About Stroke

About Stroke 2019-12-17T11:21:38+00:00

What is a Stroke?

Sometimes called a cerebrovascular accident (CVA) or “Brain Attack” a stroke is caused by an interruption of the blood supply to part of the brain, due to either occlusion of a blood vessel (ischaemic stroke) or rupture of a blood vessel (haemorrhagic stroke). The interruption in blood flow deprives the brain of nutrients and oxygen, resulting in injury to cells in the affected vascular territory of the brain. Ischaemic strokes are more common than haemorrhagic strokes.

A stroke usually occurs suddenly without any warning.

There are two types of stroke:

  • Ischaemic stroke (most common) caused by a blockage of an artery supplying blood to the brain (cerebral thrombosis) An embolic Stroke occurs when a blood clot forms somewhere in the body (usually the heart or in the blood vessels in the neck) and travels through the blood stream to the brain. A thrombotic Stroke occurs when blood vessels narrow as a result of blood fat, cholesterol or calcium which grows to completely block the blood vessel.
  • Haemorrhagic Stroke caused by a bleed from a burst blood vessel in the brain (cerebral haemorrhage). An intracerebral haemorrhage, which is the more common form, involves bleeding within the brain tissue itself. In a subarachnoid haemorrhage the bleeding occurs in the space around the brain. This is often due to an aneurysm-a thin or weak spot on a blood vessel wall.

TIA (Transient Ischaemic Attack) “Mini –Stroke” happens when for a short period of time, usually for a few minutes less blood than normal gets to the brain. TIAs are caused by small clots. A large clot causes a stroke. TIAs should be treated as a medical emergency and urgent medical attention should be sought.

Stroke Prevention

Can a stroke be prevented?

You can reduce the risk of a stroke by making lifestyle choices, e.g. not smoking, eating a healthy diet, avoiding obesity, exercising, and regular check-ups with your doctor for blood pressure, diabetes, cholesterol and irregular heart rhythm. Good control of hypertension (high blood pressure), diabetes and atrial fibrillation (irregular heart beat) are important.

Is the stroke caused by something I did?

It is not always obvious why someone may get a stroke. We do know that certain risk factors can cause a stroke, being elderly, high blood pressure, diabetes, high cholesterol, smoking, obesity, atrial fibrillation being the most common risk factors. When you are in hospital a range of investigations will be done to identify what caused your stroke and what treatment is best to reduce the risk of having a second stroke.

Is stroke hereditary?

Some strokes may be caused by genetic factors and/ or by having lifestyle/cardiovascular risk factors.

Could I get another stroke?

People do not often suffer from repeated strokes, however if you have had a stroke you are at greater risk of getting a second stroke, particularly in the first year. The risk of getting another stroke reduces considerably as time goes on. This can be prevented by following the advice of your doctor, e.g. medication and lifestyle changes.

What are the recommended cholesterol levels?

Previous Stroke, heart disease, Artery disease of legs, Diabetes
Total cholesterol less than 4.5
Bad cholesterol (LDL) less than 2.5

Smoker, High blood pressure, Family history of early stroke/heart disease

Total cholesterol less than 5
Bad (LDL) cholesterol less than 3

What are the recommended blood pressure levels?

Diabetics: At least lower than 130/80
General population: At least lower than 140 / 90

Stroke Recovery

Why does he/she sleep so much?

Feeling tired is a common complaint after a stroke. Stroke related health issues can really drain your strength or energy. Examples include: heart disease, infections, problems with your bladder or bowel pattern, weight loss caused by changes in eating, poor appetite or swallowing trouble, depression or extreme sadness, chronic pain, muscle weakness or paralysis. Medicine and other treatments may help. They can improve problems with depression or pain which may increase your energy levels. But some drugs that treat stroke related issues can have side effects that leave you feeling tired and worn out. Ask your doctor to explain the side effects of any drugs.

How long will I be in hospital?

