How to spot someone having a stroke and what to do

A stroke is a serious life-threatening medical condition that affects the brain.

It is one of the leading causes of death around the world and urgent treatment is essential.

There are different types and recovery length depends on the severity of the attack, though roughly one in eight people will die within 30 days of having a stroke.

The sooner someone receives treatment, the less the brain will be damaged.

Read on for everything you need to know about strokes, from how to recognise the symptoms to what the different types are.
  
What is a stroke?
Described by the UK's Stroke Association as a “brain attack”, a stroke happens when the blood supply to the brain is cut off.

This prevents key nutrients and oxygen from getting to the brain, causing severe damage to the brain cells, which can impair a person’s speech and the way they move and think.

What are the different types of stroke?

There are three types of stroke.
Ischemic strokes, which are most common, occur when an artery that supplies blood to your brain becomes blocked by a blood clot.
The blood clots usually form in areas where the arteries have become narrowed over time due to a buildup of fatty deposits; this process is known as atherosclerosis.
Hemorrhagic strokes happen when there is bleeding in or around the brain caused by a blood vessel rupturing. This kills all of the surrounding brain cells.
The third type, according to the British Heart Foundation, is a mini-stroke, which is caused by a brief reduction in blood supply to part of the brain. These kinds of stokes, sometimes referred to as transient ischemic attacks, shouldn’t cause permanent damage to the brain, and most symptoms should pass within 24 hours.

What causes a stroke?

For ischemic strokes, which are caused by narrowing arteries, certain things such as smoking, obesity, diabetes, excessive alcohol consumption and high cholesterol can be triggers.
Arteries naturally narrow as you get older, so elderly people are also more at risk.
The main causes for hemorrhagic strokes, which are less common, are stress, lack of exercise, obesity and smoking.

How to spot someone is having a stroke

The symptoms for a stroke depend on the person and the type of stroke, though the NHS uses the F.A.S.T acronym to list the main signs as:

• 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.

If you suspect you or someone else is having a stroke, the NHS advises phoning 999 immediately and asking for an ambulance.

What happens after someone has had a stroke?

Recovery from a stroke will vary depending on how much damage the brain has injured.
Some people will recover quickly, but others will need long-term support from a range of specialists, such as language therapists, dietitians, physiotherapists and psychologists.

After a stroke, a person's cognitive functions (communication, spatial awarenesses, memory and concentration) can be severely compromised, and in these instances, a rehabilitation plan will be created to help a person recover fully.

Strokes can also cause weakness in the body and, in some cases, paralysis. Physiotherapy will be prescribed if this is the case and a care worker may also be provided.

Other issues that may arise after a stroke include: vision problems, bladder issues, difficulty swallowing.

Mental health issues, such as depression and anxiety, may also arise after a stroke.

Some symptoms of stroke
 Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body.
Sudden CONFUSION, trouble speaking or understanding speech.
Sudden TROUBLE SEEING in one or both eyes.
Sudden TROUBLE WALKING, dizziness, loss of balance or coordination.
Sudden SEVERE HEADACHE with no known cause. 
Weakness or paralysis of any part of the body.
Gait disturbances (trouble walking) or loss of balance and coordination.
Confusion 
Memory loss
Behavioral changes
Muscle stiffness
Difficulty swallowing
Involuntary eye movements

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A stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult(CVI), or brain attack, can occur when a part of the brain is deprived of blood flow. When brain cells are deprived of oxygen they begin to die, due to which the functions controlled by that part of the brain also stops, which results in different types of disabilities among stroke survivors.
There are two types of strokes

• Hemorrhagic
• Ischemic stroke

The first is caused when a brain aneurysm or a weak blood vessel bursts. Most of the time, this type of stroke leads to death. The second one happens when a clot blocks the flow of blood to the brain. Patients suffering from stroke suffer from various side-effects, the most common ones being paralysis or loss of feeling in a certain part of the body, problem in understanding or talking and loss of vision on one side. The side-effects start showing up immediately after a person has had a stroke.

