As regular readers of PHTM will know, over the past year we’ve brought you regular features under the general category of Medical Matters, with the idea not of frightening anybody, but rather to raise awareness of various areas of vulnerability health-wise - with a view to preserving your hide, basically. And in so discussing these health issues, perhaps that raised awareness may assist licence holders in recognising potential problems incurred occasionally by their passengers.
With that in mind, this month’s category could not be ignored, as it is the third largest killer behind heart disease and cancer: that is the stroke.
Knowing the signs of a stroke can be the first step in stroke prevention. Sometimes called a “brain attack”, a stroke occurs when blood flow to an area in the brain is cut off. The brain cells, deprived of the oxygen and glucose needed to survive, die. If a stroke is not caught early, permanent brain damage or death can result.
A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (haemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to their brain (transient ischemic attack, or TIA).
We’ll not try to blow you away with all the technical medical definitions and descriptions of these various types of stroke, except to group them as above:
Ischemic stroke is similar to a heart attack, except it occurs in the blood vessels of the brain. Clots can form in the brain’s blood vessels, in blood vessels leading to the brain, or even in blood vessels elsewhere in the body and then travel to the brain. These clots block blood flow to the brain’s cells. Ischemic stroke can also occur when too much plaque (fatty deposits and cholesterol) clogs the brain’s blood vessels, severely reducing blood flow. Approximately 85 per cent of all strokes are ischemic.
Haemorrhagic strokes occur when a blood vessel in the brain breaks or ruptures. The result is blood seeping into the brain tissue, causing damage to brain cells. The most common causes of haemorrhagic stroke are high blood pressure and brain aneurysms. An aneurysm is a weakness or thinning of a blood vessel wall. This type of stroke makes up over 50 per cent of those suffered by people under 65.
Transient ischemic attack (TIA), also known as a ministroke, is a brief period of symptoms similar to those you’d have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which often last less than five minutes.
Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. A TIA doesn’t leave lasting symptoms because the blockage is temporary.
However, this is the one where many people don’t even know it’s happening, or if they do, they brush it off as inconsequential. Medical sources all stress that you must seek emergency care even if your symptoms seem to clear up. Having a TIA puts you at greater risk of having a full-blown stroke, causing permanent damage later. If you’ve had a TIA it means there’s likely a partially blocked or narrowed artery leading to your brain or a clot source in the heart.
It is not possible to tell if you’re having a stroke or TIA based only on your symptoms. Up to half of people whose symptoms appear to go away actually have had a stroke causing brain damage.
These signs and symptoms are the ones to watch for if you think you or someone else may be having a stroke. As with heart attacks and breathing/choking difficulties, time is of the essence here: note when the signs and symptoms begin, because the length of time they have been present may guide your treatment decisions:
Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech.
Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. Try to raise both arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.
Trouble seeing with one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, like a curtain falling, or you may see double.
Headache. A sudden, severe headache may come on with no known cause, which may be accompanied by vomiting, dizziness or altered consciousness. (Although headaches are a symptom of stroke, it is important to remember that they are common and most headaches aren’t caused by stroke... see last month’s feature on headaches.)
Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination, usually combined with another symptom.
It is strongly advised that you seek immediate medical attention if you notice any of these signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Don’t mess with it: dial 999.
As we’ve already stressed, stroke is a medical emergency: immediate treatment can save your, or another’s, life, and immediate treatment can increase your chances of a full recovery.
If you’ve had any form of first aid training or St Johns Ambulance training, you’ll no doubt be familiar with the phrase FAST in connection with stroke symptoms, which were set out above. However, in the event of this emergency situation it is crucial to think FAST and do the following:
• Face. Ask the person to smile. Does one side of the face droop?
• Arms. As the person to raise both arms. Does one arm drift downward? Or is one arm unable to raise up?
• Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange? (This can be difficult, as often stroke victims are mistakenly thought to be drunk.)
• Time. If you observe any of these signs, call 999 immediately.
It cannot be stressed strongly enough: every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. If you are with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.
OK, so you (or your passenger) are now in hospital. You will have a number of tests to try to find out what type of stroke it was, and which part of your brain has been affected. This will allow the 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.
