People can and do survive strokes that damage large areas or vital parts of the brain. But any serious stroke is more likely to lead to someone becoming very unwell, or their life being at risk. The medical team should help you to understand what is happening and what treatment they are giving. With rapid medical help, many people can survive an initial stroke.
Good treatment and care allows people to make the best recovery possible for them. But even with good care, a severe stroke may leave someone with serious disabilities or unable to live independently. Sometimes, a stroke can be severe enough to cause death straight away.
Looking after yourself
When your loved one is so unwell with a stroke that they may not survive, it can be a very difficult and stressful time. This can be even more difficult if the person is unwell for a long period. Often families want to stay with the person who has had a stroke, and hospitals will try to accommodate this.
But it is also important to look after yourself. No matter how unwell a loved one is, it is important that you take time to have a meal and get some sleep.
How does the stroke affect the body?
A stroke happens when the blood supply inside the brain is disrupted, killing brain cells. If this happens in a part of the brain that controls the body’s automatic ‘life support’ systems like breathing and heartbeat, it can be life-threatening.
Risk of another stroke
After any stroke, the chance of a second stroke is much higher, and if someone already has damage to the brain, a second stroke can make them much more unwell. The medical team works hard to reduce the risk of a second stroke by treating risk factors like blood clotting, high blood pressure, and heart problems.
Swelling in the brain
A serious stroke can lead to dangerous swelling in the brain. This can sometimes be treated with surgery to remove part of the skull and reduce the pressure inside the brain. This surgery is called decompressive hemicraniectomy.
If someone has swelling in the brain, they are often too unwell to make a decision about their own care, so the medical team will work closely with their family or carers to agree on the best treatment and care options. While the surgery can save someone’s life, it can leave them with very serious disabilities.
Complications after stroke
Stroke can lead to serious health complications, which can also cause someone to become very unwell. These can happen soon after a stroke, or many months or years later. The medical team in the hospital carries out checks to identify and treat problems as they happen.
These can include:
- Swallowing problems, which can mean the person inhales particles of food or drink. This can lead to chest infections or pneumonia.
- Being immobile for long periods. This increases the risk of deep vein thrombosis (DVT) forming. A blood clot forms in a vein, often in the lower leg. If the clot moves to the lungs, it can block the flow of blood to the lungs, known as a pulmonary embolism.
- Heart attacks are more likely after a stroke. They are linked to many of the same risk factors and health problems.
- Seizures after a stroke, these have been linked in some studies with a greater chance of death and disability.
When someone is unconscious or in a coma
The most severe strokes can leave a person unable to respond or in a sleep-like state. This is sometimes called unconsciousness or coma, and it means that important parts of the brain are not working well. Coma may sometimes mean that the stroke is severe enough that the person may not survive. Coma can have a number of causes. In some situations, the cause of the coma can be reversed, but often there is no direct treatment.
The medical team will support the person’s health and see if the coma improves over time. They carry out checks and treatments to reduce the risk of another stroke and avoid complications developing. They also look after the person’s comfort and well-being. They will support family members or carers at a difficult time and should let you know what is happening. If you feel uncertain about how you can help, ask the medical team what you can do.
Supporting someone in a coma
Some people who have survived a coma say that they weren’t aware of what was happening, but they recognised familiar voices and took comfort from this. So don’t be afraid to talk to someone in a coma. When you come in, say who you are and talk to them about your day and other things as you normally would. Remember that they might be able to hear everything said around them.
Physical contact like hand holding can also help, as long as the person would have been comfortable with this when awake. You can try stimulating their senses with music or a favourite perfume. A person in a coma is not always motionless. They may grasp with their hand or make sounds. This is not always a sign of recovery, and involuntary movement can be seen even in a deep coma.
Different states of consciousness
Doctors assess a person’s level of consciousness using a tool called the Glasgow Coma Scale. This allows them to monitor for signs of improvement or deterioration. The Glasgow Coma Scale measures:
- Eye opening – a score of 1 means no eye opening, and 4 means open eyes spontaneously.
- Verbal response to a command – a score of 1 means no response, and 5 means alert and talking.
- Voluntary movements in response to a command – a score of 1 means no response, and 6 means obeys commands.
After a coma, someone might have basic reflexes, like blinking at a loud noise. They may open their eyes and sleep and breathe normally, but show no signs of awareness. This is sometimes called a vegetative state. If someone has more signs of conscious awareness, like being able to respond to a command or communicate at times, this can be called a minimally conscious state.
Some people can continue to gain awareness, but it can be a long-term condition for others. If you’re not sure what state of consciousness someone is in, ask a member of their medical team. They monitor the patient closely, and they can tell you about any changes. They can explain what treatment and support is being given.
If someone can’t do things for themselves such as eating and going to the toilet, they may be given help like a feeding tube and a catheter to drain the bladder. They will be moved to keep limbs flexible and avoid pressure ulcers, and staff carry out basic hygiene like brushing teeth and washing. They can be given meaningful activities such as listening to music and looking at pictures.
Very rarely, someone can be conscious but unable to move or speak. This is known as locked-in syndrome. They can usually hear, see, blink and move their eyes. They might be able to communicate by blinking. Locked-in syndrome is often due to a stroke in the brain stem, which is the part of the brain closest to the spinal cord.
The brain stem controls vital functions like breathing and heartbeat, as well as consciousness and movement. Ask the doctor what the person is aware of and what their movements mean, to help you understand their condition.
End-of-life care is support for people who won’t recover from an illness. This can last for as long as it’s needed and could be days, months or longer. It should help the person live well for as long as they can and die with dignity. It can include palliative care, which is holistic treatment and support to make someone as comfortable as possible.
This can mean managing pain and symptoms, as well as psychological, spiritual and social support for the person and their family.
Where can end of life care be given?
It’s possible to have end-of-life care at home, at a care home, in a hospital, or a hospice. The choice depends on the advice of the medical team, as well as the wishes of the person and their family. If it’s at home or in a care home, the GP is the main point of contact. Someone in their own home can have care from community palliative care nurses and other specialist professionals.
They can also spend time at a hospice, or use the support services offered at a hospice. Care in a hospital and hospice is free. At home or in a care home, the NHS or local council may fund parts of the care provided. Funding and help available varies between UK countries and local areas. Your GP can help you understand what’s available in your area.
Signs that life may be ending
It’s not usually possible to predict exactly when someone might die, but there are some signs that show someone is close to the end of their life. In the final days and hours, they may become drowsier, or stop eating and drinking. They can appear confused or restless. Their breathing can change and become less regular. It may be noisy, due to fluids building up in the airways.
This doesn’t always cause distress to the person, but can be upsetting for people around them. Health professionals can offer help to relieve symptoms and make the person more comfortable. Some things can help, such as raising their upper body, and medication can be given if needed.
For more information, see or download our PDF guide 'When someone is seriously ill or dying after stroke guide'.