Stroke - Symptoms, diagnosis and causes of stroke

Stroke - Symptoms, diagnosis and causes of stroke

A stroke is a serious medical condition that occurs when the blood supply to part of the brain is disrupted. Strokes are a medical emergency and prompt treatment is essential because the sooner a person receives treatment for a stroke the less damage is likely to occur.

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Symptoms, diagnosis and causes of stroke

Stroke is the rapid appearance (usually over minutes) of a focal loss of brain function, due to disturbance in the blood supply to the brain .The deficit is most commonly an inability to move one half of the body ( hemiplegia) with or without other signs such as aphasia, hemisensory loss and visual field defect deficit.

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Incidence, age and sex
Stroke is currently the second leading cause of death in the Western world, ranking after heart disease and before cancer,[ and causes 10% of deaths worldwide. 95% of strokes occur in people age 45 and older, and two-thirds of strokes occur in those over the age of 65.

 
Signs, symptoms and diagnosis
The combination of severe headache and vomiting at the onset of focal neurological deficits increases the likelihood of a haemorrhagic stroke. In most cases, the symptoms affect only one side of the body. Depending on the part of the brain affected, the defect in the brain is usually on the opposite side of the body.

A stroke can produce symptoms relating to deficits in cranial nerves such as altered smell, taste, hearing or vision (total or partial) drooping of eyelid (ptosis) and weakness of ocular muscles decreased reflexes: gag, swallow, pupil reactivity to light ,decreased sensation and muscle weakness of the face balance problems and nystagmus ,altered breathing and heart rate weakness in neck muscle with inability to turn head to one side or weakness in tongue (inability to protrude and/or move from side to side).

If the cerebral cortex is involved, the following symptoms may be present aphasia , apraxia , visual field defect, memory deficits, disorganized thinking and confusion. If the cerebellum is involved, the patient may have the following: trouble in swalking, altered movement coordination, vertigo and or disequilibrium.

 
Causes and prevention;
The disturbance in the blood supply to the brain can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood).The fixed risk factors for stroke are age, gender (male > female, except in the very young and very old), race (Afro – Caribbean > Asian > European), heredity, previous vascular event, e.g. myocardial infarction, stroke or peripheral embolism and high fibrinogen levels. The modifiable risk factors are high blood pressure, heart disease (atrial fibrillation, heart failure, endocarditis), diabetes mellitus, hyperlipidaemia, smoking, excess alcohol consumption, polycythaemia, oral contraceptive and social deprivation. Stroke can be prevented by reducing all the identified risk factors. Anticoagulation can prevent recurrent stroke.

 
Complications
The weakness that affects the arm, leg, and side of the face may also impact the muscles of swallowing. Should food and saliva enter the trachea instead of the esophagus when eating, a lung infection maycan occur.

Because a stroke often results in immobility, deep vein thrombosis, pulmonary embolism, pressure sores , depression and incontinence of the bowel and/or bladder may occur.

Submit a request for further information, a quotation or indicative cost. Your enquiry will be forwarded to up to 3 private healthcare providers. They will respond directly with further information.

Treatment of stroke

Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

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Private Stroke reviews and patient stories

Functional Electrical Stimulation
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Martin’s story of how his wife bravely battled the effects of a Stroke for 11 years.

“Elaine was a PhysioFunction 'demo patient' for a health professional’s education day… I believe her life would have been much longer, had she had Functional Electrical Stimulation (FES) much earlier, rather than 11 years on from her stroke… I can see how much difference it can make to their lives, and arguably save NHS resources in the long term by maintaining better health and quality of life.”

Elaine barely survived a very serious brain haemorrhage and stroke in 2000 which left her virtually paralysed on her right side and severe cognitive problems. Her hospital case notes were marked 'do not resuscitate', which one son had noticed and argued with the consultant about to no avail but he did not want to worry the rest of the family so I only found out about after her death.

She lost her speech for 3 months and when it did come back she was very confused.

She spent 6 1/2 months in hospital during which time the ward sister was concerned that she was becoming institutionalised and so we were both keen to get her home;

She was still very confused and disabled when discharged home. She was also doubly incontinent but being in the home environment and cared for by me with home care support rapidly stimulated her to control her bowel early on.

