Stroke

A Stroke or cerebrovascular accident (CVA) occurs when the blood supply to part of the brain is insufficient, causing an area of brain damage.

A Stroke occurs when a blood vessel leading to the brain either becomes blocked or bursts. The part of the brain normally fed by the blood vessel becomes starved of oxygen, and stops functioning. The effects of a Stroke can vary from mild to very severe, depending on the size and location of the blood vessels involved. The damage caused by a minor Stroke may be limited to droopy facial muscles or slightly slurred speech, while a major Stroke can cause paralysis, dementia, coma or death. The two main types of Stroke are cerebral infarction, caused by a blocked blood vessel, and cerebral haemorrhage, caused by a bleeding blood vessel.

Cerebral infarction makes up 85% of all Strokes. Blood vessels may become blocked as a result of atherosclerosis, where a fatty plaque develops inside the vessel. Another method of blockage is a blood clot travelling to the brain from elsewhere in the body (an embolism).
Cerebral haemorrhage occurs in 15% of cases. It may be the result of untreated hypertension (high blood pressure) or a burst aneurysm (a bulge in the blood vessel). A severe bleed may be instantly fatal, while multiple small bleeds may cause a gradual decline in brain function over an extended period of time.

CAUSE
Factors that increase the risk of Stroke include hypertension (high blood pressure), heart disease, atherosclerosis, smoking, diabetes mellitus, high blood cholesterol and triglycerides, high alcohol intake, obesity and lack of exercise.

SIGNS AND SYMPTOMS
Symptoms will vary depending on the severity of the Stroke. Some may be so mild that they go unnoticed, while others can be severe. Emergency medical attention should be sought if any of the following symptoms are present:
• Sudden numbness of the face, arm, or leg, especially on one side of the body
• Confusion, trouble speaking or understanding speech
• Difficulty seeing in one or both eyes
• Difficulty walking, dizziness, loss of balance or collapse
• Sudden severe headache with no known cause.
A transient ischaemic attack (TIA) is a temporary condition that produces symptoms identical to a Stroke. TIAs usually last for less than an hour and the person does not lose consciousness. The symptoms disappear once the TIA is over. Unlike a Stroke, a TIA does not cause permanent brain damage. However, a TIA is a warning sign that the blood flow to the brain is impaired in some way. Urgent medical attention should be obtained to prevent a Stroke from occurring.

TREATMENT OPTIONS
As with all medical conditions your Doctor should be consulted. It is advisable for people over 50 years of age to have regular medical check-ups. Your Doctor can tell you if you are at risk of a Stroke and how to best prevent it. If a Stroke occurs, surgery may be needed to either clear a blocked blood vessel or stop any bleeding. A Doctor may refer a Stroke patient to a Physiotherapist or Occupational and Speech therapist, to help with the rehabilitation process.

DIET HINTS
• Recent clinical data suggests that a diet high in red and processed meats, white flour, sweets and desserts may increase Stroke risk, whereas a diet higher in fruits and vegetables, fish and whole grains may protect against Stroke.
• A high dietary intake of wholegrain foods reduces the risk of Stroke. Dark breads (e.g. rye bread), brown rice and Wholegrain cereals such as cooked oats (porridge) are good sources of Wholegrains.
• Foods high in vitamin C are recommended for Stroke prevention. Good sources of vitamin C include fruit (especially citrus fruits), berry fruits, vegetables and sprouted seeds.

PREVENTION
The following hints can reduce the risk of Stroke.
1. Quit smoking. Smoking is a major risk factor for Stroke, heart and lung disease and cancer.
2. Have your blood pressure checked yearly, or more often if you have hypertension.
3. Have your blood glucose, cholesterol and triglyceride levels checked, and follow medical advice if your levels are too high.
4. Exercise regularly. See the Exercising for Health topic for more information.
5. Avoid obesity.
6. Keep alcohol intake to within recommended limits: no more than four standard drinks per day for men, and no more than two for women.
7. Half an aspirin tablet per day (80-160 mg) may reduce blood clotting and decrease the risk of Stroke. Check with your Doctor before commencing aspirin.

Aspirin should not be given to children under 16 years of age unless specified by a Doctor.

VITAMINS/MINERALS/HERBS
• Vitamin C may reduce total cholesterol and LDL levels and can prevent their oxidation.
• Vitamin E may prevent LDL oxidation and may act as a natural blood thinner.
• Omega-3 fatty acids may reduce inflammation in the arteries and lower cholesterol and triglyceride levels.
• Garlic may reduce cholesterol levels and increases HDL cholesterol.
• Ginkgo biloba may assist prevention of stroke as it has blood thinning and anti-oxidant properties.
• Hawthorn may assist n preserving blood vessel integrity following transient ischemic attacks (TIAs).

MEDICAL TERMS
Haemorrhage: Bleeding.
Infarction: Tissue death caused by lack of blood supply.
Triglycerides: The type of fat stored in the body and present in the bloodstream.

ORGANISATIONS & SUPPORT GROUPS
Indian Patient Foundation - Stroke Support (http://www.patient.org.in/group/stroke)
Stroke Awareness Foundation - http://www.strokeinfo.org/

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. Anti-smoking products can help reduce cravings if you are trying to quit. Ask your Pharmacist for advice.
3. Half an aspirin tablet once a day may help lower the risk of Stroke. Check with your Pharmacist or Doctor before commencing aspirin.
4. Ask your Pharmacist for advice about obesity and weight management.
5. Consider a blood pressure monitor for home use. Your Pharmacist can show you how to use it.
6. Consider some nutritional supplements if the diet is inadequate.
7. A wide range of home health appliances is available to help with lifestyle changes following a Stroke.

Aspirin should not be given to children under 16 years of age unless specified by a Doctor.