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| Saturday, 20 March 2004 |
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Stroke: What is it, and what can we do? by Dr. Udaya Ranawaka, Secretary, National Stroke Association of Sri Lanka What is a stroke? Stroke is a sudden disturbance of brain function due to a disturbance to its blood supply. It is also known as a 'Brain attack'. What causes a stroke? The blood supply to the brain may be distributed in two main ways. Firstly, a blood vessel carrying blood may become blocked resulting in inadequate blood flow. Strokes that occur as a result of this type of disturbance to the blood flow are the commoner variety, and are known as ischaemic strokes or cerebral infarcts. Sometimes spontaneous bleeding may occur into the brain tissue due to a rupture of (or bursting of) a blood vessel. Strokes resulting from this are less common, and are called haemorrhagic strokes or intracerebral haemorrhages. Certain factors may increase the risk of an individual having a stroke; these are known as stroke risk factors. The risk of developing a stroke can be reduced by modifying these risk factors. The most Important modifiable stroke risk factors are: High blood pressure Heart diseases of various types Diabetes High cholesterol Smoking Excessive alcohol consumption Lack of exercise, sedentary life style and obesity What are the effects of a stroke? The effects of the stroke depends on the area of brain that is damaged; functions normally controlled by this area will be affected for some time. The commoner effects are: Weakness or paralysis of one side of the body Numbness or loss of feeling of one side of the body Loss of ability to speak, or to understand speech Alteration of, or loss of, consciousness Changes in vision Headache, vomiting, giddiness and falls Sometimes, stroke can lead to sudden death. The effects of a completed stroke last more than 24 hours; usually lasting a few days to a few weeks. Sometimes the effects due to an interruption to the brain blood flow may last only a few minutes or a few hours, resolving completely within 24 hours. These are due to 'mini-strokes', and are known as 'Transient Ischaemic Attacks' (TIA). It is important to recognise these symptoms and to seek medical attention, as these are warning symptoms that a stroke may soon follow. How can a stroke be diagnosed? A stroke is usually diagnosed by the collection of symptoms that the patient (or relatives) complain of, and the signs that are noted on examining the patient. A procedure called CT (computed tomography) scanning, which is a mechanism of taking a series of x-ray like pictures of the brain, is very helpful in finding out the type of stroke (ischaemic or haemorrhagic). How can a stroke be treated? Treatment of a patient with stroke includes: 1. Early management 2. Rehabilitation 3. Prevention of another stroke 1. Early management consists of, General care This includes attention to the basic needs of the patient which are commonly affected in stroke, such as intake of fluids, nutrition, swallowing, bladder and bowel control etc. Careful control of blood pressure, blood sugar and body temperature are vital. Drug treatment Drugs can be given to reduce the brain swelling of the area of brain damage. In certain countries, a new class of drugs, known as 'clot busters', are now used to dissolve a blood clot that may be responsible for the blockage to the blood supply producing an ischaemic stroke. Drug treatment such as these must be given very early after a stroke if they are to be effective. Therefore stroke must be considered an emergency, and medical attention must be sought as soon as possible. Stroke units A stroke unit is a separate area dedicated to the care of stroke patients, manned by a 'stroke team'. A stroke team is a group of health care professionals, which includes doctors, nurses, physiotherapists, speech therapists, occupational therapists and social workers. 2. Rehabilitation is the process by which patients after a stroke are restored to their previous functional, mental and social capacity. This is carried out by the stroke team, with the active participation of patients and the caregivers who look after them. 3. Prevention of another stroke. How can strokes be prevented? Stroke prevention includes: 1. Prevention of the first stroke in persons who have not had a previous stroke (primary prevention). 2. Prevention of a recurrence of stroke in persons who have had a previous stroke (secondary prevention). The approach to stroke prevention is same in both these groups. The main areas of attention are: * Modifying life styles: Healthy eating habits Regular exercises Stopping smoking Reducing alcohol consumption * Attention to risk factors such as high blood pressure, heart disease, diabetes, high cholesterol etc. * Drugs can be used in certain situations to minimise the risk of stroke, e.g. aspirin.
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