Stroke (cerebrovascular accident)

What is a stroke?

A stroke happens when the blood supply to the brain is

disturbed in some way. As a result, brain cells are starved of

oxygen. This causes some cells to die and leaves other cells Most strokes happen when a
blood clot blocks one of the
damaged. arteries (blood vessels) that
carries blood to the brain.

Types of stroke

Most strokes happen when a blood clot blocks one of the arteries (blood vessels) that carries

blood to the brain. This type of stroke is called an ischaemic stroke.

 Transient ischaemic attack (TIA) or 'mini-stroke' is a short-term stroke that lasts for less

than 24 hours. The oxygen supply to the brain is quickly restored and symptoms

disappear. A transient stroke needs prompt medical attention because it indicates a

serious risk of a major stroke.

 Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies

blood to the brain. Blood vessels that are furred up with fatty deposits (atheroma) make a

blockage more likely. The clot prevents blood flowing to the brain and cells are starved of

oxygen.

 Cerebral embolism is a blood clot that forms elsewhere in the body before travelling

through the blood vessels and lodging in the brain. In the brain, it starve cells of oxygen.

An irregular heartbeat or recent heart attack may make you prone to forming blood clots.
 Cerebral haemorrhage is when a blood vessel bursts inside the brain and bleeds

(haemorrhages). With a haemorrhage, blood seeps into the brain tissue and causes extra

damage.

What are the symptoms of a stroke?

Strokes usually happen suddenly. No two strokes are the same and people can be affected

in quite different ways.

To an extent it depends on which area of the brain is damaged, because different parts

control different abilities such as speaking, memory, swallowing and moving.

The most common signs of a stroke are:

 weakness down one side of the body, ranging from numbness to paralysis that can affect

the arm and leg

 weakness down one side of the face, causing the mouth to droop

 speech may be difficult or become difficult to understand

 swallowing may be affected

 loss of muscle coordination or balance

 brief loss of vision

 severe headache

 confusion.

People who have had a severe stroke may lose consciousness. Unfortunately, the likelihood

of such patients making a good recovery is poor.

Face-arm-speech test (FAST)

 The Stroke Association says three simple checks can help you recognise whether someone

has had a stroke or mini-stroke.

 Facial weakness: can the person smile? Has the mouth or eye drooped?

 Arm weakness: can the person raise both arms?

 Speech problems: can the person speak clearly and understand you?

 Test these symptoms.

If you see any of these signs, call 999 for an ambulance.

How is a stroke treated?

Immediate treatment

In hospital, brain scans are needed to find out what type of stroke you've had.

 If a blood clot is the cause, 'clot busting' medication may be used to dissolve the clot, but

this must be given within three hours of the stroke. Anti-clotting medication such as aspirin

may also be given to stop the stroke from getting worse.

 Anti-clotting medication is not given in strokes caused by haemorrhaging because it will

make the bleeding worse.

Other treatment includes:

 tests on key functions like swallowing and movement

 checks on oxygen, glucose and blood pressure levels.

If swallowing is affected, you may be fed by a tube or given fluids into a vein (intravenously)

to avoid food going into the lungs.

After a stroke
 In the first few days after a stroke, treatment concentrates on making sure you are well

hydrated and nourished.

The next phase of treatment is recovery through rehabilitation. This involves a team of health

professionals including physiotherapists, speech therapists, occupational therapists, nurses

and doctors.

If a stroke is caused by a blood clot, then taking a low-dose aspirin (eg Nu-seals 75mg) once

a day may help make the blood less sticky and less likely to cause clots.

What are the risk factors?

 High blood pressure does not cause any symptoms, so everyone over the age of 40

should have an annual blood pressure check.

 Smokers have double the risk of stroke as non-smokers.

 Irregular heart beat (atrial fibrillation) is fairly common in old age. It increases the risk of

stroke by causing blood clots to form in the heart. Blood clots can be prevented from

forming by taking warfarin (eg Marevan), a medicine that makes the blood less likely to

clot. Warfarin treatment requires careful monitoring with regular blood checks and is a

very effective way to reduce the risk of stroke.

 Diabetes affects 1 in 20 older people and can increase the risk of having a stroke. Good

control of diabetes is important and requires attention to diet, regular urine tests or blood

tests and probably some medication.

 Too much alcohol increases the risk of a stroke. The recommended safe limits for alcohol

consumption are 21 units each week for women and 28 units each week for men. One unit
 of alcohol is equivalent to a measure of spirits, a 125ml glass of wine or half a pint of beer.

People who drink more than this run a higher risk of stroke, liver disease and dementia.

http://www.netdoctor.co.uk/diseases/facts/stroke.htm