Time we did more to com­bat a

Bet­ter treat­ment is needed for the thou­sands of peo­ple who suf­fer strokes

The Jewish Chronicle - - NEWS - BY PRO­FES­SOR TONY RUDD

THE TERM “stroke” is far too gen­tle a word to de­scribe what can be a dev­as­tat­ing dis­ease that kills or maims the pa­tient and can ruin the lives of the car­ers.

It is also not a term that ev­ery­one un­der­stands, with sur­veys still show­ing that many mem­bers of the public con­fuse stroke with heart at­tack.

Per­haps a bet­ter name for stroke would be brain at­tack, which would de­scribe ex­actly what it is. A prob­lem caused by the blood sup­ply to part of the brain be­ing cut off with the re­sult that that bit of brain dies and the per­son loses all the func­tions con­trolled by it.

So, depend­ing on which part of the brain is af­fected, any ac­tiv­ity can be im­paired, with the most com­mon be­ing paral­y­sis of one side of the body, dif­fi­culty swal­low­ing or speak­ing and im­paired vi­sion.

These are of­ten the most ob­vi­ous con­se­quences of the stroke but un­for­tu­nately there are of­ten deficits that can be equally dev­as­tat­ing but are less ap­par­ent to the out­side ob­server. Dif­fi­culty with the think­ing pro­cesses and mem­ory, loss of sen­sa­tion, de­pres­sion, anx­i­ety and fa­tigue are ex­am­ples of these.

It is there­fore vi­tal that we do ev­ery­thing pos­si­ble to pre­vent and treat stroke ef­fec­tively.

When I first started as a con­sul­tant 27 years ago, stroke was re­garded as an un­treat­able dis­ease that af­fected old peo­ple. Pa­tients were ad­mit­ted to hospi t a l a nd r e c e i v e d no spe­cific treat­ment, apart from s o m e re­ha­bil­i­ta­tion if the pa­tient was f o r t unate enough to be looked af­ter by a g e r i a t r i - cian.

It is es­ti­mated that 70 per cent of all strokes could be avoided if peo­ple avoided un­healthy lifestyles and risk fac­tors were treated ef­fec­tively.

High blood pres­sure is the sin­gle most im­por­tant cause of stroke, yet if it is di­ag­nosed early and treated ef­fec­tively through diet and med­i­ca­tion,

152,000

1.2 mil­lion

The amount of stroke sur­vivors in the UK. Three in 10 stroke sur­vivors will go on to have a re­cur­rent stroke the risk is elim­i­nated.

Atri­al­fib­ril­la­tion­isacon­di­tion­where peo­ple de­velop an ir­reg­u­lar pulse which can re­sult in blood clots form­ing in the heart that dis­lodge to re­sult in a stroke. It is the cause of about 20 per cent of strokes. Fre­quently it does not cause any symp­toms and there­fore un­less some­one feels the pulse, finds it to be ir­reg­u­lar and then does a car­dio­gram to con­firm the di­ag­no­sis, the per­son may have the stroke be­fore anyt h i n g i s done about it.

T r e a t - ment with anan­ti­co­ag­u­lant such as war­farin will pre­vent two-thirds of all such

One in eight

fourth

sin­gle largest cause of death in the UK. Fig­ures from the Stroke As­so­ci­a­tion strokes.

But cur­rently of the 16,000 pa­tients ad­mit­ted to hos­pi­tal with strokes in Eng­land as­so­ci­ated with atrial fib­ril­la­tion, less than half of them are on ef­fec­tive treat­ment.

There are cur­rently ma­jor ini­tia-

A brain scan of a stroke vic­tim. The red area shows the ex­tent of the bleed­ing. tives in Eng­land to im­prove on atrial fib­ril­la­tion de­tec­tion and treat­ment, so hope­fully we can save some lives and pre­vent many peo­ple liv­ing with long-term dis­abil­ity.

Other risk fac­tors in­clude obe­sity, high choles­terol, di­a­betes, al­co­hol and recre­ational drugs.

O n c e a s t r o k e h a s h a p p e n e d the first thing that is needed is an ac­cu­rate d i a g n o s i s , which means be­ing seen by a stroke spe­cial­ist and hav­ing a brain scan. With­out the scan it is im­pos­si­ble to dif­fer­en­ti­ate ac­cu­rately be­tween the two ma­jor sorts of stroke — a bleed into the brain or a blocked artery caus­ing the brain to die as a re­sult of the loss of its blood sup­ply.

The treat­ments we know that can make a dif­fer­ence in­clude be­ing ad­mit­ted quickly to a spe­cial­ist stroke unit where high-qual­ity ba­sic med­i­cal and nurs­ing care are pro­vided by pro­fes­sion­als who know what they are do­ing and giv­ing clot bust treat­ment. For this to be ef­fec­tive it needs to be given as quickly as pos­si­ble.

If a pa­tient gets the treat­ment within two hours of the on­set of the symp­toms then one per­son will be cured for ev­ery four pa­tients treated.

T h a t de­creases t o o n e s u c c e s s for seven pati e nts a t t h r e e

Re­cov­ery is more likely when pa­tients get treat­ment within two hours

Stroke ex­pert Pro­fes­sor Tony Rudd

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