In certain conditions, blood flow to a certain part of the brain stops for only some time and hence the body suffers stroke-like symptoms which only last a couple of hours before disappearing. This is known as a transient ischemic attack (TIA). Unfortunately, the effects of a stroke can be debilitating and also permanent. Hence, it's important to know the symptoms of a stroke and rush the patient to a doctor as soon as possible. Sometimes early treatment can save a lot of damage.

What are the warning signs or symptoms?
There may be no warning signs of a stroke until it actually occurs. You might be having symptoms that may warn you that you might be about to have a stroke.

General symptoms of a stroke, according to Dr.
- Face: Does the face droop on one side when the person tries to smile?
- Arms: Is one arm lower when the person tries to raise both arms?
- Speech: Can the person repeat a simple sentence? Is speech slurred or hard to understand?
- Time: During a stroke every minute counts. If you observe any of these signs, call your local emergency number immediately.
Other symptoms of a stroke include:
All strokes involve symptoms that relate to impairment of nerve function. A patient might complain of a few of the following or all of the following symptoms:
- Confusion
- changes in the level of consciousness
- trouble speaking
- trouble understanding speech
- vertigo
- balance problems
- headache
- nausea
- vomiting
Nausea, sometimes accompanies a stroke, particularly when the stroke involves bleeding inside the brain. The symptoms typically arise suddenly and most commonly occur on one side of the body as the brain controls the ipsilateral part of the body, i.e. brain lobes control opposite parts of the body. Example, a right brain stroke would make the left side of the body weak.

Depending on the part of the brain where the stroke has occurred, be it ischemic or hemorrhagic the effect would be seen in the body. The brain controls different functions of the body like speaking, hearing, listening other than the motor functions.

For example, most people's speech center is located in the left half of the brain so a stroke affecting the left side of the brain would affect speech and comprehension. It also would be associated with weakness of the right side of the body.

Who is at a higher risk of stroke?
Many factors can increase your risk of a stroke. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include:
Lifestyle risk factors
- Being overweight or obese
- Physical inactivity
- Heavy or binge drinking
- Use of illicit drugs such as cocaine and methamphetamines
Medical risk factors
- High blood pressure
- Cigarette smoking or exposure to secondhand smoke
- High cholesterol
- Diabetes
- Obstructive sleep
- Cardiovascular disease
Other factors associated with a higher risk of stroke include:
- Personal or family history of stroke, heart attack or transient ischemic attack.
- Being age 55 or older.
- Men have a higher risk of stroke than women

What to do if you feel FAST with a patient?
Time is the key to recovery in a stroke patient. If you feel someone around you has symptoms of stroke, the patient should be rushed to a hospital in emergency services. If during the initial phase of the attack the treatment is given, maximum number of brain cells could be prevented from dying as death of brain cell is an irreversible process. The damage which has been caused by the death of brain cells cannot be recovered.
The following things can be done other than taking him to the hospital
- Make the patient lie on one side with their head slightly raised and supported in case they vomit.
- Check to see if they're breathing. If they're not breathing at all, perform Cardio Pulmonary Resuscitation. If they're having difficulty breathing, loosen any constrictive clothing.
- Do not give them anything to eat or drink.
- If the person is showing any weakness in a limb, avoid moving them.
- You yourself need to be calm and patient to tell and brief the doctor about the event.

Diagnosis
On physical examination a doctor in the emergency would be able to confirm if it is a Stoke. To confirm it clinically a CT Scan or MRI of the brain would be done which would confirm on the type of stroke i.e. ischemic or hemorrhagic, and the lobe of the brain where it has occurred.
PS: There is an urgency to make the diagnosis and determine whether treatment clot-busting drugs to "reverse" the stroke is a possibility. The time frame to intervene is narrow and may be as short as 3 to 4 ½ hours after onset of symptoms.

