Stroke

Signs and symptoms of stroke include:

• Slurred or confused speech
• Sudden paralysis or numbness of the face, arm or leg on one side 
• Sudden visual problems; blurred, blackened or double vision in one or both eyes
• Sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness
• Sudden dizziness or a loss of coordination or balance

Longer term complications

Depending on the degree and location of brain injury, temporary or permanent disabilities may include:

• Paralysis or loss of muscle movement on one side of the body or face
• Difficulty talking or swallowing
• Memory loss or thinking difficulties
• Emotional problems or depression
• Pain, numbness or tingling sensations in the parts of the body affected by stroke
• Changes in behaviour and self-care ability.

A stroke is an emergency requiring immediate medical attention. It is vital to call your local emergency number if you notice signs or symptoms of a stroke, even if they seem to come and go or disappear completely. 

Think “FAST” and do the following:

• Face: Ask the person to smile. Does one side of the face droop?
• Arms: Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise?
• Speech: Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
• Time: If you observe any of these signs, call for emergency medical help immediately.

Do not delay, every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. Watch the person carefully while waiting for emergency assistance and note time the symptoms began.

There are two main types of stroke which have different causes: 

An ischaemic stroke occurs when the brain’s blood vessels become narrowed or blocked, causing severely reduced blood flow (ischaemia).  This may be caused by a build-up of fatty deposits in blood vessels or by blood clots or other debris in the bloodstream which become lodged in the blood vessels of the brain.

Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), sometimes called a ministroke, that does not cause lasting symptoms. It is not possible to tell a stroke or TIA apart based only on symptoms, therefore emergency care is required even if symptoms appear to improve. Having a TIA increases the risk of having a full-blown stroke later.

A haemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain haemorrhages can result from many conditions, such as:

• Uncontrolled high blood pressure
• Overtreatment with blood thinners (anticoagulants)
• Bulges at weak spots in your blood vessel walls (aneurysms)
• Trauma to the head
• Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy)
• Ischemic stroke leading to haemorrhage

Risk factors

Many factors can increase the risk of stroke risk:

• Being overweight or obese, or physically inactive
• Heavy drinking or use of illegal drugs such as cocaine and methamphetamine

• High blood pressure
• Smoking or exposure to second-hand smoke
• High cholesterol
• Diabetes
• Cardiovascular disease
• Personal or family history of stroke, heart attack or transient ischemic attack.

• Some of the tests you may have include:

  • Physical examination, including checking heart sounds and blood pressure
  • Neurological examination
  • Blood tests – for blood clotting time, blood sugar level etc.
  • CT scan, or computerized tomography angiography, can show bleeding in the brain, an ischaemic stroke, a tumour or other conditions. 
  • An MRI, magnetic resonance angiography or magnetic resonance venography, can detect brain tissue damage
  • Carotid ultrasound may show build-up of fatty deposits (plaques) and blood flow in your carotid arteries.

Emergency treatment depends on the type of stroke:

Treatment for an ischemic stroke focuses on restoring blood flow to the brain. The faster this can be done, the better the chances of survival and reduced complications. Methods include:

• Emergency IV medication to dissolve or break up a clot – should be given as fast as possible, at least within 4.5 hours from when symptoms first started
• Emergency endovascular procedures – a catheter tube inserted into a blood vessel may be used to deliver anti-clot medication or remove a clot with a stent retriever 

Following emergency treatment, other procedures may be recommended to decrease the risk of having another stroke or transient ischemic attack. 

• A carotid endarterectomy may be performed to remove plaque blocking a carotid artery

• Angioplasty and stents may be used to expand a narrowed artery

Emergency treatment of haemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain caused by the excess fluid. Treatment options include:

• Emergency medications may be used to reverse the effects of prescribed blood-thinning medications, lower intracranial pressure or blood pressure, prevent spasms of blood vessels and prevent seizures.
• Surgery may be required to drain excess blood and relieve pressure on the brain, clamp a blood vessel, or repair a blood vessel malformation

The extent and time taken for recovery from a stroke depends on the area of the brain involved and the amount of tissue damaged. A stroke is a life-changing event that can affect emotional well-being as much as physical function.

A rehabilitation program is usually required, with support from various specialists and therapists.

Prevention focuses on reducing known risk factors:

• Controlling high blood pressure (hypertension)
• Eating a healthy diet and reducing cholesterol and saturated fat 
• Quitting smoking and tobacco use
• Managing diabetes
• Exercising regularly and maintaining a healthy weight 
• Avoiding heavy alcohol consumption or illegal drugs
• Treating obstructive sleep apnoea (OSA)— a sleep disorder that causes you to stop breathing for short periods repeatedly during sleep. 

If you have had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke, such as anticoagulants or anti-platelet drugs.