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Condition
Stroke

Class
Cardiovascular system
Description
A stroke happens when there is an interruption of the blood supply to an area of the brain. When the brain is deprived of blood, brain cells are not supplied with oxygen and nutrients and they become damaged or die. This can have a number of different effects, depending on the part of the brain affected and the amount of damage caused.

A 'mini-stroke' or transient ischaemic attack (TIA) happens when the blood supply to the brain is only briefly interrupted. A TIA usually lasts less than 24 hours and afterwards there is seemingly a full recovery. A TIA is a warning that part of the brain is not getting enough blood and that there is a risk of a stroke occurring in the future.

The Stroke Association estimates that every year 150,000 people in the UK suffer a stroke. Most people affected are over the age of 65, but a stroke can affect anyone of any age. Each year in the UK, an estimated 1000 people under the age of 30 have a stroke. The risk of stroke increases as people get older, men are more likely to be affected than women, while people of Asian, African and Afro-Caribbean descent are at greatest risk.

Strokes are the third most common cause of death and the most common cause of adult disability in the UK. More than a quarter of a million people in the UK live with a disability caused by a stroke. Three times more women die from a stroke than die from breast cancer.

Causes
There are two main types of stroke and each has a different cause.

The more common type of stroke, occurring in about 17 out of every 20 cases, is called an ischaemic stroke. It occurs when a blood clot blocks an artery serving the brain, disrupting the blood supply. This type of stroke often happens because of a build up of cholesterol in the arteries. A TIA is a form of ischaemic stroke.

The other type of stroke, occurring in about 3 out of every 20 cases, is called a haemorrhagic stroke. It occurs when a blood vessel in or around the brain bursts, causing a bleed or haemorrhage. Untreated high blood pressure places a strain on the artery walls, increasing their risk of bursting and bleeding and causing a haemorrhagic stroke.

Symptoms
Every stroke is different and people will be affected in different ways depending upon the area of the brain where the stroke took place, the amount of damage caused, and the time at which treatment was started following the stroke.

The most likely first symptoms to occur after an ischaemic stroke are numbness, weakness or paralysis on one side of the body, slurred speech or difficulty finding words or understanding speech, blurring, disturbance or loss of vision, dizziness, confusion, unsteadiness and/or a severe headache.

Three simple checks, called FAST (Face-Arm-Speech Test) can be used to recognise if someone has had a stroke:

  • Face - Is there facial weakness? Can the person smile? Has their mouth or eye drooped?
  • Arm - Is there weakness in the arms? Can the person raise both arms?
  • Speech - Can the person speak clearly?
The most common, longer-term problems after a stroke are weakness or paralysis, speech and language difficulties, difficulty recognising familiar objects or knowing how to use them.

As the brain also controls the way a person thinks and feels, a stroke can affect many thought processes, such as concentration, memory, decision-making, reasoning, planning and emotions. Tiredness is also very common after a stroke.

A stroke is sudden and the effects are immediate. Most recovery occurs within the first few months following a stroke, but people continue to recover several years later, perhaps as other areas of the brain take over from those areas that have been damaged.

Treatment
Speed is the most critical factor in the treatment of ischaemic stroke. The sooner that treatment can begin after the person has had a stroke, the greater the chances of the person surviving and making a full recovery. This is why it is essential that emergency medical help is called as soon as someone is suspected of having a stroke. See FAST in the 'Symptom' section above and 'Protecting yourself and others from stroke' section below.

Doctors refer to a time called the 'window of opportunity'. If a person with an ischaemic stroke is admitted to hospital within 4.5 hours of the onset of the stroke, drugs known as thrombolytic agents can be administered to dissolve the clot that is blocking the blood supply to the brain. The earlier that the thrombolytic agent is used, the less time the brain has been deprived of oxygen and therefore the greater the chances that the brain will recover, so limiting the extent of the injury and improving the chances of recovery.

