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Health Insights Series: It's time we did more to combat strokes, a disease that kills the brain

Better treatment is needed for the thousands of people who suffer strokes

    The term "stroke" is far too gentle a word to describe what can be a devastating disease that kills or maims the patient and can ruin the lives of the carers.

    It is also not a term that everyone understands, with surveys still showing that many members of the public confuse stroke with heart attack.

    Perhaps a better name for stroke would be brain attack, which would describe exactly what it is. A problem caused by the blood supply to part of the brain being cut off with the result that that bit of brain dies and the person loses all the functions controlled by it.

    So, depending on which part of the brain is affected, any activity can be impaired, with the most common being paralysis of one side of the body, difficulty swallowing or speaking and impaired vision.

    These are often the most obvious consequences of the stroke but unfortunately there are often deficits that can be equally devastating but are less apparent to the outside observer. Difficulty with the thinking processes and memory, loss of sensation, depression, anxiety and fatigue are examples of these.

    A brain scan of a stroke victim. The red area shows the extent of the bleeding. A scan is essential for accurate diagnosis
    A brain scan of a stroke victim. The red area shows the extent of the bleeding. A scan is essential for accurate diagnosis

    It is therefore vital that we do everything possible to prevent and treat stroke effectively.

    When I first started as a consultant 27 years ago, stroke was regarded as an untreatable disease that affected old people. Patients were admitted to hospital and received no specific treatment, apart from some rehabilitation if the patient was fortunate enough to be looked after by a geriatrician.

    It is estimated that 70 per cent of all strokes could be avoided if people avoided unhealthy lifestyles and risk factors were treated effectively.

    High blood pressure is the single most important cause of stroke, yet if it is diagnosed early and treated effectively through diet and medication, the risk is eliminated.

    Atrial fibrillation is a condition where people develop an irregular pulse which can result in blood clots forming in the heart that dislodge to result in a stroke. It is the cause of about 20 per cent of strokes. Frequently it does not cause any symptoms and therefore unless someone feels the pulse, finds
    it to be irregular and then does a cardiogram to confirm the diagnosis, the person may have the stroke before anything is done about it.

    Treatment with an anticoagulant such as warfarin will prevent two-thirds of all such strokes.

    But currently of the 16,000 patients admitted to hospital with strokes in England associated with atrial fibrillation, less than half of them are on effective treatment.

    There are currently major initiatives in England to improve on atrial fibrillation detection and treatment, so hopefully we can save some lives and prevent many people living with long-term disability.

    Other risk factors include obesity, high cholesterol, diabetes, alcohol and recreational drugs.

    Once a stroke has happened the first thing that is needed is an accurate diagnosis, which means being seen by a stroke specialist and having a brain scan. Without the scan it is impossible to differentiate accurately between the two major sorts of stroke - a bleed into the brain or a blocked artery causing the brain to die as a result of the loss of its blood supply.

    The treatments we know that can make a difference include being admitted quickly to a specialist stroke unit where high-quality basic medical and nursing care are provided by professionals who know what they are doing and giving clot bust treatment. For this to be effective it needs to be given as quickly as possible.

    If a patient gets the treatment within two hours of the onset of the symptoms then one person will be cured for every four patients treated.

    That decreases to one success for seven patients at three hours and one for every 14 at four and a half hours. So time is absolutely critical.

    Raising public awareness of the symptoms of stroke through the Fast campaign, training the paramedics to identify possible stroke rapidly and getting the patient to a hospital set up to receive stroke patients regardless of the time of day or day of the week, is vital.

    A new treatment has recently been shown in research trials to be effective and somehow we are going to need to find a way of making it widely available in the health service. It involves directly putting a wire into the blood vessel that is blocked, snaring the blood clot and pulling it out. This treatment for a small proportion of the stroke population can be life-transforming.

    However good the early treatment, there will inevitably still be many people left with disability as a consequence of stroke. Skilful care by the team of therapists, nurses and doctors working with the patient and their family can get someone from being bedbound and unable to do anything for themselves to someone independent with a good quality of life.

    Recovery can take many months or in some cases years, so treatment must not be stopped too early. Much of this should take place once the person is back in their own home.

    Unfortunately about 10 and 20 per cent of people who have a stroke will die as a result. Making sure that the patient dies with dignity and without suffering is as important an aspect of stroke care as the other treatments discussed.

    We should be enabling this to happen in people's own homes rather than in hospital wherever possible, with the necessary support available for everyone concerned.

    It is time we as a community started taking stroke seriously.

    It may not be a "fashionable" disease that attracts the same degree of sympathy and attention as cancer or childhood diseases but with proper treatment and more research funding we could hugely reduce the impact of the disease both by preventing it in the first place and minimising its effects when it does occur.

    Professor Tony Rudd is NHS England's national clinical director for strokes. This is a version of his lecture given at last week's Jewish Care Health Insights session. For more information about the Health Insights events, hosted by Jewish Care in partnership with the JC, go to www.jewishcare.org/health-insight-evenings or call 0208 922 2837

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