National Stroke Week
7 -13 August 2023
What is a stroke?
A stroke happens when the brain does not get the blood it needs. Blood is oxygen and nutrient rich and when the brain does not get this, up to 1.9 million brain cells quickly die.
Types of strokes:
Ischaemic stroke - Blood clot or plaque blocks the artery.
Haemorrhagic stroke - An artery breaks or bursts.
A transient ischaemic attack (TIA) has similar signs to that of a stroke, but it is different, as the blood supply to the brain is blocked for only a short time and the signs go away on their own.
A stroke is a medical emergency, and a TIA should not be ignored, even if the signs go away. Call 000 immediately, act fast. Time is crucial, the sooner medical treatment can be administered, the more the brain can be saved. It is the difference between death, disability and a good recovery.
Recognizing Stroke Signs: F.A.S.T. Method.
F.A.S.T.
Face – check their face. Has their mouth drooped?
Arms – can they lift both arms?
Speech – is their speech slurred? Do they understand you?
Time – time is critical.
Other signs to look out for are: -
Your face, arm or leg can be numb, clumsy, weak, or paralysed. This can be on one or both sides of your body.
Feeling dizzy, losing balance, or falling over for no reason.
Losing your vision. This can be in one or both eyes.
Headache, usually severe and sudden.
Trouble swallowing.
Nausea and vomiting.
If you see any of the signs of stroke, call triple zero (000) straight away. Even if you aren’t sure, or the signs only last for a few minutes, call triple zero (000).
When I was a personal trainer, I trained an older gentleman. Once I retired from personal training, opened my Pilates studio, he came along to the new Pilates studio.
Sadly, I received the news that while he and his wife were away at a remote area, he had a stroke and was not able to receive the necessary medical treatment he needed within the timeframe to save .
I continued training him at home. He was carried out of his bed and placed in his walking chair, just a ‘bag of bones.’ Unable to speak, eat or move at all on his own. He was completely dependent upon his wife and carer.
So, I urge you, share what the signs of a stroke are with you wife, husband, neighbour, and child. Time makes all the difference.
Effects of stroke
Every stroke is different and can affect each person differently with different problems and different needs.
‘There are several factors that determine the effects of a stroke and that impact recovery, these factors include:
type of stroke
where the blocked or burst artery
the area of the brain is damaged
how much brain tissue is permanently damaged
general health and level of activity before the stroke
How stroke can affect you
Some of the problems people may have after a stroke include:
Weakness on one side of the body, including arms and legs
Problems controlling or coordinating movements (also arms and legs)
Ignoring one side of your body, which is called neglect
Difficulties swallowing food, drink or your own saliva
Personality and behaviour changes
Having uncontrollable outbursts of emotion without cause, which is called emotional lability
Problems with thinking, memory and insight
Difficulty receiving messages from your senses – smell, touch, taste, sight and hearing
Problems speaking and understanding, or with reading and writing
Vision loss
Incontinence
Fatigue.’
(Source - Stroke Foundation)
The Importance of Early Stroke Treatment
“There is no medical treatment that will repair the brain damage from the stroke.”
‘Research shows that stroke patients treated in hospitals with specialist stroke staff and services have improved care and outcomes.’ - Stroke foundation.
Not all hospitals have a stroke unit. Early treatment after a stroke is vital to save the brain.
At the hospital you will be assessed immediatley by doctors who test the following:
They will ensure that the symptoms are an actual stroke.
They will work out what kind of stroke.
Which area of the brain was affected.
They will ascertain how sever the impact of the stroke was on the brain.
Once the doctors have found out what type of stroke was, they are then able to start treating the cause of the stroke.
Tests include:
Brain scan using CT or MRI scans.
Blood tests to rule out other medical conditions as well as the ability for the blood to clot, the clotting ability of your blood kidney function, iron levels, salt and blood sugar levels, while blood cells and blood tests to measure the inflammation in the body.
Heart tests - ECG and echocardiogram to check for enlargement of a heart chamber and to check for a clot.
