shown to reduce length of hospital stay and improve functional outcomes compared to continued hospital care.

NHS Stroke Rehabilitation Services

Post-stroke rehabilitation may include:

  • Physiotherapy — relearning movement, balance, and walking
  • Occupational therapy — adapting daily activities and home environment
  • Speech and language therapy — for aphasia (language difficulty) or dysphagia (swallowing problems)
  • Psychology and neuropsychology — for mood disorders, cognitive impairment
  • Community stroke teams — ongoing support after hospital discharge

Recovery can continue for months and even years after stroke. Neuroplasticity — the brain’s ability to rewire itself — means continued rehabilitation effort can produce ongoing improvements. Do not accept that no more progress is possible.

Post-Stroke Depression

Up to one third of stroke survivors experience depression. It is often under-recognised and under-treated. The NHS should screen all stroke survivors for depression and anxiety — antidepressants and psychological therapies are effective. If you feel your mood is being overlooked, ask your GP or stroke team explicitly.

Driving After Stroke

You must not drive for a minimum of 1 month after a stroke or TIA. If you have had a TIA, you may be able to resume driving after 1 month if you have no residual neurological deficits. After a stroke, a formal DVLA notification and medical assessment is usually required before you can drive again. Inform your insurer. Rules are stricter for lorry and bus drivers (Group 2 licence).

UK Support and Resources

  • Stroke Association — stroke.org.uk | Helpline: 0303 3033 100 | UK’s leading stroke charity, with local support groups and information for survivors and carers
  • Different Strokes — differentstrokes.co.uk | Charity for younger stroke survivors
  • ARNI (Action for Rehabilitation from Neurological Injury) — arni.uk.com | Specialist rehabilitation trainers
  • NHS Stroke After Care — guidance on NHS.uk about post-stroke services
  • DVLA — gov.uk/dvla | Stroke and driving guidance

What Major Health Sites Often Miss About Stroke

1. Thrombectomy: The UK’s Expanding Access

Mechanical thrombectomy is one of the most significant advances in stroke treatment in decades — with outcomes dramatically better than thrombolysis alone for large vessel occlusion. NHS England’s national thrombectomy programme is expanding access rapidly, yet many stroke patients and their families are unaware this treatment exists or that they can specifically ask whether they are eligible. US health sites discuss thrombectomy but don’t reflect the UK’s specific NHS expansion programme and eligibility pathways.

2. The Importance of TIA as a Warning Signal — Not a “Mini Stroke You Recovered From”

Many people who have a TIA don’t seek urgent treatment because symptoms resolved. UK data shows that the risk of a major stroke within 48–72 hours of a TIA is 10–20% without treatment. Every TIA should be treated as a 999 emergency. The EXPRESS study (Oxford) showed that rapid treatment of TIA reduced subsequent stroke risk by 80%. GPs now have NICE-mandated 24-hour access to TIA clinics.

3. AF-Related Stroke Prevention With Anticoagulation

Atrial fibrillation causes approximately 20% of all strokes in the UK, and AF-related strokes tend to be more severe. DOACs (direct oral anticoagulants — rivaroxaban, apixaban, dabigatran, edoxaban) are highly effective at preventing AF-related stroke and are available on NHS prescription. Yet thousands of people with AF in the UK are not prescribed anticoagulation, or are on aspirin (which is ineffective for AF stroke prevention). If you have AF, check with your GP whether anticoagulation is appropriate.

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