After about 6 months she was issued with an electric wheelchair but had no concept how to use it. I used to transfer her from her easy chair into it and then drive it around to the kitchen for her meals or to the toilet. Eventually she learned how to use it and it gave her considerable independence compared to how she had been.

Unfortunately Elaine then became very attached to the electric wheelchair and was resistant to learning to toilet herself, transferring into an easy chair to relax and straighten her back, and to learning to walk.

From about the 2nd year of Elaine's stroke I did start to feel that we were not always on the same side, as she was resistant to doing more for herself and could be quite argumentative. I remember having a 1:1 meeting with her consultant neuropsychologist during which he told me that the nature of her cognitive condition meant that it was virtually impossible to get her do anything that she did not want to do and so I would have to learn to accommodate myself to the way she was as it was virtually impossible to get her to change. The one ray of hope he offered was an incentives approach but it felt at the time I had virtually nothing left to give by way of an incentive.

In 2005 I had an Achilles tendon reconstruction operation, which meant that I would be on crutches for 3 months and unable to care for Elaine, so it appeared that the only option would be to put Elaine into residential care for 3 months. This horrified Elaine and so she learned to take herself to the toilet, which I think was an illustration of the incentive approach working!

About 2006, I pressed the NHS for support in getting Elaine walking again. She had 6 sessions of physiotherapy and during that time she walked out of one side of the cottage hospital and around the outside and back in from the other side. However it took more effort than she wanted to put in and she never did it again.

Sometime around 2010 the home carer who bathed her became concerned that she was unstable and so social services provided two carers to bath her from then on. Initially Elaine hated that but grew to love having the attention of two people and looked forward to it. The social services OT visited and confirmed Elaine needed two carers. I was disappointed that was all she did, as I felt she should be identifying appropriate remedial action to restore Elaine's stability.

Elaine was a PhysioFunction 'demo patient' for a health professionals education day at Coventry in November 2010. During the day FES equipment was tested on Elaine and Professor Ian Swainson assessed her as suitable.

On return home we saw our GP and got him to refer Elaine to our local health board for FES. There was some delay somewhere between the GP and the 'Individual Patient Commissioning Panel' I understand that and I understand it was the first referral for FES for a stroke patient. So it took some time to get approval about June 2011 to the RJ&AH Hospital at Gobowen.

This was on the basis that there would be a follow up review to assess its effectiveness and decide whether the health board should resource itself to do so.  I don't know whether this ever took place but if so I wasn't involved.

Elaine seemed to like the idea of FES and enjoyed her visits to Gobowen.

However it was difficult to get her to practice using FES, there never seemed to be a right time from Elaine's perspective. We resolved this by having a joint meeting of Elaine and me with her community physiotherapist and neuropsychologist, which concluded with an agreement that she would walk a circuit of the inside of the house at 8 am each morning. This worked well for a long time until I started my MBA degree course at Bangor University in Autumn 2012 and had to leave the house sometimes before 8 am. Unfortunately she could not normally be persuaded to walk earlier, though she used to get up at 6.45 am, nor on my return. So the regularity of practice slipped somewhat in Autumn 2012, but she did get up to 75 yards a day as the number of circuits of the house increased.

Fiona Hinton the local community physiotherapist was a gem. The health board's panel had not budgeted for her time to support Elaine, but she found it and liaised well with Gobowen, including in her own time visiting Gobowen for some of Elaine's appointments. She flagged an important issue, that in Elaine's case her FES suitability assessment should have included her cognitive condition as well as her physiological condition.

Rudi Coetzer, her consultant neuropsychologist also gave excellent committed support.

I saw Elaine as something of a pioneer for FES for strokes in North Wales and had hoped that another stroke patient could be selected to use her FES equipment. I'm pleased that it has been passed on to an MS patient who needed it. However I am hoping that the health board will still offer FES to appropriate stroke patients, as I can see how much difference it can make to their lives, and arguably save NHS resources in the long term by maintaining better health and quality of life.

Elaine died from the inspiration of blood from a duodenal ulcer. A chest scan showed that her hiatus hernia had become so enlarged as to displace her heart and that this together with the pronounced spinal curvature and compressed vertebra had severely restricted her chest cavity. So she was breathing with very limited lung capacity, and was therefore quite vulnerable to any respiratory infection etc. One of the registrars told a son that FES had probably prolonged her life by up to a year.

I believe her life would have been much longer, had she had FES much earlier, rather than 11 years on from her stroke.