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Stroke

Stroke is one of the leading causes of death and disability in South Africa. The condition can affect anyone, regardless of age, race, religion or economic status.
What is a Stroke?

Stroke is a collective term used to describe the effects of changes in the blood supply to a portion of the brain. A stroke is a sudden interruption in the blood supply to the brain. Stroke has many consequences and the effects of a stroke depend on which part of the brain is injured, and how severely it is injured.

Types of Stroke

There are several types of stroke and each type has different causes. The three main types of stroke are listed below:

Ischaemic Stroke

  • This is the most common type of stroke and accounts for almost 80% of all strokes. Ischaemic stroke is caused by a clot or blockage in an artery leading to a part of the brain. This then prevents oxygen from reaching that area of brain tissue.

Intracerebral Haemorrhage

  • An intracerebral haemorrhage is caused by the sudden rupture of an artery within the brain. Blood is then released into the brain, putting pressure on the surrounding structures, interfering with oxygen supply and damaging brain tissue.

Subarachnoid Haemorrhage

  • A subarachnoid haemorrhage is caused by the sudden rupture of an artery between the coverings of the brain, which leads to blood filling these spaces, but does not bleed inside the brain. This can put pressure on the brain structures.
What is a TIA?

When the symptoms of a stroke last only a short time (less than an hour), this is called a Transient Ischaemic Attack (TIA). While a TIA is often labeled a “mini-stroke,” it is more accurately characterised as a “warning stroke”- a warning you should take very seriously.
TIA is caused by a clot; the only difference between a stroke and a TIA is that with a TIA, the blockage is temporary and when the clot moves off the symptoms resolve. TIA symptoms occur rapidly and last a relatively short time. Most TIA’s last less than five minutes; the average is about a minute. A TIA usually causes no permanent injury to the brain.

The Signs and Symptoms

Strokes may cause sudden weakness, loss of sensation or difficulty with speaking, seeing or walking. Since different parts of the brain control different areas and functions, it is usually the area immediately surrounding the stroke that is affected. Sometimes people with stroke have a headache, but stroke can also be completely painless. It is very important to recognise the warning signs of stroke and to get immediate medical attention if they occur.

The five most common signs and symptoms of stroke are:

  • Sudden numbness or weakness of the face, arm or leg
  • Sudden confusion or trouble speaking or understanding others
  • Sudden trouble seeing with one or both eyes
  • Sudden dizziness, trouble walking or loss of balance or coordination
  • Sudden severe headache with no known cause
Problems Experienced as a Result of a Stroke

Muscle weakness, paralysis and spasticity (stiffness)

  • This may affect the whole body, only one side or just an arm, a leg or one side of the face. The area and pattern of involvement is related to the area of the brain that is damaged and can vary greatly among individuals.

Problems with balance or coordination

  • This makes it difficult for the person to sit, stand or walk, even if the relevant muscles are strong enough.

Problems using language (aphasia and dysarthria).

  • A person with aphasia may have trouble understanding speech and/or written words (receptive aphasia). Or he/she may be able to understand, but be unable to think of or formulate the correct words to say or write (expressive aphasia).
  • A person with dysarthria knows the words he/she wants to say, but has trouble pronouncing them clearly, often because of muscle weakness or poor coordination.

Being unaware of things on one side of the body (neglect)

  • A person with neglect will often not turn to look toward the weaker side, eat food from that side of a plate or even write on that side of a piece of paper. This is due to perceptual disturbance as a result of the stroke.

Problems with memory, thinking, attention or learning (cognitive problems).

  • A person may have trouble with many mental activities or just a few. For example, the person may not be able to keep track of the date or time, be confused, forget what they had for breakfast or struggle to problem solve daily life tasks.

Being unaware of the effects of the brain injury.

  • The person may show poor judgment and try to do things without realizing his/her limitations. This can be dangerous as they will try to do things that are unsafe.

Trouble swallowing (dysphagia)

  • The person may have problems swallowing safely and effectively, which may cause choking or even food going into the windpipe and the lungs (aspiration). This can cause chest infections/pneumonia. Eating can take effort and the person may struggle to get enough food into their body to maintain good nutrition.

Problems with bowel or bladder control

  • Loss of bowel and bladder sensation and control can result in incontinence and dependence on nappies.

Getting tired very quickly

  • Becoming tired very quickly may limit the person’s participation and performance in a rehabilitation programme.

Sudden bursts of emotion, such as laughing, crying or anger

  • This refers to extremes of emotions that often occur without a trigger and may stop as quickly as they start. This is as a result of the brain damage and is separate from the normal emotional responses that accompany the loss of function and identity after stroke.

Depression

  • This is common in people who have had strokes. It can begin soon after the stroke or many weeks later. Family members often notice the signs of depression first.
Stroke Rehabilitation

The outlook for stroke patients today is more hopeful than previously due to advances in both stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family and rehabilitation staff work together as a team. Family members must learn about deficits caused by the stroke and how to help the patient achieve maximal function again. It is very important that techniques and skills taught in therapy are carried over by the patient and family
and practiced at every available opportunity. Rehabilitation is designed to meet each person’s specific needs. Thus, each person’s programme is different. The success of stroke rehabilitation
depends on many variables, including the following:

  • The cause, location and severity of the stroke
  • The type and degree of any deficits from the stroke
  • The age and overall health of the patient
  • Patient motivation and self-practice
  • Family and community support

Steps to Stroke Prevention

Reducing your risk for stroke

If you have ever had a stroke (or stroke warning signs), it is very important that you work with your doctor to determine the most likely cause of the problem and to begin specific medical treatment to control your risk factors.

