From underlying causes, transient attacks and treatments to blood clot types, tests and psychological care, suffering a stroke can be tantamount to being struck off the life list. Here’s how to help prevent it happening, or cope with it constructively.

 

Though there are often warning signs, a stroke can strike out of the blue, cause severe brain damage or kill the sufferer instantly. However, few people know that if the patient is taken to a competent doctor or neurologist within three hours, the effects can be totally reversed. “Though it’s not easy, the ideal is to get the patient recognized, diagnosed and cared for immediately,” says Dr Ayan Panja, who writes regular health columns for Sweet magazine.

Roughly defined as the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain, a stroke is most often caused by ischaemia (lack of blood supply) or haemorrhage, says Dr Saul Yudelowitz.

 

ISCHAEMIC STROKE

Occurs when a blood vessel clogs because of atherosclerosis, the development of fatty deposits lining the vessel walls. These fatty deposits can cause two types of obstruction:

Cerebral thrombosis is a blood clot that develops at the clogged part of the vessel.

Cerebral embolism is a blood clot that forms elsewhere in the circulatory system, usually the heart and large arteries of the upper chest and neck. A section of the blood clot breaks loose, enters the bloodstream and travels through the brain until it reaches vessels too small to let it pass. A second cause of embolism is an irregular heartbeat, which causes clots to form in the heart, dislodge and travel to the brain.

 

HAEMHORRAGIC STROKE

Occurs when a blood vessel ruptures and causes blood to leak into the brain. The blood accumulates and compresses the surrounding brain tissue causing either an intracerebral haemorrhage or a subarachnoid haemorrhage.

The weakened blood vessels which cause haemorrhagic stroke are called aneurysms and arteriovenous malformations (AVMs). An aneurysm is a ballooning of a weakened region of a blood vessel, while an AVM is a cluster of abnormally formed blood vessels, which can rupture at any stage.

 

TRANSIENT ISCHAEMIC ATTACK (TIA)

Heed the TIA, a minor stroke in which blood supply to a restricted area of the brain is interrupted and causes stroke-like symptoms for under 24 hours. “It is often an early warning sign that an obstruction exists in an artery leading to the brain,” says Dr Yudelowitz.

Symptoms are variable, but the most common are temporary loss of vision (in which many say they feel like a shade is being pulled down over one eye), difficulty speaking, weakness on one side of the body and impairment of consciousness. Though the blood clot may resolve itself through normal methods, it is wise to consult a doctor and have tests (like a CT scan) done to prevent a major stroke occurring. “A sports biomechanic or physiotherapist can give advice on exercise, and a nutritionist on diet. Different types of medication may be prescribed to help dissolve a clot or reduce the ability of blood to clot,” says Dr Yudelowitz. “Anything that could cause hypercoagability of the blood like smoking, drug use like the pill should be avoided, and needs to be discussed with the doctor.”

 

RECOGNISE THE SYMPTOMS

Though symptoms vary from person to person, asking the sufferer three simple questions will give you a good indication whether s/he is having a stroke, advises Dr Panja:

Ask the patient to smile, speak a simple sentence coherently (i.e. I am wearing a blue jersey) and raise both arms. If the patient has problems with any of these, get hold of a doctor or ambulance immediately, and ensure that treatment (often in the form of a clot-dissolving medicine) is given within three hours to prevent permanent damage.

“Another indication of a stroke is inability to stick out the tongue straight. If the tongue is crooked or goes to one side or another, it is a sure sign of a stroke,” says Dr Panja,

 

RISK FACTORS

High blood pressure, smoking, high cholesterol, heavy intake of alcohol are the main culprits, says Dr Panja, who recommends regular exercise, avoidance of high-fat food and refined carbohydrates as the best preventive remedies. “Get your blood pressure and cholesterol checked regularly by your doctor or practice nurse, especially if you have a family history of stroke,” he advises, adding that stroke is most common in those of African-Caribbean descent.

