June 2017
Information for the Public
The Stroke Association UK reports that a stroke occurs every 3 minutes and 27 seconds. Statistics also indicate that Asians are twice as likely to have a stroke compared to Caucasians. In the USA stroke is the fifth leading cause of death and worldwide is the second leading cause of death. Recovery from a stroke differs from person to person and no two strokes are the same. Did you know that quicker the symptoms are recognised and treatment is initiated the better the recovery? What is a Stroke? When blood flow to an area of the brain is cut off, brain cells in that area are deprived of oxygen and die. Depending on the area affected various permanent disabilities like paralysis of a limb, loss of memory or inability to speak can occur. If the area affected is large, the person will have severe disability affecting many parts of the body. A massive stroke can also be fatal. Symptoms of stroke The face may be distorted and droop on one side. The person may not be able to smile. Significant weakness of one arm. When asked to raise both arms together, one arm keeps dropping or the person is not able to raise that arm. Speech may be altered or slurred. Other less common symptoms may be: Sudden severe headache that cannot be controlled by medication. Sudden blurring of vision Suddenly becoming violent or confused Numbness of a limb or part of the face with weakness Sudden dizziness or becoming unconscious Any one of the signs above when present is probably a stroke and the person will need emergency medical treatment. Get them to the nearest hospital treating strokes. Make sure the hospital has access to an emergency scanning facility. The sooner the diagnosis is confirmed and treatment begun the better the results. A stroke is a medical emergency and needs immediate medical attention. Types of Stroke: There are two types of stroke, Ischaemic and Haemorrhagic. Ischaemic Stroke: When the blood vessel supplying an area of the brain is blocked by a blood clot or build-up of fatty plaque inside the vessel wall, the blood supply to the area is cut off and an “ischaemic stroke” results. Haemorrhagic Stroke: When a vessel supplying an area of brain ruptures leaking blood (burst aneurysm), the area is deprived of oxygen and “haemorrhagic stroke” results. Stroke can also result when there is undue pressure on an area of brain by a bulging blood vessel (aneurysm). Investigation following Stroke Although the majority of strokes are caused by a clot blocking a vessel (ischaemic stroke), if a haemorrhagic stroke is treated as you would an ischaemic stroke the result would be catastrophic as more blood would leak in to the area, causing more damage to the brain cells. According to the American Stroke Association, 13% of strokes are haemorrhagic strokes. Therefore, before commencing treatment it is essential to investigate quickly and confirm the type of stroke. Scan: To distinguish between ischaemic and haemorrhagic stroke, it is necessary to have a brain scan. The scan will confirm the type of stroke. Other Tests: General examination of the patient will include checking for high blood pressure and for irregular heart beats (atrial fibrillation). An irregular heart beat can produce a blood clot which can travel to the brain and block a vessel. Routine blood tests will also check for high cholesterol. Treatment The aim of treatment is to re-establish normal blood supply to the area of brain affected. I n ischaemic stroke, the treatment is to unblock the vessel where the blood flow has been stopped. In haemorrhagic stroke, the leak from a blood vessel must be arrested. Once the type of stroke is confirmed, treatment should be started without delay. Effective and early treatment can prevent long-term disability. Treatment is usually non-surgical but surgery may be needed in some cases. Non-Surgical Treatment: Alteplase, also known as tPA, is an injection that is given to dissolve the clot (thrombolysis). Fortunately the majority of strokes are caused by a blood clot. However, for it to be effective it must be given within 4 to 5 hours of a stroke. It is estimated that 1 in 7 patients benefit from this drug. Other Drugs: Aspirin and Clopidogrel: Both d rugs can prevent further clot formation. Aspirin thins the blood. Clopidogrel acts on the platelets and makes them less sticky thus preventing clot formation. Long Term Drugs: To prevent further clots developing, anticoagulants like heparin and warfarin may be given for varied lengths of time depending on the cause for the clot forming. Anti-coagulants are particularly useful when the patient has an irregular heart rate (atrial fibrillation) or at risk of developing (or had) a blood clot in the leg (DVT). Statins: If the level of cholesterol is high statins that lower levels may be prescribed. High cholesterol levels could increase the build-up of fatty plaque inside a vessel wall. Antihypertensives: High blood pressure can cause an aneurysm in the brain to leak blood. In this case anti-hypertensive medication will be prescribed. Surgical Treatment: Surgery could be undertaken for a variety of reasons. The type of procedure will depend on the cause and type of stroke. Carotid Endarterectomy: If an artery in the neck (carotid artery) is narrowed by a build-up of fatty plaque, carotid endarterectomy will be considered. In hemorrhagic stroke, the types of surgery done will include clipping of an aneurysm, coil embolization, and repair of arteriovenous malformation (AVM). For more information about these procedures check the article “Basic Facts About Stroke” in the “Medical Forum” Conclusion: Stroke is a major cause of disability and death. As every stroke is different, there is no set pattern for recovery. However, the sooner treatment is started, the better the recovery. If you suspect something is medically not right with someone close to you, think “FAST”. It could be a stroke. F = Facial weakness, A = Arm weakness, S = Speech altered and T = Timing of treatment determines speed of recovery. K. Badrinath References: NHS Choice, American Stroke Association, National Heart Lung and Blood Institute,
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Fatty Plaque obstructing an artery
Blood clot obstructing an artery
Sudden Distortion of Face