We’ve all heard of “heart attacks” but have you heard of a “brain attack”?
The National Health Service of the UK had a publicity campaign a few years ago about stroke, where they “rebranded” strokes to try and teach the public that they need to act fast if they suspect somebody is having one.In my earlier years as a family doctor, the decision about whether to admit a patient who had had a stroke was mainly governed by whether they were able to be cared for at home.
A stroke is caused by the blood supply to part of the brain being cut off. This can be caused by a bleed in the brain, or more commonly a blood clot that blocks an artery.
Nowadays, a stroke is a medical emergency. In an ideal world, anyone with a suspected stroke should be transferred urgently to a specialist stroke unit, where they would be put through a scanner to determine whether it is a blood clot or a bleed. Then, if appropriate, they will be given clot-busting drugs quickly (ideally within 3 hours of the start of symptoms) to try and preserve as much brain function as possible.
F A S T
The symptoms of a stroke depend on which part of the brain has lost its supply, but the NHS came up with a good mnemonic for remembering the most common ones, FAST.
F for Face; has one side of their face drooped? Can they smile normally?
A for Arm; can they lift both arms in front of them and hold them there?
S for speech; is their speech slurred or are they having problems speaking?
T for Time to call an ambulance if any of the above symptoms are present.
Strokes can also cause problems with walking due to weakness in one leg, dizziness or loss of coordination, headache, loss of vision, difficulty in understanding or confusion.
Brain cells die off quickly, and the initial treatment of strokes is aimed at reversing any damage done and preventing any further damage. So called “clot-buster” drugs, (which were developed originally for use in heart attacks) break down the blood clot to allow blood to flow back to the affected area of the brain, and are usually given into a vein. Some specialist centres are however injecting these drugs directly into the affected part of the brain, and other centres are using little tiny instruments which are fed through the arteries from the groin up into the brain and used to grab the clot and literally pull it out. It is unclear yet whether these techniques give any better results than the intravenous clot busters, but it is incredible what is possible!
A transient ischaemic attack, or mini stroke, is an ischaemic stroke (a stroke caused by a clot) from which the symptoms resolve within 24 hours and often much quicker. It is still important however to seek medical attention as soon as possible as this can be the precursor to a proper stroke.
A vital part of stroke care is reducing risk of further strokes. This can be done by tackling risk factors for stroke, such as smoking, high blood pressure, high cholesterol and diabetes.
It is equally important to look at why you may have had the stroke in the first place; for example you may have a blood clot in the heart or in one of the large carotid arteries in your neck, which is sending off little emboli (clots) up into your brain. It may be that surgery to clean out your carotid artery, or a blood thinning agent will help to reduce your risk of further strokes.
After the acute care is over, and, as with any type of brain injury, rehabilitation becomes the priority. Good rehab by a multidisciplinary team of specialist doctors and nurses, physiotherapists, speech therapists, occupational therapists, dieticians, social workers, and psychologists can make an enormous difference to recovery, and it is amazing how the brain can recover at times when things seem pretty dire.
Remember though, prevention is always better than cure, and my next article will be about reducing your risk of stroke or heart disease.
By Susie Tunstall-Pedoe, May 2014