What is a stroke?
Also referred to as a cerebrovascular accident, a stroke is a sudden disruption of blood supply to an area of the brain, leading to damaged brain tissue. This disruption can either be caused by a blood clot (ischaemic), or it can be due to a burst blood vessel (haemorrhagic) in the brain.
Who is affected by strokes?
Two-thirds of all stroke patients are over the age of 65. Men and Afro-Caribbean are at higher risk of suffering a cerebrovascular accident; women tend to be older. Most risk factors that lead to a stroke are modifiable and are very similar to the cardiovascular red flags.
They include:
• High blood pressure
• Smoking or exposure to secondhand smoke
• High cholesterol
• Diabetes
• Obstructive sleep apnea
• Cardiovascular problems: heart failure or abnormal heart rhythm.
How to treat strokes?
Dead brain cells cannot be replaced or regrow, and although our central nervous system has some compensation mechanism to reduce symptoms, the resulting neurological deficit will persist. Keeping in mind that during the acute phase of a stroke, the clinical picture is often exaggerated due to an inflammatory process affecting the functioning of healthy neighbouring brain cells which will recover over time. For many years stroke was an untreatable disease, focusing its management on prevention and rehabilitation.
New treatments during the very acute phase of an ischaemic stroke are available in many stroke units all over Europe today. It aims to reperfuse the affected brain area to limit the damage by using clot-busting medication (thrombolysis). Promising interventional methods are currently being tried out, where the clot gets mechanically removed with a catheter.
Many Western healthcare providers are taking part in Public stroke education and are highlighting the importance of acting quickly. The ‘FAST’ campaign has proved to be very successful in the UK and US to help recognise signs of a stroke; it uses the acronyms as follows:
• F: Face drooping
• A: Arm weakness
• S: Speech difficulty
• T: Time to call the emergency
How to avoid strokes?
The most important aspect in the management of cerebrovascular accidents is still its prevention which also shows some promising developments in recent years. Better control of high blood pressure and diabetes and a more aggressive anticoagulation (blood thinning) in patients with atrial fibrillation has contributed a great deal to this achievement. The introduction of more patient-friendly blood thinning medication for patients with atrial fibrillation will likely protect further from strokes in the future.