After the initial treatment of an ischaemic stroke, the aim is to stabilise the patient's condition, prevent recurrence of the stroke, control blood pressure and prevent complications. There are a number of medicines that doctors may prescribe. Anti-platelet drugs such as aspirin, clopidogrel and dipyridamole will be used to reduce the chances of the blood from clotting. Drugs known as statins (atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin) may also be prescribed to lower blood cholesterol levels and reduce the risk of atherosclerosis. Other medications to control blood pressure and diabetes may also be used if appropriate.

For patients who have had a haemorrhagic stroke, surgery is usually required to stop the bleeding and to reduce the pressure on the brain.

Once the person is stable following an ischaemic or haemorrhagic stroke, he or she will begin a rehabilitation programme which aims to help the person regain as much independence as possible. This rehabilitation programme is likely to include therapy to help with posture, balance and movement, as well as speech and language and will involve a range of specialists including physiotherapists, psychologists, occupational therapists and speech therapists.

When to see your pharmacist
If you or a member of your family has suffered an ischaemic stroke, it is likely that you will be prescribed quite a large number of medicines to be taken for long periods. In such circumstances, it is worth nominating a pharmacy to be involved in the repeat dispensing of your prescriptions. In this way, your pharmacist will get to know you and the medicines that you are taking and will be available to offer advice, guidance and reassurance.

When to see your doctor
If you suspect that you or someone has suffered a stroke, seek medical help immediately. Both ischaemic and haemorrhagic strokes are medical emergencies and the sooner that the condition can be properly diagnosed and treated the less risk there is of death and the better the chances are of recovery. If you suspect that you or a relative has had a TIA but has recovered, see a doctor at the earliest opportunity to allow treatment to begin and reduce the chances of a stroke occurring.

Protecting yourself and others from stroke
Get to know FAST, the Face, Arms and Speech Test used to recognise if someone is having or has had a stroke. If a person does have a stroke, or you suspect that the person has had a stroke, treat it is a medical emergency, call for an ambulance, tell the controller what you suspect, and get the person to hospital immediately. The faster you can act and the quicker that the person can receive emergency medical treatment, the better are the chances of recovery.

If the person has any of the symptoms described above but quickly recovers, it is likely that he or she has had a TIA and they should see a doctor as soon as possible.

Living with stroke
It is important that you or the person affected by the stroke takes an active role in the rehabilitation programme to achieve as full a recovery as possible. Things may seem difficult or even impossible from the start but the multi-disciplinary team of physiotherapists, occupational therapists and speech therapists are there to help. Attend appointments, persevere with the exercises and you will find that things will gradually begin to improve.

Adopt a number of lifestyle changes to reduce the risk of ever getting a stroke. to reduce the chances of a TIA, or the recurrence of a stroke. These include stopping smoking, drinking alcohol only in moderation, taking regular exercise and avoiding becoming overweight or losing weight if obese.

Eat sensibly, avoid saturated animal fats that raise cholesterol levels and increase the chance of ischaemic stroke. Increase consumption of fruit and vegetables. Reduce intake of salt by avoiding processed foods and stop adding salt when cooking or eating meals.

Try to control stress.

If you have high choldesterol levels, high blood pressure or diabetes ensure that they are well controlled by taking all medicines prescribed according to instructions. Get your cholesterol levels and blood pressure measured regularly and, if you have diabetes, keep your blood sugar levels under control.

Useful Tips
  • Stop smoking
  • Keep alcohol intake below the recommended limits
  • Eat a diet low in salt and low in fatty and sugary foods

Further information
The Stroke Association is the only UK-wide charity solely concerned with combating stroke in people of all ages. It funds research into prevention, treatment and better methods of rehabilitation, and helps stroke patients and their families directly through its Life After Stroke Services. These include information, advice and support, and financial grants. The Stroke Association also campaigns, educates and informs to increase knowledge of stroke at all levels of society, and act as a voice for everyone affected by stroke.

The Stroke Association
Stroke House
240 City Road
London
EC1V 2PR
Tel: 020 7566 0300
Helpline: 0303 303 3100 (Monday to Friday, 9am to 5pm)
Email: info@stroke.org.uk
Web: www.stroke.org.uk

Reviewed on 27 July 2011


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