What you need to know about Stroke
Part 2 of our overview of cardiovascular diseases will focus on Cerebrovascular Accidents, commonly referred to as a stroke. Strokes are a significant cause of morbidity and mortality worldwide.
A stroke occurs when the blood supply to part of the brain is cut off. There are 2 main causes of an abrupt cut-off of blood supply to the brain. The first and most common is what is referred to as an ischemic stroke, whereby a blood clot blocks the blood vessel. The other less common cause of stroke is haemorrhagic stroke whereby a weakened blood vessel bursts and blood leaks into the brain.
Most commonly a stroke affects the face, arm and leg. They may be drooping of the face on the affected side, and the person may be unable to smile or close their eye. They may be weakness and numbness of the affected arm and leg. Speech is often involved, and patients may have slurred speech. In some instances, they are unable to talk despite looking awake or are unable to comprehend what is being said to them.
Other less common symptoms of a stroke include vision loss, double vision, loss of sensation on one side, vertigo and sudden decrease in level of consciousness.
The management of stroke depends on the type of stroke as well as the capability of the center. In the acute setting patients showing signs and symptoms of a stroke should have a CT scan of the brain to determine the type of stroke they are having. In highly specialized centers, ischemic stroke patients who present within 4 and a half hours can receive clot bursting medication or undergo procedures to retrieve the clot from the vessel.
This has been shown to have better outcomes, the only downside being it’s not a service that’s widely available. Patients with haemorrhagic stroke can undergo surgery to remove the clot or repair the blood vessels. However, in certain cases particularly if the bleeding is small or not easy to access, we manage conservatively and allow the blood to resorb the clot. Other medications used include blood thinners like aspirin and cholesterol lowering tablets which decrease the risk of subsequent strokes.
The management of stroke is best done by a multi-disciplinary team including the physicians, neurologists, dietician, speech therapist, physiotherapy and occupational therapist. This rehabilitation can often take a lot and in some case, they may not be complete recovery. In the acute phase, swallowing may be impaired, hence a tube can be passed via the nose into the stomach for feeding. The physiotherapist assists with regaining of power and mobility while the speech therapist does some exercises to alleviate speech impairment.
It is important to recognize symptoms of a stroke early and seek medical treatment. The symptoms of stroke can be easily remembered by using the acronym FAST, for Facial drooping, Arm weakness, Speech difficulties and Time. It is also important to manage the risks of stroke and for those already with a prior diagnosis of stroke to be on the right medication to reduce the chances of future strokes.