Stroke

What is a stroke?

A ‘stroke’ or cerebrovascular accident as it’s medically known is a term used to describe brain disorders. A stroke occurs when the blood supply to part of the brain is cut off in some way. When the blood supply is cut off the brain cells are deprived of oxygen and other nutrients, causing some cells to become damaged and others to die.

Around 120,000 people in the U.K. suffer a stroke every year, the majority are over the age of 65.

What causes a stroke?

There are 2 main types of stroke, the most common cause of stroke is usually when there is a blockage in the flow of blood to the brain, often as a result of a blood clot forming in an artery that carries blood to the brain. This type of stroke is called a ischaemic stroke and is usually the end result of atherosclerosis – a build up of fatty deposits (cholesterol and other debris) in the arteries over many years. The build up of fatty deposits called atheroma, causes the arteries in the brain to narrow (fur up) and a blood clot may then block the flow of blood through the artery. If the blood clot forms in a major artery that leads to the brain it may be known as a cerebral thrombosis. A blood clot may also travel in the bloodstream to the brain from another part of the body, such as the heart or neck, where it may lodge in the brain and block an artery. This is known as a cerebral embolism. If the stroke symptoms disappear within hours, this is known as a transient ischaemic attack (TIA) or a ‘mini stroke’ this is because the blockage is temporary, it either dissolves on its own or moves. A TIA can be a warning sign of a possible major stroke and so should never be ignored.

Less often a stroke may occur from bleeding within or around the brain from a burst blood vessel. This type of stroke is called a haemorrhagic stroke and you may experience a sudden severe headache. This type of stroke may be due to a weakness in the wall of the artery, which causes it to stretch, a bit like a balloon. The walls then become so thin that they are more likely to stretch and burst, this condition is called an aneurysm.

What are the symptoms of a stroke?

There is usually little warning that you are going to suffer a stroke and most people do not know the symptoms of a stroke. If the symptoms you are experiencing are due to a stroke, immediate medical attention could save your life, and greatly enhance the chance of recovery. The F.A.S.T. method, which stands for Face, Arms, Speech, Time is an easy way to remember the most common stroke symptoms.

Face – Ask if they can they smile? Does one side look uneven or has it dropped on one side?

Arm – Can they lift both arms? Does one side appear weak or drift down?

Speech – Is their speech slurred or muddled? Can they understand what you say can they repeat a phrase?

Time – If any of these signs are present call 999. Brain cells die every second.

If you believe you or someone else is suffering from any of these symptoms you should call 999 immediately, delay can result in death or major long term disabilities.

Other stroke symptoms include:

• A sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
• Weakness or inability to move one side of the body.
• Difficulty speaking or understanding what others are saying.
• Sudden blurred or decreased vision in one or both eyes.
• Dizziness or loss of balance and co-ordination.
• Sudden severe headache, which has been described as being like a blow to the head (associated with a haemorrhagic stroke).
• Slurred speech.
• Difficulty swallowing.

What are the risk factors of a stroke?

A stroke is one of the most preventable of all life threatening problems, there are a number of risk factors that you can control these are as follows:

• High blood pressure – this is the most important risk factor for stroke, as left untreated high blood pressure can damage the walls of the arteries. 40% of stroke patients have high blood pressure.
• High cholesterol levels – a healthy diet can help lower your cholesterol. We offer cholesterol tests on this website, for more information or to buy click here.
• Diet – a diet high in salt is linked with high blood pressure and a diet high in fatty foods is linked to atherosclerosis (narrowing of the arteries). Try to stick to a diet high in fruit and vegetables.
• Alcohol – if you drink heavily your blood pressure will be higher.
• Being overweight – excess weight puts strain on the entire circulatory system.
• Smoking – 12% of all strokes are caused by smoking.
• Lack of exercise – people who are thinner and fitter tend to have lower cholesterol levels and therefore there is less of a risk of having a stroke.

However, there are a few risk factors that cannot be changed and these include:

• Increasing age.
• Atrial fibrillation – a type of irregular heartbeat, which is fairly common in old age and increases the risk of blood clots forming in the heart, these clots may then dislodge and travel to the brain.
• If you are diabetic.
• A previous stroke or heart attack.
• Family history of heart disease.

What can be done to avoid having a stroke?

To avoid a stroke you should stop smoking, limit the amount of alcohol you drink and stick to a healthy diet. You should also aim to take regular exercise.

If you have already suffered a stroke a single prescribed tablet a day is usually all that is required to reduce your risk of suffering a further stroke. Ordinary aspirin is also known to reduce the risk associated with stroke but you should ask your doctor for advice before beginning to take them.

How is a stroke diagnosed?

If you suspect that someone is having a stroke they should be taken to hospital immediately. The doctor will usually be able to diagnose a stroke fairly easily from the symptoms. He/she may examine the patients ability to speak and the ability to move their limbs. The main test for stroke is a CT scan or MRI scan, which will give a detailed picture of the brain and help diagnose the cause of the stroke, type of stroke and where the damage is. If you have had a suspected stroke a brain scan should be carried out within an hour of arriving at hospital. Blood tests are also usually carried out to check cholesterol and sugar levels, you will also have blood pressure and pulse rate checked.

A swallow test is also an essential test to check your ability to swallow, usually this is just with water.

How is a stroke treated?

The immediate treatment of a stroke includes close monitoring to stabilize the condition and depending on the severity of the stroke you may need to be admitted to hospital. The treatment you receive will depend on the type of stroke but treatment usually starts with medication, these can help to thin your blood and dissolve blood clots, reduce blood pressure and cholesterol. You may be given a medicine directly into the vein this is called alteplase. Surgery may sometimes be required to remove blood clots.

Once a patient’s condition has settled, intensive treatment from a physiotherapist will be required to improve mobility and speech. The underlying cause of the stroke, such as high blood pressure or high cholesterol will need to be found and then treated. You may have an ECG (electrocardiogram) to ensure your heart function is normal.

There are also many drugs available and the type the doctor prescribes will depend on the individuals’ needs.

What happens after a stroke?

The after-effects of a stroke may range from mild to severe. The most severe effect of a stroke is temporary or permanent paralysis, caused by an impairment of the nervous and muscular systems. The majority of stroke patients suffer partial or total paralysis on one side, this usually lasts for 3-6 months. You may also suffer fatigue, loss of speech and understanding. Your eyesight and balance may also be affected and most stroke patients will need help dressing, bathing and eating for up to 6 months after the stroke though for some people it can lead to long-lasting problems.

The type of disability you suffer depends on the area of the brain that has been affected and the extent of the damage to the brain. Recovery can be a long, slow process, after 3 months you should have made good progress in your recovery but it can take up to 2 years for you to be fully functional again.

Other long term problems caused by a stroke can include the following:

• Depression
• Anxiousness
• Difficulty swallowing
• Mood swings
• Memory problems

There are also medications available to prevent future strokes. The drugs you are advised to take may just be a low dose of aspirin every day or a drug called warfarin, both drugs help to thin the blood to prevent any further blood clots forming.