You will also have a brain scan (for example, a CT or MRI) as soon as possible. This will help to find out if your stroke happened because of a bleed or a blockage. Subsequently you may have some other tests on your heart and blood vessels to find out what caused the stroke.
Obviously treatment will vary tremendously depending upon the circumstances and the type of stroke that occurred. You may be treated on a general ward, or in a specialist stroke unit. IV fluids, tubes or oxygen may be required, and the length of time the patient stays in hospital will vary and depends on how severely you have been affected by the stroke.
Again, the type of medication administered will very much depend on the type of stroke you had. These may include medicines to break up blood clots and restore blood flow, and/or medicines to prevent further blood clots. Medicines to control blood pressure and possibly to reduce cholesterol levels may be required.
On some occasions the doctor may recommend surgery; this will depend on the type of stroke, and isn’t suitable for everyone. An operation may be performed to remove fatty deposits from the carotid artery that takes blood to the brain; to drain blood from the brain, or relieve swelling in the brain.
Stroke recovery can be difficult to predict: some patients make most of their recovery in the early weeks and months following the stroke, but recovery can continue after this time and you may carry on improving for years afterwards.
A team of health professionals usually works out a programme of rehabilitation for each individual, designed around your particular needs and will aim to help you in the long term. This medical team may include physiotherapists, speech and language therapists, occupational therapists, dietitians, and many other specialists as well as doctors and nurses.
Is it possible to prevent a stroke?
The general medical consensus is that 50 per cent of all strokes are preventable. Many risk factors can be controlled before they cause problems, such as:
Uncontrollable risk factors
Not all doom and gloom...
Naturally this whole subject matter is shrouded in risk, danger, emergency and the rest – you can’t discuss stroke in a light-hearted manner, as its implications can be more than just serious. However, there are hundreds and thousands of people all over the world who have survived a stroke, sometimes at quite an early age, and gone on to live active and happy lives for many years afterwards.
Here are just a handful of prominent politicians, celebrities and iconic individuals who have survived a stroke:-
Dwight D Eisenhower: 34th President of the United States, following his career as five-star General and Supreme Commander of Allied Forces during World War II. He actually suffered a stroke during a Cabinet meeting in 1957, but remained President for another four years.
Samantha Morton and Sharon Stone: Both actresses; Samantha Morton had a stroke at age 31, and Sharon Stone, still a prominent actress today, suffered a haemorragic stroke at 43 in 2001.
Dick Clark: Prominent and well known American producer and broadcaster of “American Bandstand” and other popular music programmes; suffered a stroke in 2004 but was back broadcasting just months later, and survived until 2012.
Hugh Hefner: Most famous for his Playboy empire, undeniably a successful businessman, Mr Hefner suffered a stroke in 1985 while in his fifties. He’s still going strong today in his eighties.
Other prominent stroke survivors: tennis player Rod Laver (stroke at 59); actress Candace Bergen (stroke at 59, still alive today); actress and former wife of Roald Dahl, Patricia Neal (stroke at 39, continued acting for three more decades, died at 84); broadcaster and professional gardener Monty Don (stroke at 53, back broadcasting within a year and now again presenting Gardener’s World on BBC), and Chris Tarrant, who has been on our TV screens ever since Tiswas, presented “Who Wants to Be a Millionaire” for 12 years, and who suffered a series of ministrokes in 2013, is very much still with us.
Political broadcaster and analyst Andrew Marr’s story is remarkable and newsworthy in itself: a fitness fanatic, he suffered a major stroke in January 2013 at the age of 53, attacked his rehabilitation programme with the same determination and vigour as he has done with every other phase of his life and work, and is back broadcasting his weekly news analysis programme on Sundays.
So there is hope following a stroke, no doubt about it. However, nobody would argue that prevention – where possible, looking at lifestyle changes – certainly beats cure in this particular category of illness. By the sheer nature of the trade, people in our industry unfortunately collect too many of those risk factors listed above; so it’s a case of recognising how many of them apply to you, and trying to cross them off the list. Pronto!!