You will remain in hospital until your medical condition is stable and you don’t have any complications. There are a number of tests that need to be done to determine the cause of your stroke and plan the best treatment for you. If you need rehabilitation, the length of stay will be determined by your progress and what support you have at home and in the community; the rehabilitation team will plan your discharge with you from early in your stay.

Do most people die from a stroke?

The majority of people survive after their stroke. However, stroke is the third most common cause of death in Ireland after heart disease and cancer

How long does recovery take?

Most return of function is seen in the first few days and weeks. Recovery is a gradual process and varies from person to person; it also depends on the type of stroke you have suffered.

Early recovery is probably due to recovery of function of less damaged and swollen areas of the brain – it can take up to a month for swelling to go out of the brain. Later, recovery probably develops as the person learns techniques to compensate for their impairments. The ‘pattern’ of the recovery depends on a host of factors, so it can be difficult to predict the full extent of an individual’s functional recovery. Continued improvement can certainly be achieved many months and years following a stroke, however, it is usually at a slower pace.

Will I be able to do the things I did before?

The aim of recovery is to become as independent as possible within the limitations of the stroke. You may have to do things differently, but it is important to try to return to your previous occupation/pastimes if it is safe to do so. Physiotherapy, occupational therapy and speech and language therapy aim to assist you to become more independent in the things you previously did. You may require assistance with some of these things.

Will I get better?

The majority of people get better and progress is gradual. Often getting better may mean learning to do things differently than before and may include lifestyle changes, taking prescribed medication and learning to cope with a disability of some sort.

Will his/her condition get worse?

The condition can get worse if there are medical complications, for example, chest infections, depression, another stroke. It is important to continue your therapy programme at home.

Will someone always have to help me to dress?

Depending on the type of stroke you have you may need to learn new ways to dress or may need assistance when dressing. An Occupational Therapist may be able advise and train you to dress yourself.

Will my memory get better?

Every stroke is different and some people will have memory problems that will resolve quickly, however others may have memory problems for longer periods of time.

Can speech and language therapy make a difference in the early days?

Research has shown that people who had difficulty speaking or understanding speech after a stroke showed significant improvement in language and communication skills after a short term of intensive therapy.

Will my speech get better? How long will it take?

Rehabilitation is a slow and often frustrating process. Improvements in a persons understanding and use of language can be seen after months and even years post stroke.

General Questions

What are the signs of someone having a stroke?

Stroke is a medical emergency. You need to seek medical attention immediately.
Signs of a stroke may include:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion
  • Sudden difficulty speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

For more information click here.

Where can I get incontinence wear?

Contact your Public Health Nurse at your local health centre. You will need a medical card to avail of incontinence wear through the HSE. There is a variety of incontinence wear available, sizes, styles to suit your needs. Your Public Health Nurse will talk to you about this.

How can I deal with incontinence issues?

There may be a number of reasons why someone is incontinent, as a consequence of stroke or for some other reason. You need to talk to your doctor and Public Health Nurse to see if the incontinence can be treated or managed better. Often just by going to the toilet every 2 hours during the day will keep the person drier.

For more information click here and here.

How long will I have to wear “Ted” anti- embolic stockings for?

Anti-embolic stockings are usually provided when you are admitted to hospital and have poor mobility. They help to prevent a clot forming in the veins in your legs. They can be removed when you become mobile again or if you are on medication to thin your blood. They can be useful to reduce swelling in your ankles / feet. It is important to remove the stockings to check your skin regularly and to clean and moisturise. Your Public Health Nurse or doctor will advise you.

Can I fly/travel?

When your medical condition is stable and you have spoken to your doctor about planning a trip there is no reason why you shouldn’t travel again. You also need to inform your insurance company. You also need to consider other precautions if going on a long journey, particularly if your mobility has been affected by the stroke, e.g. prevention of Deep Vein Thrombosis. Speak to your doctor about this

Is there any wheelchair accessible taxis/public transport?