 

PREVENTATIVE TREATMENTS

In Ischaemic Stroke, obstructions are removed to restore blood flow to the brain. For the five percent of victims who reach the hospital within three hours of the stroke, the clot-busting drug tPA has shown the best results. Antiplatelet tablets like aspirin and anticoagulants like warfarin can also play a big role in preventing stroke, while carotid endarterectomy, by which surgery removes blockages from the carotid artery, and balloon angioplasty and the imposition of steel stents remedy fatty build-up.

In Haemhorragic Stroke, an obstruction is introduced to prevent rupture and bleeding of aneurysms and arteriovenous malformations. Metal clips are placed at the base of the aneurysm by means of surgery, or coils and the like are introduced by means of a catheter through a major artery in the leg or arm.

 

GET A DIAGNOSTIC TEST

Diagnostic tests are generally safe and painless and outline the injured brain area, by examining the workings of the brain, how it functions and gets its blood supply.

Diagnostic tests fall into three categories:

* Imaging tests (MRI, CT or CAT scan) give a picture of the brain similar to X-rays.   

* Electrical tests (EEG, Evoked Response) record the electrical impulses of the brain.   

* Blood flow tests (B-mode imaging, Doppler testing, duplex scanning, angiography) provide information about the condition of arteries and pick up problems that may cause changes in blood flow to the brain.

 

PHYSICAL EFFECTS

The effects of a stroke are wide-ranging, but are chiefly affected by the location of the obstruction and the quantity of brain tissue affected. Because one side of the brain controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the side of the body if affects. While paralysis and memory loss are common in both, a stroke on the right side is characterized by vision problems and quick, inquisitive behaviour. A stroke on the left side is likely to produce speech/language impairment and slow, cautious behaviour.  

If the stroke occurs towards the back of the brain, some disability involving vision is sure to result.

 

COPING WITH STROKE

In addition to the physical side-effects, the psychological effects of stroke can be just as devastating or demeaning, says Dubai consultant health psychologist Dr Melanie Schlatter, “Mood is typically affected during the first few months post-stroke, with depression being the most common disturbance. Anxiety and a tendency for labile emotions are also frequent.”

Though there are plenty of common-sense ways to make life easier for the victim, assessment and intervention are complicated by the type of stroke and range of symptoms.

“In general, if a mood disturbance has been diagnosed, it must be closely monitored, especially during the first six months after leaving the hospital,” says Schlatter, who recommends sound psychological care.

  1. Arrange counselling. One of the biggest problems patients have is not understanding what has happened to them and why they feel the way they do. While doctors and aftercare facilities can provide regular monitoring, the best solution for all-round support is regular sessions with a trained counsellor.
  2. Follow up. Rehabilitation involves helping the individual to return to as active a life as possible, including reintegration into the community. The needs of the patients and their families differ in the short and long term, and need regular follow-up from a multidisciplinary team.
  3. Treat with dignity and respect. “Imagine how distressing it must be for a previously high functioning individual to have sensorimotor impairments, perceptual difficulties, and having to rely on people around them for help. Also use clear communication, provide support and encouragement, and encourage hope for the future,” recommends Schlatter.
  4. Arrange social support. Social support has been shown to correlate with post-stroke improvement and it is vital when patients return home. Instrumental, educational and emotional forms of support are the most important aspects. In many countries, there are community-based services (often voluntary) which help caregivers, families, and friends of the patient. These services may be in the form of home help including delivery of meals, help with transport, or professionals involved in the rehabilitation directly.
  5. Educate yourself. Especially if the victim is elderly, s/he is more likely to have lost some insight or executive functioning and lots of confidence. It is therefore vital for family members to come to term with the change in the patient and the new responsibility that it all involves. A good way to do this is to set up peer support groups for family members; where techniques and knowledge can be shared.

 

FURTHER READING

Striking Back at Stroke by Cleo Hutton and Louis R Caplan (Kindle Books)

 

(Published in August 2008 in Aquarius, Dubai, copyright Sharon Marshall 2008.)