Stroke in NZ: Symptoms, treatment, recovery, and support options

What is a stroke?

A stroke is a life-threatening medical emergency that happens when blood supply to part of the brain is disrupted, either by a blood clot (ischaemic stroke) or bleeding from a burst or leaking blood vessel (haemorrhagic stroke). This lack of blood flow means the brain cells aren't getting enough oxygen, which can cause them to become damaged or even die. 

The consequences of a stroke range from mild to severe and may include irreversible brain damage, long-term complications, permanent disability, or death, depending on which area of the brain is affected. In the event of a stroke, immediate medical attention is required.

Stroke remains a major health issue in Aotearoa New Zealand. While it usually affects older people, thousands of patients are still of working age, raising families, or supporting dependants.

Below are some key statistics from the New Zealand government and Stroke Aotearoa New Zealand:

• Over 9,500 individuals experience stroke each year. It is one of the most common causes of death and severe disability in adults.
• It is estimated that 50-80% of stroke events are preventable, highlighting the importance of early, proactive risk management.

• Up to 30% of strokes occur in people under 65. But among Māori and Pacific peoples, 60% of strokes occur between ages 15 and 64.

• Stroke mortality has declined over time, but total admissions continue to rise due to population increase and ageing.

Stroke causes and types

There are two main types of stroke, each with different causes:

Ischaemic stroke, the most common, is usually caused by atherosclerosis, where plaque narrows or blocks arteries, or forms a blood clot that stops blood flow to the brain. It may also be caused by medical issues, including clotting disorders and heart defects.

Haemorrhagic stroke occurs when a blood vessel in the brain bursts or leaks, interrupting delivery of oxygen to the brain. The resulting bleeding also increases pressure in the brain and damages brain tissue. Haemorrhagic strokes can be linked to uncontrolled high blood pressure, aneurysms, blood vessel defects, and blood-thinning medicines. 

Transient ischaemic attack (TIA) vs stroke

TIAs are temporary blockages of blood flow to the brain. Symptoms are similar to a stroke but usually resolve quickly once the clot moves or dissolves on its own. TIAs are considered a medical emergency and a serious warning sign that you may suffer a major stroke later on.

Stroke risk factors

There are controllable and non-controllable risk factors for stroke. Managing your modifiable risk factors can significantly lower the chance of having a stroke.

Conditions that raise risk

• High blood pressure
• Heart disorders, including coronary artery disease (CAD) and atrial fibrillation
• High cholesterol
• Diabetes
• COVID-19 infection
• A history of stroke or TIA
• Sickle cell disease
• Frequent migraines
• Pregnancy, especially if you’ve had pre-eclampsia or high blood pressure during pregnancy.

Behaviours and lifestyle choices that increase risk

• Smoking or exposure to secondhand smoke
• Drinking too much alcohol
• Lack of regular physical activity
• Unhealthy eating habits, especially diets high in saturated fats, cholesterol, and sodium
• Being overweight or obese.

Non-modifiable risk factors

• Age: risk increases as you get older
• Family history of stroke and genetics
• Sex: women are more likely to die from stroke.

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Stroke symptoms

Stroke symptoms require immediate attention. They can appear without warning and may be mild or severe, lasting only minutes, or much longer. 

Even when symptoms disappear quickly, such as in a TIA, emergency medical care is critical, as some treatments must be given within a limited time. Getting urgent care reduces the risk of permanent brain damage and helps improve treatment outcomes.

Some common stroke symptoms include:

• Facial weakness or drooping
• Arm weakness
• Difficulty speaking.

Other signs to watch out for: 

• Numbness or paralysis on either or both sides of the body
• Sudden loss of vision or blurred vision
• Difficulty walking, dizziness, or loss of balance
• Sudden severe headache
• Sudden confusion or difficulty understanding others.

The F.A.S.T. test offers an easy way to recognise if someone is having a stroke:

• Face drooping: Does one side of the face droop?
• Arm weakness: Can they raise both arms?
• Speech difficulty: Is their speech slurred or unclear? Can they understand you?
• Time: Call 111 immediately if any of the above signs are present.