The specialist, a Neuro physician or Neuro surgeon would further decide on the treatment and keep the patient in the Intensive Care Unit for further care.

Treatment
Depending on the type of stroke the treatment is planned. For an ischemic stroke, the treatment is generally through medications by a Neuro physician. If the stroke is hemorrhagic then the intervention of a Neuro surgeon may be required to remove the blood clot depending on the site of clot. If the clot is deep inside the brain it is generally not operated upon. If the clot is in the outer coverings or near the coverings of the brain the Neuro surgeon might take a call.

Recover from a Stroke
After first aid and treatment, the stroke recovery process varies. It depends on many factors, such as how fast treatment was received or if the person has other medical conditions. The first stage of recovery is known as acute care. It takes place in a hospital where your condition is assessed, stabilized, and treated. Rehabilitation is usually the next stage or the main of stroke recovery. The goals of rehabilitation are:
- strengthen motor skills
- improve mobility
- limit use of the unaffected limb to encourage mobility in the affected limb
- use range-of-motion therapy to ease muscle tension

Preventing a stroke
The best way to prevent a stroke is to address the underlying causes. This is best done by living healthfully, which means:
- Eating a healthy diet.
- Maintaining a healthy weight.
- Exercise regularly.
- Don't smoke.
- Avoiding alcohol or drink moderately.

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Is that stress or stroke?

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 Every stroke patient might have different symptoms; however, the symptoms of a stroke are very sudden.

What is a stroke?
Strokes occur due to problems with the blood supply to the brain; either the blood supply is blocked or a blood vessel within the brain ruptures. A stroke is a medical emergency, and treatment must be sought as quickly as possible.
There are three main kinds of stroke; ischemic strokes, hemorrhagic strokes and transient ischemic attacks (TIAs), also referred to as mini-strokes.

The Warning Signs of a Stroke:

· A terrible headache
· Weakness on one side of your body
· Trouble walking, talking, or understanding things
· Vision loss in one or both eyes

At times, other health issues can mimic stroke symptoms. A high blood pressure can cause headaches, feelings of weakness, and vision problems. Hypertension is the major cause of stroke.
Chronic stress in life, increases the risk of older people having a stroke or transient ischemic attack.
Understand your body & learn to differentiate between symptoms for stress/anxiety attacks, stroke or migraines.

Better understanding of important & potentially modifiable stroke risk factors, including stress and hypertension, is required given the aging population and increasing burden of stroke.

How is a stroke different from a heart attack/cardiac arrest?

A heart attack occurs when blood flow to a part of the heart is blocked, usually by a blood clot. Without oxygenated blood, the heart muscle begins to die. A stroke is a brain attack, cutting off vital blood flow and oxygen to the brain.

Heart attacks are almost always the result of progressive coronary artery disease (CAD). In CAD, the arteries that supply blood to the heart become choked with fatty deposits called plaque, which narrows and blocks arteries. The condition is called atherosclerosis. When pieces of plaque break free, blood clots can form, blocking the flow of blood to the heart. When that happens, the heart muscle does not get the oxygen and nutrients that it needs, and parts of the heart may become damaged or die. This is a heart attack.

When the blood supply to the brain is interrupted, causing a part of the brain to die, it is called a stroke, or "brain attack." A stroke requires immediate medical attention. Stroke is similar to a heart attack, but it affects the blood vessels in the brain instead of the heart.

Preventive Tips for Stroke:

If you've had a stroke, preventing a second stroke is a top priority. The risk of a stroke is tenfold higher in someone who has had a stroke in the past.

Keep your blood pressure low since high blood pressure exerts continuous pressure on the walls of the arteries. If it is left untreated, it damages and weakens your arteries, making them more likely to clog or burst and cause a stroke.

Don't smoke or expose yourself to second-hand smoke. Limit your calories and make exercise a daily habit. Know your risks - your age & your genes can put you at risk of stroke.


Inputs by Dr. PN Renjen, Senior Consultant - Neurology, Indraprastha Apollo Hospitals