stroke

Although stroke remains the third leading cause of death in Australia and New Zealand, many promising new drugs, devices and therapies are being developed to boost survival rates and improve
the quality of life for those who experience one.

What is happening

A stroke occurs when oxygen-rich blood is suddenly unavailable to your brain, much like when the heart is deprived of blood during a heart attack. Blockages, usually clots, inside the tiny arterties in the brain cause ischaemic strokes. There are two types. When the clot forms in or near the brain in an artery narrowed by the build-up of cholesterol and other fatty substances, it's called a cerebral thrombosis; when it forms in another part of the body, travels to the brain and gets lodged there, it's known as a cerebral embolism. Ischaemic strokes are treated very differently than haemorrhagic strokes, in which a vessel bursts open, allowing blood to sleep into the brain itself. While they are ofen more deadly, haemorrhagic strokes, in which a vessel bursts open, allowing blood to seep into the brain itself. While they are often more deadly, haemorrhagic strokes are also far less common (See on shortly for illustrations of all three types).
  Whatever the cause of the stroke, once deprived of their blood supply, brain cells die. And those parts of the body controlled by the part of the brain affected by the stroke no longer function--often temporarily but sometimes permanently. Common results of a serious stroke include weakness, paralysis, numbness, problems understanding and speaking and emotional difficulties. Because such damage can cause major disabilities, just getting through a day can become challenging. Strokes tend to affect only one side of the brain. If it's the side that controls speech, your ability to speak may be imperiled even though your thoughts and emotions remain intact. If the stroke occurs in the part of your brain that controls movement, muscle activity on the other side of your body may suffer.

LIKELY FIRST STEP

• At the first signs of a stroke, call 000 in Australia and 111 in New zealand or go to hospital right away.
• For a clot-related stroke, medication to dissolve the clot.
• Once stabilised, close monitoring in an intensive care unit for 24 to 48 hours.
• Post-stroke rehabilitation (physio, occupational, speech) to help restore lost functions.

QUESTIONS TO ASK

• Will I ever be the same person again?
• Is there someone who can help make my home more 'stroke friendly' after I get out of hospital?
• Will I able to return to work after my stroke?
• Do I have to worry about having another stroke when I have sex?
• After i recover, is there some way I can be tested to see if I can drive safely?

Treatments

Brain cells are precious. They perish quickly when deprived of oxygen-rich blood and irreversible damage can occur is as little as 30 minutes. That said, urgent treatment is the byword when you (or someone else) appear to be having a stroke. The most effective treatments need to be started right away, ideally within the first few hours. Once you're at the hospital, doctros will determine if your stroke is ischaemic or haemorrhagic so they can begin the appropriate treatment. A neurological examination, blood tests, CT and MRI scans, Doppler ultrasound and arteriography can help distinguish one type of stroke from the other. If it's ischaemic, you'll get a drug to dissolve the clot and literally stop the stroke. It it's haemorrhagic, doctors will first try to lower your blood pressure to minimise bleeding, after which surgery may be done (see on shortly).

                                                                     Treatment Options 
MEDICATIONS
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Thrombolytics                                           First-line clot-blusters, given at hospital.                             ------------------------------------------------------------------------------------------------------------------------------------------
 Antiplatelets                                             Aspirin is a top choice to prevent future clots.
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Thienopyridine                                         Ticlid, Plavix or Iscover (if aspirin is out).
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Specialised drugs                                      Antidepressants, stimullants, relaxants, Parlodel,rays.


PROCEDURES
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 Physical therapies                                     Physio and OT early to regain muscle control.
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NDT                                                              Enhances nerve function on damaged side. -----------------------------------------------------------------------------------------------------------------------------------------------
Movement therapy                                     Improves limb mobility.
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speech therapy                                             Helps in forming words and sentences. ----------------------------------------------------------------------------------------------------------------------------------------------
 Endarterectomy                                          Cleans blocked artery to prevent future smoke.
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 Bypass (EC-IC)                                            Scalp artery rerouted; mixed results.


TAKING CONTROL

• Inspect your local hospital. If you've had a stroke, you're at high risk for another. Familiarise yourself with services nearby.
• Make your family stroke-savvy. Do they know the major signs of stroke and when to call 000 (or 111 in New Zealand)? key alerts: one-sided weakness or numbness, vision loss, sudden balance problems, difficulty speaking or understanding, severe headache.
• Do a medications check. Certain drugs can interfere with your recovery so bring all your medicine bottles in for the doctor to review. Common culprits: anticonvulsants, antipsychoitics, anti-anxiety medications and blood pressure drugs.
• Try biofeedback. Physical therapy combined with biofeedback techniques has helped some stroke sufferes reorient themselves to sensations in their body. If you have difficulty swallowing, for example, biofeedback training of key muscles may acclerate your ability to releam this action. Working with the wrists and fingers shows similar promise.
• Seek support, be it from family, friends or an outside group. A stroke generates unique stresses, ranging from dependence on others to mood changes. You should  never try to deal with these problems alone.

         After the stroke, if your brain has experienced considerable damage, you'll have to stay in an intensive care unit so the functions of your brain, heart and other organs can be monitored until your condition stabilises. Life-support machines will supply oxygen, medicines and nutrition. If your stroke caused relatively little brain damage, you might be able to go home in just a few days, although you'll probably have to do daily rehab therapy in the hospital or a special stroke center. Recouping lost functions becomes one goal, preventing will occur after physio, occupational or speech therapy. Disabilities lingering beyond a few months become harder to fix.