What to do if you suspect a stroke

If you suspect someone is having a stroke, do the following:

1. Call 111 right away. Tell the operator that you suspect the person is having a stroke and they will send an ambulance. Do not delay or try to drive the person to hospital yourself. 
2. Do the following while waiting for the ambulance: 
   • If the person is conscious, help them lie down on their side with their head supported and slightly raised. Keep them calm and still. Stay with them to ensure they don’t try to move
   • If they’re unconscious, check if they are breathing. If they are breathing normally, place them on their side (the recovery position). If they aren’t breathing or have no pulse, start CPR. If you don’t know how to do CPR, follow the instructions from the emergency call taker
   • Do not give them food, drink, or medication (including aspirin)
   • Keep them warm with a blanket or clothing
   • Loosen tight clothing that may restrict breathing
   • If another person is around to help you, try to get the patient’s belongings ready, such as their clothes, usual medications, keys, wallet, and phone.

Diagnosis

Timely diagnosis is essential following a suspected stroke. Understanding the type of stroke enables doctors to provide appropriate treatment quickly. The sooner treatment starts, the greater the chance of limiting permanent brain damage.

Doctors will ask about your symptoms, when they started, and your medical history. If speech is affected, information may be provided by family or others present. 

• A physical and neurological examination is carried out to understand how the stroke is affecting your brain and nervous system

• Brain imaging: A CT scan is usually performed to check for bleeding in the brain and other conditions. An MRI scan may also be used to provide more detailed images of brain tissue damage

• Blood tests: To assess clotting and blood sugar levels and rule out other medical conditions

• Heart tests, such as an ECG, to detect heart rhythm problems and other conditions that could have caused the stroke.

Stroke treatments

Stroke treatment depends on the type of stroke and how quickly care begins. 

Ischaemic stroke treatment

Most strokes are caused by a blood clot blocking blood flow to the brain. Emergency treatment aims to restore circulation as quickly as possible. This is known as reperfusion therapy and may include clot-busting medication (thrombolysis) and/or clot retrieval (thrombectomy). These treatments are time-critical and only suitable for some patients.

Haemorrhagic stroke treatment

Haemorrhagic strokes are caused by bleeding in the brain. Treatment focuses on stopping the bleeding and reducing pressure on the brain. This may involve medications to manage blood pressure or reverse blood-thinning medicines, and sometimes surgery to manage brain swelling or prevent further bleeding.

Possible complications

The effects of a stroke depend on various factors, including how quickly treatment is received and which area of the brain is affected. Some patients experience temporary effects, while other survivors live with ongoing disabilities and need long-term rehabilitation and support.

Possible stroke complications include:

• Paralysis (partial or whole body)
• Problems with speech and understanding language
• Difficulty swallowing
• Vision impairment
• Problems with memory, judgement, and concentration
• Dizziness, nausea, vomiting
• Fatigue 
• Issues with balance or coordination and a higher risk of falls
• Sleep problems such as sleep-disordered breathing and sleep-wake disturbances
• Pain
• Incontinence
• Emotional or behavioural changes such as depression, anxiety, irritability, impulsivity, and lack of awareness or insight
• Deep vein thrombosis or pulmonary embolism
• Coma
• Death.

The longer a stroke goes untreated, the greater the risk of brain damage and serious complications. This is why early treatment and continued care are critical. Ongoing rehabilitation can also help reduce the severity of complications.

Stroke rehabilitation: Rebuilding skills and independence

Stroke rehabilitation helps people relearn skills, regain independence, reduce long-term disability, and work toward the best possible quality of life. It focuses on improving physical, cognitive, communicative, and emotional function. 

When rehabilitation starts

Rehabilitation often begins in hospital and continues in outpatient, community, or home-based programmes. While the most noticeable improvements often happen in the first few months, meaningful gains can continue well beyond this period with consistent support.

What rehabilitation may involve

Rehabilitation is not a one-size-fits-all process and looks different for everyone. It may include:

• Physiotherapy: Helps improve strength, balance, coordination, and mobility. This may involve relearning how to sit, stand, walk or use affected limbs
• Occupational therapy: Focuses on daily living skills, such as dressing, bathing, cooking, and returning to work. Occupational therapists may also recommend home modifications or assistive equipment
• Speech and language therapy: Supports people with speech difficulties, language problems or swallowing issues following a stroke
• Counseling, psychiatry, or neuropsychology: Psychological or psychiatric support for patients needing help dealing with grief, anxiety, depression, mood swings, personality changes, or dementia
• Preventing another stroke: Patients stay on medicines (for blood pressure, cholesterol, etc.) indefinitely to lower recurrence risk. Survivors are also advised to make lifestyle changes, such as eating healthy, staying active, and quitting smoking.

Support for stroke survivors and carers

Many people need rehabilitation for weeks or months, and sometimes longer. Public health services and non-government organisations provide essential support, and patients with insurance may be able to use their cover to fund additional therapy, private rehabilitation, or ongoing medical, living, and caregiving costs.  