Urine tests
Chest xray
Cerebral angiogram – ‘a catheter is placed in an artery and used to inject a contrast dye. The dye will show if there are any blockages in the blood flow. X-rays are taken to show how the dye moves through the artery and blood vessels of the brain.
Transcranial Doppler (TCD) - An ultrasound to identify the speed of blood flow in the brain.
Carotid duplex or a doppler) – an ultrasound of the neck arteries to check if arteries are narrow or partially blocked.
Blood pressure monitoring
Heart rate
Temperature
Oxygen levels
Breathing pattern
Early treatment after a stroke
There is no medical treatment that will repair the brain damage from the stroke, but as previously mentioned urgent medical attention is needed to save the brain cells around the stroke as the damage spreads outwards from the center of the stroke.
According to Stroke Foundation ‘To minimise the damage caused by an ischaemic stroke, some people may be suitable for thrombolysis and endovascular clot retrieval.
Thrombolysis is the process where rt-PA is administered.
rt-PA is a clot-busting drug that breaks down a blood clot. This allows blood flow to return to the brain.
Endovascular clot retrieval or intra-arterial thrombectomy is another treatment used to return blood flow to the brain, often in conjunction with thrombolysis.
After the clot has been pinpointed by a brain scan, a tiny tube is fed into the blocked blood vessel, usually inserted through an artery in the leg and fed up through the body into the brain. A wire stent or suction device captures the blood clot and allows it to be pulled back out.’
Risk factors that you can’t change: -
Age
The risk of stroke increases with age, with the rate of 85 and over were twice the rate of the 75-84 year age group and almost 6 times the rate of the 65–74 year age group
Gender
In 2020, it was estimated that 21 000 males suffered stroke while 18 500 females.
The risk of stroke increases after menopause.
Family history
Having family history can increase the risk of stroke. i.e., High cholesterol can run in the family.
Previous stroke history
Having a previous stroke could increase the likelihood of having another.
Autoimmune conditions
Autoimmune conditions can inflame the walls of blood vessels, making them narrower and more likely to clot.
Medications
Some medications like blood thinners can reduce the risk of ischaemic stroke or clot, but they may increase the risk of haemorrhagic stroke or bleed.
Head or neck trauma
Suffering from head or neck trauma could break cause a bleed or a clot.
Race
South Asian, African heritage, Aboriginal and Torres Strait Islander people are more likely to have high blood pressure, diabetes and or other risk factors for stroke.
Socioeconomic area
Based on the 2018 Survey of Disability, Ageing and Carers, the age-standardised prevalence of stroke among people aged 15 and over living in the lowest socioeconomic areas (1.8%) was more than twice as high than for those than in the highest areas (0.8%).
Remoteness area
Based on the 2018 Survey of Disability, Ageing and Carers, for both men and women, there were no statistically significant differences in the age-standardised prevalence of stroke across remoteness areas (Figure 2).
Regional and rural Australians are 17% more likely to experience a stroke than their metropolitan counterparts.
For more risk factors go to Stroke Foundation
What can be done to help prevent stroke?
Modifiable Risk Factors
Risk factors that a person can change:
Be physical active.
Being inactive increases the risk of stroke and other health conditions such as:
High blood pressure
High cholesterol
Obesity and
Diabetes.
Aim at least 30 minutes of exercise most days that increases your heart rate.
To find out the how much exercise the Australian Health department recommends, click here.
Stop smoking
Smoking (in all forms) can increase the risk of stroke by 12% for every 5 cigarettes smoked per day.
Smoking can damage the blood vessels and heart
Carbon monoxide reduces the amount of oxygen that the blood can carry.
Eat healthy food
Reduce salt and sugar intake.
Eat a variety of fresh veggies and fruit from different types and colours.
Limit foods high in saturated and trans fats, i.e. fats that are solid at room temperature, like butter, tallow, cream, ice-cream or cheese.
See a qualified dietitian or nutritionist for proper nutritional advice for you.
Control blood pressure
90% of all strokes are linked to high blood pressure.
It’s estimated that good blood pressure control can prevent about 40%.
Avoid alcohol
Drinking alcohol makes it difficult to maintain a healthy weight.