Yes. Most taxi companies have wheelchair accessible transport. Contact the taxi or hackney service in your local area or the Stroke Support Club coordinator on 087 254 6742 for phone numbers.

Can I smoke?

Smoking is a risk factor for stroke or having a second stroke. If you have difficulty giving up smoking you should talk to your G.P. or you can be referred to a smoking cessation officer within the HSE.

For advice, help and support on giving up smoking call The National Smokers Quitline on 1850 201203
For more information click here to see some additional information from the HSE.

Will I be able to return to work?

The type of stroke and level of resulting disability will impact on whether it will be safe and practical for you to return to work. Getting back to work is another goal of your rehabilitation but you may find it difficult to access such services without talking to an Occupational Therapist. A vocational assessment service is available in the National Rehabilitation Hospital, Dublin to people under age 65 who have had a stroke. The aim of this service is to consider vocational options, working with you, to pinpoint your strengths and weaknesses, skills and experience. Together with the rehabilitation team you should discuss the best way to approach your employer about returning to work, possibly in a phased way. You may need to make some adaptations or changes if your stroke has affected your ability to manage computers or machinery that is relevant to your job. Many workplaces will have an occupational health service which is meant to help you and your workplace to adapt to your present condition.

Medication

Do I have to stay on medication?

Generally yes. The choice of medication for stroke depends on your individual condition. It depends on what may have caused the stroke and what is required to prevent another stroke. Many people take medication for high blood pressure, high cholesterol or diabetes. Your doctor will be able to inform you on the best course of action for you.

What is Warfarin ?

Warfarin is a tablet that thins the blood to help prevent clots forming around the heart. It can be prescribed for artrial fibrillation. Careful monitoring of your blood is required.

How much alcohol can I have with Warfarin?

The best advice is to not to drink alcohol while you are taking Warfarin. Since this is not practical for everyone, only a daily moderate amount of alcohol is suggested, 1 or 2 units of alcohol only. Remember, 1 unit is ½ pint of beer or 100ml glass of wine or a measure of sherry/spirits. You need to talk to your doctor about this.

How will I manage my medication?

A prescription will be given to you on discharge from hospital for your doctor and pharmacy. An explanation of your medicines can be provided by your doctor or pharmacist. If you are having difficulties with understanding, opening the packet or swallowing your medicines you need to contact your Public Health Nurse and GP. Your pharmacist may be able to help. If you are in the Stroke Unit in St Camillus Hospital a medication education programme may be incorporated in your preparation for discharge. Remember, like with any medicine, if there are side effects you must always consult your G.P or consultant and always follow the instructions.

Why am I on cholesterol tablets if my cholesterol is normal?

Research has shown that a combination of medication may help to reduce the risk of another stroke; this may include the use of “statins.” The choice of medication depends on your individual condition. You need to ask your doctor what your medications are for.

The tablets I was on in the hospital have a different name to the ones the chemist gave me what do I do now?

While in hospital the names of the tablets are written in their generic name, the chemist sometimes uses a trade name and a different supplier but if you look closely at the packet the generic name should also be there in smaller print. If you are not sure talk to your pharmacist. Drugs can have different trade names in different countries.

What are the side effects of medication?

Most medication has a list of side effects in the information that comes with the packaging. It is important to tell your doctor the names of all the medications you are taking including “over the counter” drugs, vitamins or herbal products as these may interact with the medicines you have been prescribed.

Depression and Mood

Is depression after a stroke common?

Yes. 30-50% of people can suffer from post stroke depression. Coping with a stroke can be very difficult for the person and for loved ones. Understanding the nature of the stroke, the likely prognosis and acknowledging the difficulties you are all facing can help. Support the person’s efforts to make decisions, visit and talk but relax with the person too. Sometimes medication is needed to treat depression.

Why is he/she crying every time I visit?