Support for patients

• Government-funded services: 
  • Public health services provide free hospital care, community rehabilitation and other services
  • Many strokes are not covered by ACC as they are non-injury related, but you may qualify for other government-funded assistance. Check the Ministry of Social Development website to find out if you’re eligible for Jobseeker Support, disability allowance, supported living payment, or other types of one-off or ongoing support
• Charities and NGOs: Stroke Aotearoa offers a free helpline (0800 STROKE) for patients and their families. Stroke advisers offer in-home support, information on local stroke groups, and advice on accessing services. They also help stroke survivors get back to the workforce through the government-funded return-to-work services
• Community resources: Patients can join in-person or online stroke groups or attend 'life-after-stroke' workshops offered in many regions. Online forums and Māori stroke guides are also available.

Support for carers

• Government help: Carers of stroke survivors can check if they are eligible for various types of financial support or other services, such as the Supported Living Payment for carers and Carer Support subsidy to fund respite or paid help. 
• Health checks: Carers should look after their own health, too. Stroke Aotearoa and other organisations offer advice on coping with stress and fatigue and self-care while looking after someone with a long-term disability.

How insurance can help stroke patients and their loved ones

Strokes are among the leading causes of disability in adults, and can impact working age individuals who are still at the peak of their careers or are supporting dependants. Insurance can ease the financial impact of strokes and help cover other expenses to support the patient’s recovery, rehabilitation, or transition back to the workforce. 

Here’s how each type of insurance you may have can help support you if you suffer a stroke: 

• Trauma (critical illness) insurance: Trauma cover, whether standalone or accelerated against your life cover, can provide a lump sum if you suffer a condition covered by your policy, such as a stroke, cognitive impairment, coma, paralysis, and loss of independent existence. You can use it to support living, medical, rehabilitation, and private care costs while you recover. 
• Total & permanent disability (TPD) insurance: Standalone or accelerated disablement cover can provide a one-off payout if a stroke causes permanent disability that prevents you from working. It can be used for home modifications, specialised equipment, and  long-term care, or pay for living costs.
• Income protection or mortgage protection insurance: If a stroke or its complications forces you to take time off work, these plans can replace part of your income. The monthly benefit helps you keep up with mortgage or rent payments and day-to-day bills. If you are totally disabled after a stroke, some plans provide full-time care benefits to help pay for your carer or replace the income your family caregiver has given up. 
• Life insurance: Life insurance pays a lump sum if a stroke leads to death. It can help cover funeral costs, pay off large debts, and support your dependants financially after your passing. 
• Medical insurance: Depending on your plan, health insurance can cover private specialist consultations, diagnostic tests, and treatment. 

Insurers may apply exclusions or waiting periods for claims related to pre-existing conditions, including medical issues that increase stroke risk. If you’re considering cover, it’s important to speak with an adviser to understand what protection may be available for your specific situation. 

Even if your condition is permanently excluded, having insurance can still provide meaningful protection. It can cover you for unrelated major illnesses or injuries, helping replace lost income and support you and your family in case you suffer a condition that affects your working life and independence. 

Prevention: How to reduce your stroke risk

Managing risk factors early can significantly reduce the chance of a first or recurrent stroke.

Some risk factors cannot be changed, such as age, genetics, or family history. However, many of the most important risks are modifiable.

Medical conditions that increase stroke risk need careful management, including:

• High blood pressure
• High cholesterol
• Diabetes
• Atrial fibrillation, coronary artery disease, and other heart conditions.

Regular health checks help identify and treat medical problems early, even when there are no symptoms.

Healthy lifestyle choices are just as important. Small, consistent steps can make a meaningful difference:

• Eat a heart-healthy diet rich in vegetables, fruits, and wholegrains. Choose foods that are low in salt, cholesterol, saturated fat, and trans fat. Doing this can help you avoid high cholesterol and high blood pressure, which contributes to your risk of having a stroke
• Stay physically active. Exercise can help manage stroke risk factors, including high blood pressure and cholesterol levels
• Maintain a healthy weight. Obesity is linked to a number of complications, such as diabetes and elevated cholesterol and blood pressure levels, which increase stroke risk
• Quit smoking and avoid secondhand smoke, as these contribute to the narrowing of arteries, increase blood pressure, raise “bad” cholesterol levels, and make the blood more prone to clotting
• Limit alcohol intake, as alcohol can raise blood pressure.

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