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Stroke

Dr Roger Henderson
Reviewed by Dr Roger HendersonReviewed on 13.10.2023 | 6 minutes read
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A stroke happens when blood flow to a part of the brain is cut off. Without blood, brain cells start dying within minutes. This makes the speed of treatment very important, so the most important thing that people can do is recognise the signs of a stroke and call for help quickly. Every year in the UK around 115,000 people have a stroke, and a further 30,000 have a recurrent stroke. Although strokes can occur at any age – even in the very young – the vast majority of cases are in the elderly. This means that in the UK about 1 in 100 of the over-75 population have a stroke every year.

To remember the signs to identity a stroke, think “F-A-S-T”.

F stands for face (face droop)

A stands for arm (weakness in one or both arms)

S stands for speech (trouble in speaking)

T stands for time (immediately call the emergency number local to you, such as 999 in the UK).

Other symptoms of stroke can be sudden confusion, blurred vision in one or both eyes, seeing double, dizziness or loss of balance and coordination, and a severe headache.

What should I do next?

Once you have recognised that someone you are with has symptoms of a stroke, call for help as soon as you can. While you wait, avoid giving them medication, food or anything to drink.

Once they arrive at the hospital, the medical team will carry out a series of tests to determine if this is a stroke. If a stroke is diagnosed, there are different treatment options available, including medications and surgery, depending on the type of stroke.

How can a stroke cause damage?

Different parts of the brain can be affected by a stroke, and so this gives different symptoms and long term deficits. The whole of one side of the body may be affected, or just one arm, hand or leg. The anatomy of the brain is complex, and one side of the brain carries messages via nerves to muscles on the other of the body, so a stroke on the right side of the brain may affect movement or sensation of the left side of the body

A stroke at the back of the brain, over the occipital region, is more likely to affect visual function. If a stroke hits very specific areas of the brain, this may affect speech, either articulating sounds or understanding words.

What are the different types of stroke?

Whilst in all strokes there is a loss of blood reaching a part of the brain, this can happen in two ways – ischaemic and haemorrhagic strokes.

Ischaemic Stroke

An ischaemic stroke occurs in around 4 out of 5 of cases and happens when an artery (a blood vessel taking blood away from the heart) is blocked by plaque or a blood clot, stopping blood from reaching a particular part of the brain. This clot often forms over time in the artery itself but can sometimes travel to the brain from another part of the body, such as can occur in the condition atrial fibrillation.

Symptoms

Symptoms of an ischaemic stroke can vary, but common signs include sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Additionally, individuals may experience confusion, trouble speaking or understanding speech, sudden trouble seeing in one or both eyes and difficulty walking.

Diagnosis

Diagnosing an ischaemic stroke typically involves a combination of medical history review, physical examination, and imaging studies. Brain imaging, such as a CT scan or MRI, helps determine the location and extent of the blockage. Identifying the type of ischaemic stroke (large vessel or small vessel) is crucial for determining the most appropriate treatment.

Treatment

The primary goal in treating ischaemic strokes is to restore blood flow to the affected part of the brain as soon as possible. Anti-clotting medications like tissue plasminogen activator (tPA) can be administered within a specific time window to dissolve the clot and improve blood flow. Mechanical thrombectomy, where a catheter is used to remove or break up the clot, is another intervention, particularly for large vessel occlusions. Additionally, medications to control risk factors, such as antiplatelet drugs (aspirin) and anticoagulants, may be prescribed to prevent future strokes. Depending on the cause, there may also introduce a heart rate-controlling medication, such as a beta-blocker. This is often the case when there is an irregular heartbeat.

Risk Factors

Several risk factors contribute to the development of ischaemic strokes. Hypertension (high blood pressure) is a significant factor, as it can damage blood vessels over time. Other risk factors include smoking, diabetes, high cholesterol, obesity, and a family history of stroke. Advancing age and certain medical conditions, such as atrial fibrillation (an irregular heart rhythm), also increase the risk of ischaemic strokes.

Hemorrhagic Stroke

A haemorrhagic stroke occurs when a blood vessel in the brain breaks and bleeds into the brain tissue, and about 1 in 10 cases of strokes are of this type. This can be an intracerebral bleed, where the blood vessel bursts in the brain itself, or a subarachnoid haemorrhage where a blood vessel burts in the narrow gap between the brain and the skull. Sadly, a stroke can cause vascular damage, which means it is non-repairable and can cause patients to lose functionality. This can cause vascular dementia.

Symptoms

Symptoms of a hemorrhagic stroke can include a sudden severe headache, nausea, vomiting, seizures, and neurological deficits similar to those of ischaemic strokes.

Diagnosis

Diagnosing a hemorrhagic stroke involves imaging studies such as CT scans or MRIs to locate the site and extent of bleeding. Distinguishing between ischaemic and hemorrhagic strokes is crucial for determining the appropriate treatment approach. It differs because the results of the scans will show internal bleeding, whereas in ischaemic stroke, there is stop of blood flow

Treatment

Treatment for hemorrhagic strokes aims to control bleeding, reduce pressure on the brain, and prevent re-bleeding. Surgery may sometimes be necessary to repair the ruptured blood vessel or remove accumulated blood. Medications to lower blood pressure may also be administered, as hypertension is a common factor contributing to hemorrhagic strokes. Unlike ischaemic strokes, the use of blood-thinning medications is generally avoided in hemorrhagic strokes to prevent further bleeding.

Risk Factors

Hypertension is a significant risk factor for both types of strokes, but it is particularly relevant for hemorrhagic strokes. Other risk factors include age, gender (more common in men), smoking, excessive alcohol consumption, use of illicit drugs like cocaine, and certain medical conditions such as aneurysms or arteriovenous malformations (AVMs). Family history can also play a role in predisposing individuals to hemorrhagic strokes.

Transient Ischaemic Attack

There is a third type of stroke called a transient ischaemic attack (TIA), also sometimes referred to as a “mini-stoke”. This is where the blockage of blood flow to the brain is temporary, lasting anywhere from a few minutes up to 24 hours. The symptoms of a TIA are very similar to a stroke, but they then improve whereas a stroke often causes permanent damage. Anyone who has a TIA should be seen by a specialist within 24 hours of their symptoms developing.

How can I prevent stroke?

Common risk factors for strokes include high blood pressure, smoking, a history of atrial fibrillation (a type of irregular heart beat), diabetes and high cholesterol levels - these are all cardiovascular disease risk factors.

Dietary changes such as reducing salt, cholesterol, saturated and trans-fat intake can reduce the overall risk of stroke. Exercising daily, even for small periods can help improve general health and further reduce the risk of stroke as can stopping smoking and drinking less than 14 units of alcohol a week.

Some risk factors such as high blood pressure, diabetes and high cholesterol can be treated with medication alongside lifestyle changes, so if you are concerned you have any of these, see your doctor for advice.

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Dr Roger Henderson
Reviewed by Dr Roger Henderson
Reviewed on 13.10.2023
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