Following a stroke many people cry very easily, even if they don’t feel particularly sad. This is referred to as “emotional lability” This inappropriate emotional response is a sign of injury to the brain, it can be distressing for everyone; sometimes it helps the person to distract them or change the subject.

Relationships

Will my relationship be affected by my stroke?

Like any major life crisis stroke can impact on the relationship you have with a partner, other family members and friends. A stroke may affect you physically, cognitively or emotionally. It takes time to adjust to the longer term effects of the stroke. Returning to things you did together prior to the stroke may take time and involve some changes.

Can I resume sexual activity after a stroke?

There’s no reason why a stroke survivor can’t resume sexual activity as soon as they feel ready to do so. Couples who have enjoyed sexual relationships before the stroke are often fearful of resuming them in case a further stroke should result. There is no evidence to show this happens. Be aware that your feelings about your body may have changed since your stroke.

Can we leave them alone?

As each person’s stroke affects them in a different way, it is best to seek the advice of the health professionals involved in the care of the person who has had a stroke.

Why doesn’t he/she recognise us?

Some people who have strokes have damaged a part of their brain that processes visual information, or memory and this may be why he/she does not recognise you. Sometimes this can be resolved in time. Creating a routine during the week can be beneficial for the person who has suffered a stroke.

How can family help?

The role of your family and friends is of vital importance in coping when you return home. The natural response for many carers and relatives is to be protective, but sometimes this can interfere with the person having the opportunity to practice their skills as prescribed by the clinical team. The role of relatives and carers is to strike a balance between being protective and encouraging independence – the best way to achieve this is with continuous communication with the person with the stroke and the clinical team.

Effects of a Stroke

The effects of stroke can vary widely depending on what part of the brain has been affected. When brain cells die, function of the body parts they control is impaired or lost, the following are some of the effects:
Paralysis or weakness of one side of the body or just a part of the body causing problems with walking, balance, strength in the muscles

  • Loss of sensation/numbness
  • Loss of vision
  • Difficulties in communication
  • Swallowing difficulties
  • Loss of intellectual ability/confusion/memory problems
  • Emotional changes

Stroke kills more people in Ireland than lung cancer, bowel cancer and breast cancer combined. The Irish Heart Foundation, in association with the Department of Health and Children has commissioned the largest research project about stroke services ever undertaken in Ireland.

Full details of the report (2008) can be seen on the Irish Heart Foundation website.

Stroke is the third leading cause of death and disability worldwide and constitutes a formidable burden of disability for patients, their carers and the wider community. Approximately 10,000 people experience a stroke each year in the Republic of Ireland (ESRI) and it is estimated that over 30,000 people in Ireland are survivors of stroke. Using international data, it is calculated that many who survive stroke have significant ongoing disability including hemiparesis (48%), inability to walk (22%), need for help with activities of daily living (24-53%), clinical depression (32%) and cognitive impairment (33%).

Risk factors for a Stroke

High blood pressure – High blood pressure is the most important risk factor for stroke

Increasing age – As you get older, the chance of having a stroke does increase. However, many older people will go through life without having a stroke. You can reduce the risk of stroke by making lifestyle choices.

Male Sex Gender – Stroke is more prevalent if you are a male. While you cannot control your gender, you can reduce the risk of stroke by lifestyle choices.

Heredity (family history) – The risk of stroke is greater in people who have a family history of stroke.

Prior stroke – The risk of stroke for someone who has already had a stroke increases the risk of a second stroke but this risk decreases over time.

Transient ischaemic attacks (T.I.A.s) – TIA’s are “mini strokes” that produce stroke-like symptoms but no lasting damage. They are strong predictors of future permanent stroke.

Smoking – In recent years studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the circulation system in many ways.

