Stroke

Signs and symptoms

Since a stroke occurs suddenly, its signs and symptoms can appear very quickly. During a stroke, brain cells are starved of oxygen and begin dying within minutes. The expression 'time is brain' in stroke treatment represents the principle that more brain cells are lost as time passes. The time between the start of a stroke and its treatment is therefore crucial.

Early warning signs - FAST test

The FAST test is a simple set of early warning signs used to recognise a stroke. FAST is an acronym used to remember these points:

• Face - is the person's face droopy, flaccid, especially just on one side? Can they smile?
• Arms - can the person lift both their arms above their head?
• Speech - is the person having problems with speaking and/or understanding speech? Is the speech slurred?
• Time - the quicker you act, the better the chance of survival and recovery. Call 000, even if the symptoms go away.

The FAST test is used to diagnose early warning signs of a stroke. 

Symptoms of a stroke

Symptoms and effects of a stroke can include:

• Sudden weakness on one side of the body, such as the inability to move or lift the arm;
• Sudden paralysis of one side of the body;
• Movement and coordination problems, particularly only on one side;
• Confusion, memory loss and difficulty with formulating thoughts, speech and understanding speech;
• Sudden, severe headache;
• Dizziness, vertigo;
• Nausea, vomiting;
• Blurred vision, loss of vision, or seeing only half the regular vision field (hemianopia);
• Seizure, and;
• Loss of consciousness.

Methods for diagnosis

A doctor will initially suspect stroke based on the symptoms and a physical examination.

A brain scan such as a computerised tomography (CT) scan or magnetic resonance imaging (MRI) is needed to identify the type, location, and severity of the stroke.

In many cases of stroke, heart activity will also be examined and monitored, as it may be related to heart conditions.

Types of treatment

Treatment of stroke is broadly divided into two categories - treatment that is given during and immediately after a stroke occurs, and rehabilitation that takes place after the situation has stabilised.

Immediate treatment

Stroke treatment should be done by medical professionals. The immediate concern during a stroke is to restore normal blood flow to the brain. The treatment for the two types of stroke are very different. For an ischemic stroke, treatment involves dissolving the blockage in the artery. For haemorrhagic stroke, the bleeding must be stopped and the pressure on the brain relieved.

Rehabilitation

After the cause of stroke has been successfully treated, the rehabilitation stage can begin. Its general goals are to restore the person to normal function if possible and to prevent complications. The character, length, intensity and outcome of this stage are different for every person.

Rehabilitation follows a cycle composed of these steps:

• Assessment of the person's condition;
• Setting goals for this rehabilitation stage, and;
• Intervention (therapy).

After a certain period, the person's condition is reassessed and the cycle begins again, if needed.

Lifestyle modifications

People recovering from stroke are encouraged to change their lifestyle - to stop smoking, eat a healthier diet and become more physically active to have a healthy weight. In addition, medication may also be prescribed to treat specific problems.

Therapy

In order to help a person adjust to and improve their condition after a stroke, other healthcare professionals can offer assistance, including:

• Physiotherapy, which will aim to improve the person's physical function and strengthen their limbs;
• Occupational therapy, which aims to help the person re-learn how to perform daily activities (such as walking, eating and dressing) and modify the lifestyle and surroundings to the person's capabilities;
• Speech therapy, to help speech and communication capabilities, and;
• Counselling, to help with any emotional difficulties that arise as a result of the stroke.

The rehabilitation process also includes the affected person's family, who will be taught what to expect and how to adapt to the new circumstances.

Prevention of further strokes

People who have had a stroke are at increased risk of having another. For this reason, after a stroke a person will often be placed on medication that will lower the risk of another stroke happening. Medications to prevent clotting, lower blood pressure and reduce cholesterol levels have been shown to reduce the risk of recurring strokes.

Potential complications

A stroke can damage any area of the brain. As such, its effects can vary widely depending on which part or parts of the brain have been affected and to what degree.

In addition to the effects of stroke listed in the 'Symptoms' section above, long-term complications of stroke can include:

• Vision problems;
• Bowel problems;
• Incontinence (urinary and bowel);
• Urinary tract infections;
• Pain (uncommon), numbness;
• Swallowing and eating difficulties, leading to nutrition problems as well as pneumonia (caused by food and drink accidentally entering the lungs);
• Sleeping problems;
• Emotional problems - such as depression, anxiety or lack of energy. Less common are mood swings, personality changes, psychosis and mania;
• Balance problems leading to falls;
• Dementia;
• The formation of blood clots, including in the legs (deep vein thrombosis) and the lungs (pulmonary embolism), due to prolonged inactivity during recovery from a stroke;
• Heart problems;
• Bleeding in the intestines;
• Recurrent stroke, and;
• Death.

Prognosis

Stroke is a serious condition and a leading cause of death and disability throughout the world. Unfortunately, about a quarter of all people who have a stroke die within a month; about half die within a year. Haemorrhagic stroke is particularly fatal, with nearly half of all victims dying within a month.

For those who survive a stroke, rehabilitation will depend on the severity of the stroke. Many people will recover completely within weeks or months. More severe stroke can cause long-term or lifelong disability.

Prevention

The risk of stroke cannot be completely eliminated, but there are many things you can do to lessen the chance of it happening. These are similar to the steps recommended for stroke rehabilitation and can include:

• Stopping smoking;
• Consulting your doctor about reducing high blood pressure;
• Becoming more physically active;
• Following a more healthy diet by reducing consumption of fats and salt;
• Reducing your alcohol consumption to a moderate level, and;
• Avoiding recreational drugs, such as cocaine, which can increase the risk of strokes.

Awareness

Knowing what stroke looks and feels like can help you recognise it if it happens to you or to others. A quick response will improve the chance of surviving a stroke.