Stroke

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Every five minutes in Britain someone has a stroke.

Every year over 150,000 people have a stroke

It is the third largest cause of death, after heart disease and cancer.

·         A stroke happens when the blood supply to part of the brain it cut off

·         There are two types of stroke-

·         Ischaemic (accounting for over 80% of all cases) – This is where the blood supply is stopped due to a blood clot 

·         Haemorrhagic – is where a weakened blood vessel supplying the brain bursts and causes brain damage

      Like all organs the brain needs oxygen and nutrients which is provided by blood to work properly. If this is restricted or stopped then brain cells die which can lead to brain damage and possibly death.

         If you are over 65 years- more older people have strokes

·         If you have a  family history of stroke

·         If you are South Asian, African, Caribbean- increased risk

      ·      If you have medical conditions such as  diabetes, atria fibrillation and hypertension

·      If you have had a previous TIA (mini stroke, transient ischaemic attack) or heart attack

·      If you smoke are overweight or if you consume large amounts of alcohol.

·      A stroke is very serious and they are often life changing

·      One day a person can be an active independent individual and then the next they could be lying in a bed unable to move without any prior warning.

·      Depending on what side of the brain the stroke happens, depends on what effects a person can experience.

If the stroke happens on the right side of the brain it affects the left side of the body and vies versa. It can cause one sided weakness or paralysis which can cause problems with a person’s balance and movement. It can also cause half the face to drop.

·      It also depends on where in the brain the stroke happens.

·      If the stroke happens in the frontal lobe it can cause Dysphasia (difficulty in speech) Aphasia (no speech), problems with planning, organising and problem solving

·      If the stroke happens in the temporal lobe a person can have problems with memory and distinguishing smells and sounds. If a stroke happens in the right temporal lobe it can affect a person visual memory where as if it happens in the left temporal lobe is affects a person’s verbal memory.

·      If the stroke happens in the parietal lobe it will effect a person’s physical sensations such as pain and pressure it will also affect their ability to identify objects.

·      If the stroke happens in the occipital lobe it will affect a person’s ability to process visual stimuli and recognise shapes and colours.

·      It’s important to recognise a stroke as quick as possible because early diagnosis and early treatment can reduce the effects of a stroke

·      Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped

·      Arms – may not be able to lift one or both arms and keep them there

·      Speech – their speech may be slurred or garbled, or the person may not be able to talk

·      Time – it is time to dial 999 immediately

·      prompt transfer to a hospital providing specialist care (A&E)

·      an urgent brain scan (CT Scan)

·      If it is a ischemic stroke they can be given a clot busting drug, thrombolysis

·      immediate access to a high quality stroke unit

·      early multidisciplinary assessment, including swallowing screening

·      stroke specialized rehabilitation (community hospital), OT, Physiotherapist and speech therapy  

·      planned transfer of care from hospital to community and longer term support

·      aspirin (an anti-platelet medication)

·      warfarin (other anticoagulant medication)

·      thiazide diuretics

·      angiotensin converting enzyme (ACE) inhibitors

·      calcium channel blockers

·      beta-blockers

alpha-blockers

Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.

·      Emergency surgery is often needed to treat hemorrhagic strokes to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.

·      I want to introduce you to Paul

·      Was admitted to the hospital I work in (not his real name)

·      Paul is 51 years old,

·      He is a former Royal Marine. Having joined the Marines at 19 years old, he served with the Royal Marines for 18 years; He saw active service in the Falklands.

·      He left the RM when he was 37 years old and joined a company working as an electrician.

·      He is now married with 2 children age 17 and 15. He enjoyed family life, meeting with his old RM friends and playing darts. When he first left the RM he carried on going to the gym and keeping fit.

·      6 months ago, Paul suffered a devastating stroke caused by a blood clot.

·      The clot happened in the left hand side of his brain in between the frontal and the temporal lobe which.

·      Was taken to A&E and then onto a specialist stroke unit- thrombolysis but not effective-

·      This caused him to have paralysis on the right side of the body, Dysphasia (difficulty in speech), he also had problems with his memory and distinguishing smells and sounds

·      As a result of the stroke he also became incontinent

·      Initially needed peg feed and needed a wheel chair.  

·      Admitted to community hospital- physiotherapy, OT and speech therapy – improvement able to move his hand a little bit, swallowing improved and didn’t need to be peg fed and his memory improved

·      He managed to go home from hospital with a package of care

·      However when he went home,

·      As well as the physical effects the stroke also affected Paul’s social and emotional health.

·      He became isolated from peers, family.

·      Difficulties for whole family. – they needing to move to a bungalow.

·      Unable to work which put a economic strain on the family

·      Unable to drive his and do things around the house which put a strain on wife

·      It also affected his mood and because his body had changed dramatically he had body image problems.  

·      I chose to use Paul as an example because he was relatively young to of had a stroke and he was a member of the Royal Marines which are renowned for their level of fitness. He had a big impact on the ward because he was the same age as some of the nurses and his children were the same age as me.

Even thought Paul was in the Royal marines and lead an active lifestyle when he was younger there are ways in which the likely hood of a stroke can be reduced.

·      His stroke could have been prevented if he considered his lifestyle when he was younger and as he got older and left the Marines. 

·      Some people have a predisposition and are more likely to have a stroke however research has shown that the this risk can be reduced by changing your life style

·      Eat a healthy diet, - this can be controlled by the navy while on base/ship

·      Exercise regularly- ensure that you do regular exercise (once out of the marines too)

·      Stop smoking- was a big part of naval culture; more common in the Navy that it is in civilian life (35% compared to 28%). 

·      Reduce consumption of alcohol- not excessive amounts

so the likely hood of a stroke can be reduced by a few life style choices