Clinical tips: stroke


stroke

A stroke is a life-threatening emergency, writes Louis Roller

A stroke, previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain.

This can be due to ischaemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a haemorrhage (leakage of blood).

As a result, the affected area of the brain is unable to function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

Brain cells usually die shortly after the stroke starts. However, some can last a few hours, if the blood supply is not cut off completely. If the blood supply can be returned in the minutes and hours after the stroke, some of these cells may recover. If not, they will also die.

Facts and figures about stroke

  • Stroke is one of Australia’s biggest killers (third) and a leading cause of disability.
  • Stroke kills more women than breast cancer and more men than prostate cancer.
  • In 2017 there were more than 56,000 new and recurrent strokes – that is one stroke every nine minutes.
  • More than 80% of strokes can be prevented.
  • In 2017 there were more than 475,000 people living with the effects of stroke. This is predicted to increase to one million by 2050.
  • Around 30% of stroke survivors are of working age (under the age of 65).
  • 65% of stroke survivors suffer a disability which impedes their ability to carry out daily living activities unassisted.
  • The financial cost of stroke in Australia is estimated to be $5 billion each year.

Symptoms of a stroke

A stroke is not a heart attack. A stroke happens when the supply of blood to the brain is suddenly interrupted. Some strokes are fatal, while others cause permanent or temporary disability.

The longer a stroke remains untreated, the greater the chance of stroke-related brain damage. Emergency medical treatment soon after symptoms begin improves the chance of survival and successful rehabilitation.

Facial weakness, arm weakness and difficulty with speech are the most common symptoms or signs of stroke, but they are not the only signs.

Other signs of stroke may include one, or a combination of:

  • weakness or numbness or paralysis of the face, arm or leg on either or both sides of the body;
  • difficulty speaking or understanding;
  • dizziness, loss of balance or an unexplained fall;
  • loss of vision, sudden blurring or decreased vision in one or both eyes;
  • headache, usually severe and abrupt onset or unexplained change in the pattern of headaches; and/or
  • difficulty swallowing.

The signs of stroke may occur alone or in combination, and they can last a few seconds or up to 24 hours and then disappear. When symptoms disappear within 24 hours, this episode may be a mini stroke or transient ischaemic attack (TIA).

Diagnosis of stroke emergency (pharmacists please note)

The FAST test is an easy way to recognise and remember the most common signs of stroke. Using the FAST test involves asking three simple questions. If the person has a problem with any of these functions, dial triple zero (000) for an ambulance immediately.
FAST stands for:

  • Facial weakness – check their face. Has their mouth drooped?
  • Arm weakness – can they lift both arms?
  • Speech difficulty – is their speech slurred? Do they understand you?
  • Time – is critical. If you see any of these signs, call 000 straight away.

If you suddenly experience any of these symptoms, get to a hospital immediately.

Remember, a stroke is a life-threatening emergency.

Effects of a stroke

There are several factors that impact on recovery and the effects of stroke. These factors include:

  • type of stroke;
  • location of the blocked or burst artery;
  • which area of the brain is damaged;
  • how much brain tissue is permanently damaged;
  • your general health before the stroke; and
  • your level of activity before the stroke.

The brain is divided into several areas that control different functions. These include how the body moves, receives sensory messages (such as touch, sight or smell), uses language and thinks. Because different arteries supply different areas of the brain, where the brain is damaged will determine which functions are affected.

Every stroke is different. Each person affected by stroke will have different problems and different needs. The way in which a person might be affected depends on where in the brain the stroke happens and how big the stroke is.

A stroke on the right side of the brain generally causes problems on the left side of the body. A stroke on the left side of the brain causes problems on the right side of the body.

Some strokes happen at the base of the brain and can cause problems with eating, breathing and moving.

Lifestyle factors that increase risk of stroke include:

  • high blood pressure
  • cigarette smoking
  • diabetes
  • high cholesterol level
  • excessive amounts of alcohol
  • being overweight or obese
  • a diet high in salt and fat
  • lack of exercise.
  • Atrial fibrillation (AF)

It is vital that all the conditions listed above be controlled (blood pressure, diabetes, hyperlipidaemia, etc. with appropriate medication) and that exercise and modified diet be implemented. Pharmacists must ensure that all people who are on medications adhere to their prescribed regimens.

https://strokefoundation.org.au/About-Stroke/Facts-and-figures-about-stroke

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/stroke

Therapeutic Guidelines: Neurology, Version 5, 2017

Associate Professor Louis Roller, from the Faculty of Pharmacy and Pharmaceutical Sciences Monash University, was the 2014 recipient of the PSA Lifetime Achievement Award.

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