What is a stroke?
A stroke is a potentially life-threatening condition that is caused by the interruption of blood flow to the brain. The brain requires oxygen carried within the blood in order to function properly. Without oxygen, brain tissue begins to die. This can cause serious issues like movement problems, speech difficulties, cognitive impairments and swallowing problems..
What are the different types of stroke?
There are two main types of stroke: ischaemic and haemorrhagic stroke.
Ischaemic Stroke
The most common type is an ischaemic stroke – this is when blood flow to your brain is blocked by a clot and oxygen can no longer reach your brain. This type of stroke makes up 85% of all stroke cases (NHS).
Blood clots are formed over time from the development of fatty deposits within your blood vessels (known as atherosclerosis). Over time, the fatty deposits can narrow the blood vessels so much that blood flow is completely obstructed and can no longer reach your brain. Once this happens, an ischaemic stroke occurs.
Certain factors put you at more risk of developing a blood clot, including:
- Smoking
- Obesity
- High blood pressure or high cholesterol
- Excessive alcohol intake
Haemorrhagic
The second most common type of stroke is a haemorrhagic stroke. This is caused by a weakened blood vessel within your brain bursting, allowing blood to flow outside of the vessel.
The main cause of a haemorrhagic stroke is high blood pressure. Over time, the sustained high pressure within the blood vessels weakens the vessel walls. Once they become too weak, blood bursts from the vessel and leaks into the surrounding area – in the case of a stroke this is the area between the brain and the skull.
Factors that cause high blood pressure are:
- Poor diet
- Lack of exercise
- Smoking
- Stress
Transient Ischaemic Attack (TIA)
There is a third condition related to stroke which is called a transient ischaemic attack (TIA or mini stroke). A TIA occurs due to the partial obstruction of oxygen to the brain. Symptoms are the same as stroke but they resolve within 24 hours. Although the symptoms settle, this is a very serious condition as 1 in 5 people will develop a stroke or heart attack within one year if they have had a TIA (Hill and Couts, 2011) so they should not be ignored.
What do I do if I think someone is having a stroke?
A stroke occurs every 5 minutes in the UK (Stroke Association) and brain tissue dies within 4 minutes of oxygen starvation. The effectiveness of treatments also diminish as time passes so acting quickly when you think someone is having a stroke is literally life-changing.
Call 999 immediately if you think someone is having a stroke.
The main symptoms can be remembered as FAST.
(Stroke Association) There are other signs of stroke:
- Complete loss of movement from one side of the body
- Dizziness
- Changes in vision/blurriness
- Difficulty swallowing
- Confusion
- Poor balance or coordination
- Not understanding what you are saying
It is important to act FAST when you suspect someone is having a stroke – a stroke starves the brain of oxygen so the quicker you act, the less brain damage occurs.
What are the treatments for a stroke?
The treatment for stroke is time dependent – the quicker treatment is administered, the quicker the blood flow to the brain is restored and less brain damage occurs.
Ischaemic Stroke:
To treat ischaemic strokes, medicines are normally used. In the first instance, thrombolysis may be an option. Thrombolysis is a clot-dissolving treatment and is most effective if started within 4-5 hours of stroke symptoms. The most common thrombolysis medication used in the UK is Alteplase (NICE). This is administered via an injection. Thrombolysis is never used in haemorrhagic strokes as this can make the bleeding worse.
If thrombolysis is not an option, aspirin will be administered. Aspirin is an antiplatelet which reduces the chance of another clot forming. Other medicines like anticoagulants, or blood thinners, may also be prescribed which reduce the risk of blood clots forming in the future. These medicines are commonly Warfarin or Apixaban. As well as this, if the patient has high cholesterol they will be prescribed statins to prevent future risk of blood clots forming (NICE).
In some instances, a surgical procedure may be performed to take the clot out manually. This is an emergency procedure known as thrombectomy. This procedure involves a surgeon inserting a catheter into a major blood vessel via the groin. The catheter is then passed into the blocked blood vessel and the clot is removed by the surgeon. This procedure is performed either under local or general anaesthetic.
How can I prevent myself or a loved one from having a stroke?
The best way to reduce your risk of having a stroke in the future is to maintain a healthy lifestyle. All preventable stroke risk factors can be altered with healthy lifestyle options (NHS).
Lifestyle changes that will help reduce a stroke are exercising regularly, eating a healthy and balanced diet, stopping smoking and reducing your alcohol intake.
If you are more active and have a healthy diet, your risk of stroke can decrease by up to 43% (Hooker et al, 2022).
How can I prevent myself or a loved one from having a stroke?
A stroke can be a life-changing event for yourself and your loved ones, especially if you have a new physical or cognitive disability. After your initial injury you will begin a period of rehabilitation, the good news is your body is able to heal, regenerate and build new pathways to help restore your previous abilities. It’s important to access physiotherapy, occupational therapy, speech therapy and any other services that may be relevant to ensure you start on your path to recovery.
Recovering from a stroke is rarely easy or quick, however having the right support around you and the motivation to improve your health you can recover some or all of the abilities you may have lost.
References:
https://www.nhs.uk/conditions/stroke/
Hill and Coutts (2011) Preventing stroke after transient ischaemic attack. CMAJ.
https://www.stroke.org.uk/
https://www.nice.org.uk/guidance/ng128
Hooker et al (2022) Association of Accelerometer-measured sedentary time and physical activity with risk of stroke within US adults. JAMA.