Certain medical conditions greatly increase your likelihood of having a stroke (or another stroke).

  • Previous stroke or “mini-stroke” (transient ischaemic attack, TIA) – Your doctor may prescribe medication depending on your risk factors
  • High blood pressure – Hypertension is one of the leading risks for heart disease and stroke. Your doctor may advise you on dietary or lifestyle changes, or specific medications to lower your blood pressure.
  • Diabetes – High blood sugar can increase your risk, so you should work closely with your doctor to manage it.
  • Heart disease – Of concern are particularly heart beat irregularities (atrial fibrillation), disease of the heart valves, congestive heart failure or recent heart attack. If you have one of these conditions, your physician may prescribe medications to thin your blood and/or reduce your cholesterol levels.
  • Smoking – Tobacco use is a major preventable risk factor for stroke and heart disease. Even if you have smoked for years, you can still reduce your risk by quitting now.
  • Obesity, elevated cholesterol, and elevated lipids – Reducing your dietary intake of saturated fats and cholesterol may help reduce your risk of a stroke.
  • Physical inactivity – A sedentary lifestyle devoid of regular exercise can contribute to heart disease which may lead to stroke.
  • Increasing age – Stroke is more common in people over 60.
  • Heredity and ethnicity – Stroke is more common in people whose close relatives have had a stroke at an early age.
What is My Risk of Having Another Stroke?

If you have had a stroke, you are at risk of having another stroke in the future. But remember, you can do a lot to prevent this from happening. You can reduce the risk of having another stroke if you make some changes to your lifestyle and take the medication that your doctor prescribes.

Prevention of a second stroke starts by addressing the conditions that caused the first stroke, such as atrial fibrillation (an abnormal heart rhythm that can result in clots) or narrowing of a carotid artery in the neck. Treatment is also aimed at managing other factors that put you at risk, including high blood pressure, diabetes and high cholesterol. However, it takes more than just your doctor’s efforts; you also have an important role to play in preventing stroke. It’s up to you to make lifestyle changes that can lower your risk.

Get Help Fast

Many strokes are reversible if the patient arrives at a certified stroke hospital within an hour of onset of signs and symptoms.

FAST is the easiest way to remember the sudden signs and symptoms of a stroke:

Face drooping
Arm weakness
Speech Difficulty
Time to call an ambulance

What Can I Do To Prevent a Stroke?

Exercise

Physical activity can improve your health by reducing risk factors for stroke such as high blood pressure, obesity and high cholesterol. Exercise can also improve digestion, sleep quality and mood. It can reduce stress and increase levels of energy. Overall, exercise will make you feel better about yourself.
NOTE: You should check with your doctor or therapists before starting any exercise program.

Find an activity that you enjoy doing. Find an exercise partner if possible. Vary your routine, try different activities. Wear comfortable and appropriate clothing. Don’t overdo it! Don’t over-exert yourself. Reward yourself and make it fun. While exercising, you should expect to be a little out of breath since you are demanding extra effort from your heart and muscles. Likewise, you can expect your heart rate to increase. It is important that you stay within your own comfort limitations and never exercise past moderate effort. If you stick within these limitations and seek the appropriate support, exercise is safe. In the event that you feel any discomfort such as weakness, numbness, visual problems, trouble speaking, sudden severe headache, dizziness or chest pain, you should stop exercising and seek medical attention immediately.

Diet Modification
Studies have shown that adopting a Mediterranean diet which consists mainly of antioxidant-rich foods such as fish, fruits, vegetables, legumes and nuts, as well as food rich in omega 3 fatty acids, can help prevent strokes. Avoid foods that contain high amounts of saturated fats and cholesterol (consumption should be less then 200mg/day, or less then 100mg/day if you have diabetes). Stay away from salt, as salt is known to increase your risk of stroke.

Reduce Your Stress
The body’s nervous system reacts to mental or emotional stress and this reaction is linked to an increased rate of heart disease and stroke. There are a number of reasons why lowering your stress levels will make you feel better. From a medical point of view, controlling your stress could help to: decrease heart rate, lower blood pressure, slow your
breathing rate and improve the quality of breaths, increase blood flow to major muscles and reduce muscle tension. You should also experience other positive effects such as fewer headaches and back pain, more energy, fewer emotional extremes (such as anger and frustration), improved concentration, better ability to handle problems and more efficiency in daily activities.

Stop Smoking
Stopping smoking is one of the most important lifestyle changes in preventing strokes. Studies have shown that 5 years after quitting, your risk of stroke decreases substantially. Quitting is also associated with a reduction of stroke-related hospitalisations. It will also enhance your sense of taste and smell and go a long way to enhancing your overall health. Furthermore, your being free from addiction will provide a good example for generations to come!

Take Control of Your Health
You are the one who experienced the stroke, so you might have your own ideas regarding what caused it; perhaps linked to a recent event (such as the death of a family member) or things happening in your life that are causing you stress. Your opinions are important and you should openly discuss your concerns with a healthcare professional and your family. Once you have identified and discussed the causes, address each of them individually and find ways to gain control so that you can be active in preventing recurrence. The strategies will be different for each cause. The goal is for you to make a plan and take control of your health as well as your emotional well-being.

How can we help?