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Stroke

A stroke happens when the blood supply to the brain is interrupted. If your brain doesn't get enough blood to provide the oxygen and nutrients it needs, your brain cells will become damaged or die. It happens suddenly and can cause immediate loss of feeling and weakness, usually on one side of the body. A stroke can also affect speech, vision, memory and emotions.

A stroke is a medical emergency, so recognising the symptoms quickly and getting early treatment in hospital is important.

Key facts about stroke

  • About 60,000 Australians a suffer a stroke each year.
  • Stroke is the second highest cause of death for women in Australia after coronary artery disease.
  • More women than men die from stroke - latest statistics show that 6,706 women died of stroke in 2009, compared to 4,514 men.
  • About 300,000 Australians are living with the disabling effects of a stroke.
  • Stroke costs the nation an estimated $2.14 billion a year.

Types of stroke 

There are a number of different types of stroke:

  • Ischaemic stroke. This happens when the blood supply to part of your brain is blocked by a blood clot or a piece of fatty material
  • Haemorrhagic stroke. This is caused by bleeding inside your brain. It can happen when a blood vessel bursts inside your brain or more rarely, on the surface of your brain
  • Transient ischaemic attack (TIA or 'mini-stroke'). TIA is a stroke in which the symptoms are only temporary. TIA's happen when the blood supply to your brain is interrupted for a short time
  • Stroke from cervical artery dissection. This is caused when the lining in one of the arteries in your neck is torn, restricting the blood supply to your brain.

Symptoms of stroke 

The symptoms of a stroke come on suddenly and could be all or any of the following:

  • weakness, usually on one side of the body
  • numbness
  • dizziness, loss of balance
  • loss of vision or blurred vision
  • severe headache
  • difficulty swallowing
  • difficulty speaking
  • difficulty walking

Depending on the size and location of the damage and the treatment available, the effects of a stroke can vary. The ability to move your arms, legs or face may be affected or you may be unable to speak or hear properly.

Because of the way the nervous system works, a stroke affecting the left side of the brain affects movement on the right side of the body and vice-versa. Symptoms usually come on suddenly, within seconds or minutes. Headaches that are a symptom of stroke are usually severe and come on suddenly or you'll notice a change in the pattern of your headaches.

Stroke is a medical emergency

As a stroke is a medical emergency, "000" (triple zero) should be called.

The acronym "FAST" is a good way to remember what to do if you think someone may be having a stroke:

F - face: Ask the person to smile. Does one side of the face droop?

A - arms: When raising both arms does one drift down or not move?

S - speech: Ask the person to repeat a simple sentence. Are the words slurred or incorrect?

T- time: Act fast, ring 000 and rush to hospital.

If you suspect that someone is having a stroke, don't hesitate to act and seek help. Urgent treatment in hospital within three hours can help minimise the chance of permanent brain damage.

Long term effects of stroke 

Some strokes may be quite mild and the effects only temporary, whereas others may be more severe and cause lasting damage. Long term effects of stroke include:

  • weakness or paralysis, usually on one side of your body
  • lack of awareness of one side of your body (usually the left side)
  • loss of sensation on one side of your body
  • difficulty swallowing
  • extreme tiredness and sleep problems
  • problems with speech, reading and writing
  • problems with vision - for example, double vision or partial blindness
  • memory and concentration difficulties
  • difficulty controlling your bladder and bowel movements (incontinence), or constipation
  • behavioural changes.

Problems such as anxiety, depression and seizures (fits) can often improve as you recover.

Long-term complications of stroke due to reduced ability to move may include:

  • Pressure ulcers - more commonly known as bed sores
  • Deep vein thrombosis (DVT) - blood clots in the leg
  • Pneumonia
  • Contractures - altered position of your hands, feet, arms or legs because of muscle tightness.

Rehabilitation can help those affected by stroke to learn new ways of using and moving weak arms and legs. This can help reduce the risks of these complications.

Causes of stroke 

As you get older, the risk of having a stroke increases.

Risk factors for stroke include:

  • high blood pressure
  • high cholesterol
  • smoking
  • migraine
  • family history of stroke or blood clotting disorder
  • irregular heart beat (in particular atrial fibrillation)
  • obesity
  • diabetes
  • poor diet and inadequate exercise.
  • Hormone replacement therapy (HRT) to treat symptoms of menopause may be an additional risk factor for women. Read more about HRT.

Diagnosis of stroke 

You will have a number of tests in hospital to try and find out what type of stroke you had and which part of your brain is affected. This will allow your doctor to plan your treatment.

You will have your blood pressure measured and an electrocardiogram (ECG) to record the rhythm and electrical activity of your heart. You may then have blood tests to measure your cholesterol and blood sugar levels, and to check for clots. You will also have a brain scan such as a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan as soon as possible. This will help to find out if your stroke happened because of a bleed or a blockage.

Later on, you may have some other tests on your heart and blood vessels to find out what caused your stroke.

Treatment of stroke 

When you go to hospital, you may be treated in a general ward or a specialist stroke unit.