It can also cause high blood pressure and atrial fibrillation (a heart condition where your heart beats fast an out of rhythm.)
Drinking too much alcohol can increase triglycerides levels in the blood, which increases the risk of stroke.
Speak to your doctor about your alcohol intake.
Reduce stress
Know your stresses and seek expert strategies to manage them if you experience high stress levels.
A 2022 study found that people with high blood pressure and persistently high levels of psychological stress had an increased risk of experiencing their first stroke or first ischemic stroke.
Manage blood sugar
Improve blood cholesterol
Maintain a healthy weight
For as long as I can remember, it has always been recommended to refer to the Body Mass Index (BMI) i.e. weight to height ratio.
A 2021 study showed that using waist-to-hip (WHR) is a more effective tool for predicting Hypertension Than Waist-To-Hip Circumference and BMI in Patients with Type 2 Diabetes.
Other studies include:
A 2018 study shared that a high WHR was a significant predictor of death in women with heart failure (although researchers didn’t find a link between WHR and men with heart failure).
A 2016 study found that a high WHR was associated with hypertension and diabetes.
Sleep
Research has shown a link between poor sleep quality and an increased risk of stroke.
Medical check-ups
Knowledge is power. Prevention starts with knowing your risk. More than 80 percent of strokes can be prevented.
Make sure that you see your GP regularly to check the following:
Research shows new ways of reducing blood pressure | Watch (msn.com)
Check blood pressure
High blood pressure or hypertension:
Normal blood pressure is about 120/80. High blood pressure is 140/90 and over.
High blood pressure can damage the blood vessels walls, making them weaker. The blood vessels may may narrow, burst or leak.
Having high blood pressure can cause blood clots to form in these blood vessels.
When blood flow to the brain is blocked by these clots, the brain does not receive oxygenated blood and nutrients, this can cause a stroke.
High blood pressure is the high-risk factor for haemorrhagic stroke.
Check cholesterol
High cholesterol could cause the risks of plaque, a buildup in the arteries.
When plaque builds up, it can reduce the space inside the arteries for blood to flow from the heart to the brain. Left untreated could cause a stroke.
Diabetes
People with diabetes have an increase risk of stoke.
Type 1 diabetes can damage the blood vessels due to the increased blood glucose.
People with type 2 diabetes have many other health issues like high cholesterol that could increase their risk of stroke.
Heart disease
Having heart conditions like heart valve defects, irregular heart beat or enlarged heart chambers or coronary artery disease can increase the risk of stroke, as the plaque builds up in the arteries, blocking blood flow to the brain.
Post-Stroke Recovery: Understanding Fatigue, Thinking, Memory.
What to expect after a stroke?
Getting help
Fatigue
What you need to know about fatigue, the causes, how to manage fatigue click here.
Thinking and memory
What you need to know about thinking and memory, perception, treatment and recovery and things you can do, click here.
Muscle spasticity
What you need to know about muscle tone and spasticity, the effects, treatment and recovery, click here.
Thinking and memory
What you need to know about thinking and memory, perception, treatment and recovery, things you can do and how to stay safe, click here.
Communication
How a stroke can affect communication, treatment and recovery, communication tips for family and friends, click here.
Emotional and personality changes
What you need to know about personality changed, strategies you can use, treatment and recovery, click here.
Incontinence
What you need to know about incontinence, types of incontinence, assessing incontinence, products that can help, click here. For more about incontinence, go to Incontinence Australia.
Vision loss
Types of vision loss, Management and recovery, click here.
Depression and anxiety
What you need to know about depression and anxiety, treatment and support and getting help, click here.
To assess your stroke risk, click here.
To register for Living Well After Stroke, click here.
Other help
StrokeLine provides advice on stroke prevention, treatment and recovery. StrokeLine’s allied health professionals can help you find the support and services you need.
Call 1800 787 653 Monday to Friday 9am to 5pm, Australian Eastern Standard Time.
Email strokeline@strokefoundation.org.auEnableMe can help with your stroke recovery. Get the information you need and connect with other survivors and families.
Visit EnableMeFind an occupational therapist at Occupational Therapy Australia