Diabetes mellitus – Diabetes is an additional risk factor for stroke and is strongly linked with high blood pressure

Carotid artery disease – The carotid arteries in your neck carry blood to your brain. A carotid artery damaged by atherosclerosis (a fatty build-up of plaque in the artery wall) may become blocked by a subsequent blood clot, which may result in a stroke.

Heart disease – A diseased heart increases the risk of stroke. In fact, people with heart problems have more than twice the risk of stroke as those with hearts that work normally. Atrial fibrillation (the rapid, uncoordinated beating of the heart’s upper chambers), in particular, raises the risk for stroke

High blood cholesterol and lipids – Make sure that you have regular check-ups to establish your cholesterol levels

Lack of exercise – Excessive weight, a poor lifestyle, poor dietary regimes and leading a lifestyle without exercise can contribute to an increased risk of having a stroke. If you feel that your body has had little exercise, consult with your GP who will advise of the right form and quantity of exercise that your body, based on your health requires.

Obesity – While often described as being grossly overweight or fat, obesity can be measured by calculating Body mass index (BMI) which is a measure of body fat based on height and weight that applies to both adult men and women. Talk to your GP to see if you are at an increased risk and if you should lose weight. Your doctor will evaluate your BMI, waist measurement, and others risk factors for heart disease and stroke.

High red blood cell count – A moderate or marked increase in the red blood cell count is a risk factor for stroke. The reason is that more red blood cells thicken the blood and make clots more likely.

Excessive alcohol intake – Excessive drinking (an average of more than one drink per day for women and more than two drinks per day for men) and binge drinking can raise blood pressure, contribute to obesity, produce high fat levels in the blood stream, cause heart failure.

Certain kinds of drug abuse – e.g.; Intravenous drug abuse carries a high risk of stroke from cerebral embolism. Cocaine use has been closely related to strokes, heart attacks and a variety of other cardiovascular complications.

Stroke Treatment

Drug therapy – Drug therapy is a relatively recent approach to the treatment of stroke, and a tremendous amount of research is under way to find effective new drugs that can minimize stroke damage.

Clot dissolving treatment, tissue plasminogen activator (TPA) – This is a major advance in medical therapy for acute strokes caused by blood clots. A risk of brain haemorrhage accompanies use of the drug. TPA is effective only if given promptly. The therapy should only be started after a CT brain scan has shown that there is no evidence of brain haemorrhage. As yet TPA treatment is rarely given in Ireland.

Acute hospital care and rehabilitation – For stroke patients suffering loss of speech, movement, impaired thought processes or loss of feeling, rehabilitation is possible with the assistance of physiotherapists, speech and language therapists, occupational, and other therapists.

Surgery – Carotid Duplex ultrasound test can help a vascular surgeon advise people with either TIA or mild stroke whether surgery to the carotid artery in the neck would further protect against further TIA or stroke. When a neck artery has become partially blocked, surgery might be used to remove the build-up of the fatty deposits. This procedure called carotid endarterectomy is performed by a vascular surgeon.

Rehabilitation

The goal of rehabilitation is to reduce dependence and improve physical ability. Rehabilitation begins early when nurses and other hospital staff work to prevent such complications as stiff joints, pressure sores and pneumonia, which can result from being immobile or confined to bed for a long time.

People with the least severe strokes are likely to recover the most. But even when improvement is limited, the person should benefit from stroke unit care and may still enable the person to return home from hospital. Part of rehabilitation is aimed at helping the person adapt to physical weakness or other problems caused by the stroke. Treatment of depression, proper bed and sitting/wheelchair positioning following a stroke, are all regarded as part of rehabilitation. The amount of therapy given and the time when it starts is governed by the effects of the stroke and the amount of recovery that takes place over the weeks and months following the stroke and obviously the availability of a full rehabilitation team. The intensity of therapy will be a matter for the person, his/her therapists and the doctor to discuss. The outcome of rehabilitation depends on the extent to which the brain is affected, the person’s attitude, the rehabilitation team’s expertise and very importantly the support of family and friends.

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