Fatal pause
In a recent survey, the Stroke Foundation showed that 15 per cent of people aged over 40 were unable to name even one symptom of stroke. This is a worry, because lack of recognition can cause a delay in treatment, which results in much poorer outcomes for sufferers.
The foundation is trying to remedy this situation by promoting the FAST test. This acronym stands for Facial weakness, Arm weakness, Speech difficulties, and Time to act fast and call 000.
This does not cover all possible stroke symptoms, but if it results in early intervention, there will be a reduction in death and disability from strokes.
The Stroke Foundation is also running the "know your numbers" campaign, encouraging people to know their own blood pressure by holding BP checks in shopping centres. For more information, visit www.strokefoundation.com.au
In Australia, approximately 50,000 people have a stroke each year, resulting in about 15,000 deaths. Stroke is also a major cause of disability in the community.
After having a stroke, about 20 per cent of patients die before discharge from hospital, 33 per cent go into rehabilitation and another 33 per cent go home. About 20 per cent are left with severe disability and end up in a nursing home.
WHAT IS A STROKE?
A stroke is caused by a blockage in the blood flow to the brain, causing some of the brain cells to die. This is the equivalent of what happens in the heart during a heart attack. Most commonly, this is caused by cholesterol deposits with or without a clot. This type is called an ischaemic (pronounced is-key-mick) stroke, the word "ischaemic" meaning lack of oxygen.
The less common type is a haemorrhagic stroke, where a blood vessel in the brain ruptures, often related to uncontrolled hypertension (high blood pressure).
In a transient ischaemic attack (TIA) the deficiency of oxygen is not bad enough to cause cell death and the symptoms resolve when the blood flow is restored, so it is like angina of the brain. However, there is an increased incidence of stroke in people who have a TIA, particularly in the next few months.
RISK FACTORS
Diabetes is a common cause of stroke, and diabetics with persistently raised blood sugar levels are at the greatest risk. Tight sugar control is very effective in minimising stroke risk, as is controlling blood fats and blood pressure. Stopping smoking also helps.
Heart rhythm disorders, like atrial fibrillation, allow small clots to form inside the heart, and these can travel to the arteries in the brain, blocking them and causing strokes. If a normal rhythm cannot be restored, it is often necessary to take blood thinning treatments, such as warfarin.
However, the biggest risk of all is having had a stroke or TIA, therefore attention to the risk factors mentioned above becomes critical after a stroke.
SYMPTOMS
Strokes can present in a wide variety of forms. Most common symptoms are weakness or clumsiness on one or both sides of the body, altered sensation on one side of the body and trouble swallowing and slurred speech. There can also be trouble reading or understanding; giddiness or unsteady gait; and double vision or loss of vision. Other more general symptoms can include incontinence and altered consciousness. These symptoms can be mimicked by other medical conditions like migraine, epilepsy, MS, brain infections and low blood sugar in diabetics. Tests sometimes need to be done to rule out these conditions.
TREATMENT
The patient should be taken immediately to a hospital that has scanning facilities, ideally one with a stroke unit. A CT or MRI scan before treatment will differentiate between ischaemic and haemorrhagic strokes, which is important as clot-dissolving therapy would only increase bleeding in a haemorrhagic stroke.
Having an intravenous infusion of TPA (tissue plasminogen activator) within the first three hours dramatically improves outcomes in ischaemic strokes, and management in a stroke unit decreases nursing home admission by about 20 per cent.
It is impossible to manage strokes optimally in remote country areas in Australia as none of the necessary facilities are available. Therefore, attention to prevention strategies is most important when planning RV trips in these areas. As well as risk factor reduction, this can involve drug therapies, including aspirin.
IMPACTS OF STROKE
In the days after a stroke, the patient is more susceptible to infections like pneumonia, heart problems and deep venous thrombosis (DVT) from lack of mobility.
Long-term stroke outcomes include loss of mobility and speech, depression and changes in brain function. The latter can be particularly distressing as they can include changes in personality and temperament, as well as difficulties understanding the written or spoken word, finding the right words and altered perception. Loss of driving licence (and livelihood) can follow.
Where strokes are concerned, prevention is much better than cure. Stopping smoking is paramount. Maintaining a healthy body weight with a low-fat diet and exercise can be incorporated into the RV lifestyle without too much inconvenience, along with regular checks of blood pressure and blood fats and sugar.
If you can just avoid having a stroke, it will be well worth the effort.
Be sure to see your GP for individual advice.