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Understanding Stroke
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What is a Stroke?

Stroke is caused by damage to the brain as a result of bleeding into the brain or interruption of the blood supply by blocking the small arteries in the brain. This leads to loss of function in the affected part of the brain. The larger the area involved, the greater will be the resulting loss of function.

Stroke is the third leading cause of death after heart attack and cancer. It accounts for over 3,000 deaths annually. It increases in frequency in the elderly.

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People at special risk of developing stroke
People at risk are those with:
  1. family history
  2. high blood pressure
  3. smoking
  4. diabetes
  5. history of heart disease
All of these factors lead to hardening of the of the arteries

 

     

Other predisposing factors are:
  1. excessive fats in the blood
  2. faulty lifestyle, including inadequate exercise

Stress is no doubt contributory to stroke, but not the sole cause. Stroke in young patients is usually due to other causes, including a defect in the small blood vessels present from birth (aneurysm).

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Causes (Primary)
  1. Hypertension, which is high blood pressure
  2. Blocking of the small arteries in the brain (thrombosis)
  3. Blocking of the small arteries by particles arising in other parts of the circulation (emboli)

While high blood pressure is a well known cause of stroke, it is not the most common, accounting for approx. 10%. It is essential that high blood pressure is diagnosed and when diagnosed should be treated effectively. Particles arising in other major blood vessels or in the heart account for over half of all cases. This is a very important cause of stroke. Since the source of the problem can be diagnosed and treated it offers a very significant prospect of STROKE PREVENTION.

The major blood vessels responsible are most frequently in the neck (the carotid arteries) and the heart itself.

STROKE CAUSES
 
HYPERTENSION
THROMBOSIS
EMBOLI

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Symptoms

The symptoms will depend on the part of the brain affected. Paralysis of the right side of the body results from damage to the left side of the brain. Many patients have symptoms which are indications of an impending stroke. These are commonly known as T.I.A. (transient ishaemic attack)

The most common are:
Less dangerous symptoms are:
  1. Temporary loss of power in either the hand or leg.
  2. An unusual sensation of pins and needles in the limbs on one side.
  3. Partial loss of vision in one eye.
  4. Temporary loss of speech.
  5. Short blackout attacks.
  1. Dizziness.
  2. Unsteadiness.
  3. Memory loss.
  4. Light-headedness.
  5. Confusion.

It should be emphasised that symptoms affecting one side of the body, for example, slight power loss or sensory disturbance, are more significant than if affecting both sides, as a potential stroke.

When a patient has any of these symptoms, especially if they are repetitive, the risk of stroke developing is high and full investigation is required.

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Investigation

Disease can be diagnosed by examination followed by investigation.

The major investigations are

  1. ULTRASOUND - this is a relatively simple method and may be repeated
  2. ANGIOGRAM - this is a special x-ray method which involves hospital admission and injections to outline the arteries
  3. HEART INVESTIGATION - this again involves ultrasound and x-ray

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Prevention

As a result of investigation, disease in other parts of the cardiovascular system may be discovered, such as irregularity of the heart-beat or potential for heart attack. Distended blood vessels (aneurysm) or blockage of major arteries in the lower limbs may also be detected.

PREVENTION
OTHER PREVENTATIVE MEASURES
  1. rigorous blood pressure control
  2. blood thinning agents, e.g. aspirin
  3. control of any heart disease
  4. close diabetic monitoring

Changes may be made in lifestyle

  1. drinking habits
  2. weight control
  3. cessation of smoking
  4. stress control

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Consequences of Stroke
1. PARALYSIS
When this occurs on one side of the body it is referred to as hemiplegia. This indicates damage to the opposite side of the brain. Sensation may also be reduced on the stroke side.
2. COMMUNICATION PROBLEMS
These are common when stroke affects the left side of the brain. The patient may also have difficulty in comprehending or expressing spoken or written language.
3. SWALLOWING
Problems with swallowing may be severe early on following stroke. This difficulty will usually resolve although liquids may be difficult for some time.
4. URINARY INCONTINENCE
It can be prevented by regular toileting and possibly drug treatment.
5. MENTAL & EMOTIONAL PROBLEMS
Shock, denial, anger and guilt are various stages patients pass through. Mental function such as concentration and memory may be disturbed due to brain damage. In some cases, however, such defects may be a manifestation of depression which responds very well to anti-depressants.
6. FATIGUE
Most patients encounter chronic fatigue in the first year after stroke.

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Treatment

Acute stroke is usually treated in hospital, where the exact cause is investigated by the use of a brain scan which may be either a C.T. scan (Computed Tomography) or MRI (Magnetic Resonance Imaging).

It is important to distinguish between stroke which is due to a bleed or to a blocked artery, as the treatment is different. The former requires blood pressure control, whereas blockage of the small artery will require treatment to dissolve the clot.

Other forms of drug treatment are under investigation in an effort to reduce mortality and disability.

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Rehabilitation

The aim of rehabilitation is to maximise the recovery that will naturally take place and return the patient to maximum independence.

Rehabilitation involves a team of Doctors, Nurses, Physiotherapists, Occupational Therapists, Speech and Language Therapists, Psychologists and Social Workers together with relatives.

Physiotherapy is essential in preventing muscles becoming tense and spastic. This involves proper positioning of the patient in the lying and sitting positions early after stroke.

The Occupational Therapist works to help the person to become as independent as possible in their daily life using aids and equipment to make it easier for the person to manage.

The Speech and Language Therapist will assess in detail and advise patients and relatives on exercises that will improve speech and communication skills.

Many patients will be well enough to return home where treatment will be continued by visits from visiting medical and paramedical personnel. Family support is of the utmost importance. Family members caring for the stroke patient need all the support they can get.

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Community Care

HEALTH BOARDS

Community care varies within health board regions. The public health nurse in the patients area will provide advice on the care available. This may involve a home care team which includes speech and physiotherapists. They also run excellent day care centres. This service is not means tested. Health Boards have helpful literature available documenting services free of charge.

The Department of Social Welfare provide a free booklet called - A Guide to Social Welfare Services.

TECHNICAL AIDS

The Occupational Therapist and Public Health Nurse will advise stroke patients and their carers on the range of technical aids that are available. These can range from non slip mats for placing under dinner plates to special showers for wheelchair patients. These aids are means tested, but are usually available free to medical card patients. Non eligible patients with special needs may sometimes avail of technical aids free if prescribed.

RESPITE CARE

This is arranged through the patient's G.P. or Social Worker. It provides a much needed break to both patient and carer.

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Voluntary Community Groups

The Volunteer Stroke Scheme was set up in Ireland in 1983. The main aim of the association is to help patients with speech and allied problems as a result of stroke. They provide clubs where patients attend once a week.

These clubs provide great support for the stroke victim. The V.S.S. also provide social outings, short holiday breaks, relative support groups, counselling services and annual newsletter.

A very important service provided by the V.S.S. is the home visit. This is available to people with speech and communication difficulties as a result of stroke. They offer weekly visits by a trained volunteer who follows a program given by their speech therapist. Stroke patients find this very valuable.