Stroke is one of the biggest killers in the UK. For this month’s Health and Wellbeing section, Sussex Business Times turns its focus to the different kinds of stroke and why they are caused. We outline the symptoms to look out for, risk factors and the treatments to follow a medical incident of this kind

Stroke is the third leading cause of death in the UK each year and is the leading cause of disability. More than 150,000 people have a stroke every year in the UK but according to The Stroke Association, up to 10,000 of these could be prevented if more people were aware of the symptoms and sought out emergency treatment….

There are two types of strokes, ischaemic and haemorrhagic, both of which are caused by different factors but essentially, result in the same outcome. According to stroke.org, ischaemic strokes are caused by a blockage cutting off the blood supply to the brain. The blockage can be caused by a blood clot forming in an artery leading to the brain or within one of the small vessels deep inside the brain.

Haemorrhagic strokes, on the other hand, are caused when a blood vessel bursts within or on the surface of the brain. Because the blood leaks out into the brain tissue at high pressure, the damage caused can be greater than the damage caused by strokes due to a clot. Approximately 85% of all strokes are ischaemic and 15% haemorrhagic, although haemorrhagic strokes are generally more severe and are associated with a considerably higher risk of mortality within three months and beyond, when compared to ischaemic strokes.

Strokes occur approximately 152,000 times a year in the UK; that is one every three minutes 27 seconds. First-time incidence of stroke occurs almost 17 million times a year worldwide; one every two seconds. There are over 1.2 million stroke survivors in the UK and three in ten stroke survivors will go on to have a recurrent stroke or TIA. One in eight strokes are fatal within the first 30 days, and one in 4 are fatal within a year. Stroke is the fourth single largest cause of death in the UK and second in the world. By the age of 75, one in five women and one in six men will have a stroke.

Stroke kills twice as many women as breast cancer and more men than prostate and testicular cancer combined in a year, and is one of the largest causes of disability; half of all stroke survivors have a disability. Over a third of stroke survivors in the UK are dependent on others, of those, one in five are cared for by family and/or friends. For every cancer patient living in the UK, £241 is spent each year on medical research, compared with just £48 a year for every stroke patient.

Incidence rates in the UK vary depending on the country or region being researched. It can range from 115 per 100,000 population to 150 per 100,000 population depending on the study. Additional statistics show that stroke incidence rates fell 19% from 1990 to 2010 in the UK. Men are at a 25% higher risk of having a stroke and at a younger age compared to women, however, as women live longer there are more total incidences of strokes in women. The greatest risk of recurrent stroke is in the first 30 days. Every two seconds someone in the world will have a stroke for the first time. There were almost 17 million incidences of first-time stroke worldwide in 2010.

“Where’s the relevance to the business demographic?” you might ask. Most people believe that strokes only occur during later life, which for the most part, is true. However, the number of people having strokes aged 20 to 64 increased by 25% from 1990 to 2010 worldwide, and around 1 in 150 strokes in the UK occur in people under 20 years old.

There is no set cause of strokes and while every case is different, there are a number of risk factors that can cause people to become more susceptible to such an incident. These include:

High blood pressure: High blood pressure is a contributing factor to 54% of strokes in England, Wales and Northern Ireland.120/80 is generally accepted as normal and 140/90 as high. However, blood pressure naturally increases with age and your GP can check if your blood pressure is within normal range.
Diabetes: Diabetes almost doubles your risk of stroke and is a contributing factor to 20% of strokes in the UK.
High cholesterol: There is ‘good’ and ‘bad’ cholesterol. Too much ‘bad’ cholesterol causes the fatty substance to build up on the artery walls. The use of statins in individuals with a high risk of cardiovascular events reduces the risk of stroke by 25%.
Smoking and alcohol use: Regular consumption of large amounts of alcohol greatly increases your risk of ischaemic stroke. 20% of the UK population are active smokers and smoking single-handedly doubles your risk of stroke.

As with any such illness or incident, it’s crucial that the symptoms of a stroke are recognisable and understood by all, as survival rates drop significantly over time. The signs and symptoms of a stroke vary from person to person, but usually begin suddenly, and as different parts of the brain control different parts of the body, symptoms will depend on the part of the brain affected and the extent of the damage. However, the main stroke symptoms can be remembered with the word FAST:

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: The person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in one arm.
Speech: Their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake.
Time: It’s time to dial 999 immediately if you notice any of these signs or symptoms.

Of course, there are treatments for those suffering from a stroke, although it’s harder to reverse the effects of a stroke the longer it takes for the victim to receive treatment. England Health Secretary, Jeremy Hunt says a major challenge is getting all parts of the country to meet the performance levels of the best. For example, if all patients suffering from a mini stroke (transient ischaemic attack or TIA) were treated as rapidly as those treated in the top 25% of hospitals, 540 strokes would be avoided each year, which in turn would save the NHS £4.5m a year. So what are the treatments for a stroke?

Treatment depends on whether it is ischemic or hemorrhagic. If you’ve had an ischaemic stroke, a combination of medications to treat the condition and prevent it happening again is usually recommended. Ischaemic strokes can often be treated using injections of a medication called alteplase, which dissolves blood clots and restores blood flow to the brain, however a small proportion of severe ischaemic strokes can be treated by an emergency procedure known as thrombectomy, which removes blood clots and helps restore blood flow to the brain. Meanwhile, most people will be offered a regular dose of aspirin. As well as being a painkiller, aspirin is an antiplatelet, which reduces the chances of another clot forming. Some people may be offered an anticoagulant to help reduce their risk of developing further blood clots in the future. If the victim has suffered from this kind of stoke due to high cholesterol, they will more often than not be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking a chemical in the liver that produces cholesterol.

As with ischaemic strokes, people who have had a haemorrhagic stroke will also be offered medication to lower their blood pressure and prevent further stroke. Occasionally, emergency surgery may be needed 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, which entails a section of the skull to be cut away to allow the surgeon access to the cause of the bleeding.

Of course, treatment doesn’t stop there, and a large amount of victims of a stroke will continue to undergo rehabilitation for weeks – or months – afterwards. As one of the UK’s biggest killers, there is a huge amount of information out there, so there really is no reason to be unaware of such medical incidents!

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