Don’t let that ‘funny turn’ become a stroke
. . . make sure you have the scan that could save you
DIZZINESS and blurred vision are symptoms many people might shrug off as a ‘funny turn’ — but they can also be the sign of a transient ischaemic attack, or mini-stroke, which can itself be a warning sign that a more major, life-threatening stroke is to come. And it can come soon. one in 12 people who have these mini-strokes (known as a TIA) will go on to have a full stroke within a week.
Thankfully, relatively simple surgery can prevent a full-blown one — but four out of ten victims of mini-strokes aren’t having the operation in time. Shocking new figures reveal that the chance of having the vital surgery after an early-warning mini- stroke varies wildly across the country.
TIAs cause the same symptoms as a stroke, such as blurred vision, slurred speech, dizziness or weakness. However the difference is these symptoms are over far quicker with a TIA — and resolve completely within 24 hours, if not within minutes.
A stroke, on the other hand, can cause life-changing disabilities that are permanent. Like a fullblown stroke, a TIA is caused when oxygen to the brain is cut off, most commonly by a blockage in the carotid artery in the neck — typically as a result of a build-up of fatty deposits on the inside of the artery.
The National Institute for Health and Clinical Excellence (NICE) recommends that anyone who has a TIA should have a carotid endarterectomy — an operation to clear the carotid, the main artery to the brain, within two weeks.
The operation significantly reduces the risk of a subsequent ischaemic stroke — a stroke caused by blockage of the artery (there are other, less common types of stroke caused by bleeding in or around the brain).
The Stroke Association says: ‘The greatest risk of stroke is within the days immediately after a TIA.’
But according to new figures from the Royal College of Surgeons, 43 per cent of the 4,256 people who had a mini-stroke in 2015 didn’t receive the potentially life- saving surgery even within the 14-day target.
The good news is that the average time patients have had to wait for the operation has fallen, from 20 days in 2009 to 13 days in 2015, with 57 per cent now being treated within the 14-day target.
But, despite the improvement, there is still considerable variation in the times taken to give patients surgery.
Every year there are about 152,000 strokes in the UK (some people will have more than one). A third of those affected die, while a third are left disabled.
A carotid endarterectomy involves an incision about 20cm long, running down from just under the ear lobe to expose a section of the carotid artery, which is then opened and the blockage removed.
(Carotid endarterectomy is not without risks: between one to three in a hundred people who have it will suffer a stroke, ranging from mild to severe, during the operation.)
Most people will remain in hospital, under close observation, for between two and four days.
‘Urgently investigating and treating people who have a TIA, or mini- stroke, could reduce their risk of having a devastating stroke by 80 per cent,’ says Esmee Russell, head of policy at the Stroke Association. ‘When the right treatment and support is not in place, people’s health is put at real risk.’
The alternative, she says, is leaving people at risk of having a full stroke, with its potential ‘devastating consequences.’
About 80 per cent of those affected will suffer some form of loss of movement, ranging from mild weakness to complete paralysis in one or more limbs.
‘Up to 10,000 strokes could potentially be prevented if everyone who has a TIA gets the right diagnosis and treatment quickly,’ she adds.
NICE says patients who have had a suspected mini- stroke should have an MRI scan of their carotid artery to see how badly it’s blocked — anything more than a 50 per cent blockage needs surgery ‘within a maximum of two weeks of onset of symptoms’.
The new report, from the National Vascular Registry, reveals extreme variations in care across the UK among the 87 trusts that run stroke clinics. The quickest treatment is to be found at Southend University Hospital NHS Foundation Trust, which last year operated within two weeks on 85.2 per cent of patients deemed to need the surgery. Near-neighbour Mid-Essex Hospital Services NHS Trust, on the other hand, carried out the surgery on only 10 per cent of its 34 patients in time. The Stroke Association is calling on the government to introduce a new National Stroke Strategy to ‘address the unacceptable variations in stroke care and treatment’. Failing to do so means ‘lives could be at risk’, it says. The new report ‘is evidence of a wider issue and that’s why we are calling for a new strategy to address these variations in care,’ says Esmee Russell. In the meantime, she adds: ‘Anyone who experiences a ministroke should not hesitate to highlight the treatment guidelines to their health professional to ensure they get the treatment they need as quickly as possible. Don’t be afraid to speak out.’ Professor Robert Sayer, president of the Vascular Society, says that while British stroke treatment has ‘led the way internationally’, with greatly reduced delays for treatment and also pioneering treatments, ‘the challenge now is for centres to make sure they supply that care 365 days a year’.
WHAT TO LOOK OUT FOR
FOR all kinds of stroke, think FAST: Facial weakness (can the person smile, or has their mouth or eye drooped?); Arm weakness (can they raise both arms?); Speech problems (can they speak clearly?); Time to call 999.
With a mini- stroke, however, there can be other, less obvious symptoms, such as:
SUDDEN loss of vision or blurred vision in one or both eyes;
SUDDEN weakness or numbness on one side of your body (including in your leg);
SUDDEN memory loss or confusion;
SUDDEN dizziness or unsteadiness, especially with any of the other symptoms.