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,
Fatty Plaque obstructing an artery
Blood clot obstructing an artery
Sudden Distortion of Face