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