If you're unable to swallow, you will be given fluid through a drip in your arm to stop you becoming dehydrated. You will have a tube in your nose to give you all the nutrients and medicines you need. You may also be given oxygen through a face mask, if you need it, to help you breathe.

You will be helped to sit up and move around as soon as you are able. If you're unable to move, you will be helped to regularly turn in your bed, to reduce your chance of getting bed sores and DVT.

Medicines

The type of medicine you have will depend on the type of stroke you had. For example, if you had an ischaemic stroke or a TIA, you may have medicines to prevent further blood clots, such as aspirin or clopidogrel. Or, if you had a haemorrhagic stroke, you may have medicines to promote blood clotting and/or medicines to control your blood pressure. You may be given medicines to help prevent DVT, but this will depend on the cause of your stroke.

Surgery

Your doctor may advise that you have surgery. This will depend on the type of stroke you have and isn't suitable for everyone. You may have:

  • Surgery to remove fatty deposits from an artery (carotid endarterectomy)
  • Surgery to drain blood from your brain.

Rehabilitation

After a stroke, you may need to relearn skills and abilities, which can help you adapt to any damage a stroke may have caused. This is known as stroke rehabilitation.

Generally, people will make most of their recovery in the early weeks and months following a stroke. However, recovery can continue after this time.

The stroke team at the hospital will work out a rehabilitation program for you that will be designed around your particular needs. This will continue after you leave the hospital. Your rehabilitation program may involve physiotherapists, speech and language therapists, occupational therapists, ophthalmologists and psychologists, as well as doctors and nurses.

Prevention of stroke 

You can take steps to lower your risk of stroke by making changes to your lifestyle. Some examples are listed below.

  • Stop smoking. This can greatly reduce your risk of stroke, no matter how old you are or how long you have been smoking.
  • Don't exceed the recommended alcohol intake limits. By reducing the amount of alcohol you drink, you can reduce your blood pressure, which in turn reduces your risk of stroke.
  • Eat less salt and cholesterol in your diet. Reducing your cholesterol levels and salt intake can reduce your risk of stroke.
  • Increase the amount of activity you do. Regular activity (30 minutes a day at least five days a week) can help to lower your blood pressure and achieve or maintain a healthy weight.

Further information 

National Stroke Foundation of Australia

www.strokefoundation.com.au

Signs of Stroke

www.signsofstroke.com.au/

Sources 

Australian Bureau of Statistics. Causes of death, Australia, 2009. [online] Belconnen, ACT: Commonwealth of Australia. May 2011 [Accessed 13 Jul 2011] Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0

Brain Foundation. Stroke. [online] Crows Nest, NSW: Brain Foundation. c2011 [Accessed 13 Jul 2011] Available from: http://brainfoundation.org.au/

Clinical Knowledge Summaries. Stroke and TIA. [online] London: National Institutes for Health and Clinical Excellence. 2008 [last updated Feb 2011, accessed 13 Jul 2011] Available from: http://www.cks.nhs.uk/stroke_and_tia

Cruz-Flores S. Ischemic Stroke in Emergency Medicine. [online] New York: WebMD LLC. [Last updated Jul 2011, accessed 13 Jul 2011] Available from: http://emedicine.medscape.com/article/1910519-overview

Goldstein JN. Transient Ischemic Attack. [online] New York: WebMD LLC. [Last updated May 2011, accessed 13 Jul 2011] Available from: http://emedicine.medscape.com/article/1910519-overview

Merck Manuals Online Medical Dictionary. Overview of stroke (cerebrovascular accident). [online] Whitehouse Station, NJ: Merck, Sharp and Dohme Corp. [Last updated Jan 2007, accessed 13 Jul 2011] Available from: http://www.merckmanuals.com/professional/sec17/ch221/ch221a.html

Merck Manuals Online Medical Dictionary. Stroke rehabilitation. [online] Whitehouse Station, NJ: Merck, Sharp and Dohme Corp. [Last updated Feb 2009, accessed 13 Jul 2011] Available from: http://www.merckmanuals.com/professional/sec23/ch357/ch357h.html

National Institute for Health and Clinical Excellence (NICE). Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). [online] Jul 2008 [accessed 13 Jul 2011] Available from: http://guidance.nice.org.uk/CG68

National Stroke Foundation. What is a stroke. [online] Melbourne, VIC: National Stroke Foundation - Australia. [Last updated 1 Jun 2011, accessed 23 Jun 2011] Available from: http://www.strokefoundation.com.au/what-is-a-stroke

Personal communication, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician, Spire Leeds Hospital, 5 January 2011

Rossi S (ed). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. 2011.

Senes S. How we manage stroke in Australia. Cat. no. CVD 31. [online] Canberra: AIHW. 2006 [Accessed 23 Jun 2011] Available from: http://www.aihw.gov.au/publication-detail/?id=6442467815

Simon C Everitt H van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press. 2010: 570-571.

Zohrabia D. Carotid artery dissection. New York: WebMD LLC. [Last updated Oct 2009, accessed 13 Jul 2011] Available from: http://emedicine.medscape.com/article/757906-overview

Last published: 30 July 2011

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This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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