STROKE - What is a stroke?
A stroke is brain damage resulting from the interruption of the flow of blood to a part of the brain. There are two common causes of stroke. In one a blood clot leaves the heart and passes up the arteries until it reaches a point as the arteries get smaller and smaller where it can go no further, and it then blocks that artery therefore cutting off the oxygen supply to the part of the brain supplied by that artery. The second type of disorder that causes a stroke is when a blood vessel burst because the blood vessel wall has been damaged. Both these causes are linked to diseases of the arteries of the body and therefore due to the same common risk factors, notably
- high blood pressure
- cigarette smoking
- high levels of cholesterol in the diet and bloodstream
- atrial fibrillation causing irregual heart beats
The term Transient Ischemic Attack (TIA) is used to describe an interruption of the blood supply that does not cause long term health effects because it is only a transient effect, for example lasting less than twenty-four hours. The importance of a TIA however is that it is a signal that the blood supply to the brain is not in good order and a person who has had a TIA, identifying using the FAST checklist needs urgent assessment in hospital to identify and correct risk factors.
· F: Face drooping. Ask the person to smile, and see if one side is drooping. ...
· A: Arm weakness. Ask the person to raise both arms. ...
· S: Speech difficulty. ...
· T: Time to call 9-1-1!
If a sroke is suspected et help FAST
Why are strokes important?
Strokes are important because they are common causes of disability.
Most of the problems they cause are very disabling, but strokes can affect parts of the brain other than those that control movement, for example parts of the brain that affect the ability to speak which results in a very distressing condition in which the person appears to be healthy but has difficulty in turning what they want to say in words.
It isalso now clear that one of the principal causes of dementia is multiple minor strokes none of which affect the ability of the body to move and therefore they do not have obvious symptoms to alert the person or their family that a mini stroke has occurred but the net effect of multiple mini strokes is dementia.
Why is it important to understand strokes?
It is very important to understand strokes because the risk of a stroke can be reduced. They are not due to ageing but one or more of the risk factors listed above. Furthermore when somebody has a stroke or mini-stroke it is vitally important that steps are taken to identify the cause or causes and correct them. If for example the cause is atrial fibrillation namely irregular beating of the heart which allows clots to form in the heart and then pass to the brain, then the diagnosis and treatment of atrial fibrillation will prevent strokes or mini strokes and therefore prevent dementia.
Can the effect of a stroke be reduced or reversed?
If someone has a stroke, then it is very important that they receive expert help from a team who have all the skills required to identify the cause or causes of the stroke and mitigate the effects. Because a stroke may impair mobility it accelerates loss of fitness and this needs to be communicated to the person affected and to their family so that instead of doing things for the person means are found to help them regain the ability to do something for themselves, perhaps using some equipment to do this.
People can certainly make a complete recovery from a stroke, but it is a devastating condition and many people, doctors included, fear a stroke more than they fear cancer because of the effect on the brain and the mind.
What can be done?
Firstly it is very important to reduce the risk of stroke and this is done by reducing the risk of vascular disease described in a separate section.
Secondly people need to be aware of the possibility of a stroke and this link to the FAST website https://www.thinkfast.org.uk/provides clear information.
Thirdly when a stroke has occurred it may be possible to help the older person at home but referral to a specialised centre for accurate diagnosis of the cause of the stroke is now agreed to be of high importance. Some strokes can be cured by injecting anti-coagulants right at the spot where the blood vessel is being blocked but this needs to be done in specialised centres.
Once a stroke has occured of course the principle remains true that healthcare is what the person does for themselves but the second most important of care being that provided by friends and family.