Stroke (cerebrovascular accident)

Written by Professor Marion McMurdo, honorary consultant in medicine for the

elderly

What is a stroke?
A stroke happens when the blood supply to the brain is disturbed in some way. As a
result, brain cells are starved of oxygen. This causes some cells to die and leaves other
cells damaged.

Types of stroke
Most strokes happen when a blood clot blocks one of the arteries (blood vessels) that
carries blood to the brain. This type of stroke is called an ischaemic stroke.

• Transient ischaemic attack (TIA) or 'mini-stroke' is a short-term

stroke that lasts for less than 24 hours. The oxygen supply to the brain is
quickly restored and symptoms disappear. A transient stroke needs prompt
medical attention because it indicates a serious risk of a major stroke.
• Cerebral thrombosis is when a blood clot (thrombus) forms in an
artery that supplies blood to the brain. Blood vessels that are furred up with
fatty deposits (atheroma) make a blockage more likely. The clot prevents
blood flowing to the brain and cells are starved of oxygen.
• Cerebral embolism is a blood clot that forms elsewhere in the body
before travelling through the blood vessels and lodging in the brain. In the
brain, it starve cells of oxygen. An irregular heartbeat or recent heart attack
may make you prone to forming blood clots.
• Cerebral haemorrhage is when a blood vessel bursts inside the brain
and bleeds (haemorrhages). With a haemorrhage, blood seeps into the brain
tissue and causes extra damage.

What are the symptoms of a stroke?

Strokes usually happen suddenly. No two strokes are the same and people can be
affected in quite different ways.

To an extent it depends on which area of the brain is damaged, because different parts
control different abilities such as speaking, memory, swallowing and moving.

The most common signs of a stroke are:

• weakness down one side of the body, ranging from numbness to

paralysis that can affect the arm and leg
• weakness down one side of the face, causing the mouth to droop
• speech may be difficult or become difficult to understand
• swallowing may be affected
 • loss of muscle coordination or balance
• brief loss of vision
• severe headache
• confusion.

People who have had a severe stroke may lose consciousness. Unfortunately, the
likelihood of such patients making a good recovery is poor.

Face-arm-speech test (FAST)

The Stroke Association says three simple checks can help you recognise whether
someone has had a stroke or mini-stroke.

• Facial weakness: can the person smile? Has the mouth or eye drooped?
• Arm weakness: can the person raise both arms?
• Speech problems: can the person speak clearly and understand you?
• Test these symptoms.

If you see any of these signs, call 999 for an ambulance.

How is a stroke treated?

Immediate treatment

In hospital, brain scans are needed to find out what type of stroke you've had.

• If a blood clot is the cause, 'clot busting' medication may be used to

dissolve the clot, but this must be given within three hours of the stroke. Anti-
clotting medication such as aspirin may also be given to stop the stroke from
getting worse.
• Anti-clotting medication is not given in strokes caused by
haemorrhaging because it will make the bleeding worse.

Other treatment includes:

• tests on key functions like swallowing and movement

• checks on oxygen, glucose and blood pressure levels.

If swallowing is affected, you may be fed by a tube or given fluids into a vein
(intravenously) to avoid food going into the lungs.

After a stroke

In the first few days after a stroke, treatment concentrates on making sure you are well
hydrated and nourished.

The next phase of treatment is recovery through rehabilitation. This involves a team
of health professionals including physiotherapists, speech therapists, occupational
therapists, nurses and doctors.
If a stroke is caused by a blood clot, then taking a low-dose aspirin (eg Nu-seals
75mg) once a day may help make the blood less sticky and less likely to cause clots.

What are the risk factors?

• High blood pressure does not cause any symptoms, so everyone over
the age of 40 should have an annual blood pressure check.
• Smokers have double the risk of stroke as non-smokers.
• Irregular heart beat (atrial fibrillation) is fairly common in old age. It
increases the risk of stroke by causing blood clots to form in the heart. Blood
clots can be prevented from forming by taking warfarin (eg Marevan), a
medicine that makes the blood less likely to clot. Warfarin treatment requires
careful monitoring with regular blood checks and is a very effective way to
reduce the risk of stroke.
• Diabetes affects 1 in 20 older people and can increase the risk of
having a stroke. Good control of diabetes is important and requires attention to
diet, regular urine tests or blood tests and probably some medication.
• Too much alcohol increases the risk of a stroke. The recommended
safe limits for alcohol consumption are 21 units each week for women and 28
units each week for men. One unit of alcohol is equivalent to a measure of
spirits, a 125ml glass of wine or half a pint of beer. People who drink more
than this run a higher risk of stroke, liver disease and dementia.