by Dr John Rees
What is a stroke and could you spot the warning signs? Dr Rees explains the symptoms how quick action could save your life.
Strokes or ‘Brain Attacks’ as they are sometimes called are the most common cause of death and disability in adults after heart disease. These are emotive words, but they help to underline the serious nature of strokes, which mostly affect older people but increasingly in the middle aged.
A stroke is characterised by sudden onset of weakness and, or sensation loss on one side of the body of varying degree and may include language impairment and visual loss.
FAST is the acronym which stands for Face, Arm and Speech impairment, and Time to get help urgently. In nearly all major centres these days, a stroke patient is admitted to an acute stroke unit for immediate CT scanning, further investigation and treatment. If necessary, they will be transferred later to the rehabilitation unit where physio, occupational and speech and language therapists will aim to maximise recovery before discharge home. Patients with significant disability may well require outpatient therapy for some months and many patients will need personal physical aids arranging and occasionally reorganisation of their home including things such as stair lifts.
Return to previous activities after a stroke will be fine for some but many will find that difficult, some, impossible. DVLA will need to be informed after a significant stroke and driving will not be possible for everyone. However, many will return to driving some needing adaptation to their vehicle.
For years we have been aware that the major risk factors for stroke are raised blood pressure, diabetes, smoking, high cholesterol and obesity. It is only relatively recently that we have started to treat strokes aggressively as they develop by dissolving the arterial blockage or physically removing it. We know that providing patients can be hospitalised, investigated and treated within 3-4 hours or so, it is possible in some cases to prevent the stroke developing, often restoring the patient to full or nearly full function.
This only relates to patients where a blockage of a brain artery has caused the stroke (70%) and not to the 20% who have had a haemorrhage into the brain. A small proportion of strokes (5%) will be due to the rupture of a weakness in an artery called an aneurysm. These are usually treated by surgery or more commonly today by an interventional – radiology technique that blocks up the cavity of the aneurysm.
It is increasingly recognised that some irregular heart rhythms particularly in older people can cause embolic strokes, when a clot forms in the heart and then flies off into the brain circulation. Anticoagulation (blood thinning), of these patients will reduce the likelihood of future strokes by two thirds. The remaining 5% of strokes are due to a variety of relatively uncommon conditions. Occasionally strokes can be confused with other conditions such as migraine, MS or brain tumours.
It is important to prevent strokes occurring. Brief strokes, so-called Transient Ischaemic Attacks (TIAs or mini strokes), lasting minutes or hours are a wake-up call to investigate just as severe chest pain is a warning for potential heart attacks. Up to 30% of TIAs can go onto a major stroke if unrecognised and untreated. In addition to treating the major stroke ‘risk factors’ where present, the very narrowed artery that caused the TIA may be identified which can then be unblocked surgically, preventing a major stroke occurring in the future.
The future management of strokes looks very encouraging, in terms of prevention, better treatment and research. There is a wealth of information and practical help available from the Stroke Association which also supports major research.