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Dr Cooper on the life-threatening topic of strokes. This is what you need to know

As a fast-striking neurological condition, according to Dr Bianca Cooper, Principal Clinical Manager Mediclinic Newcastle, strokes are more common in our community than one would imagine. “We see at least one a week in the emergency centre, at its quietest. On average, we get one stroke patient every two to three days through the emergency centre doors. This doesn’t include the patients who present to their GPs or are admitted from the specialist’s rooms directly to the hospital. It also doesn’t take into account strokes patients who either don’t seek medical attention or are treated in state facilities.”

In light of this, the doctor stresses the prevalence of strokes will be much higher than what she and her team see at Mediclinic Newcastle emergency centre. Moreover, she adds, “We do see a lot of patients with previous strokes who present for other reasons, such as pneumonia. There is a significant amount of permanent disability and morbidity from old strokes in the community. Unfortunately, it is not uncommon to see patients with a previous history of strokes, come in with a repeat episode, sometimes years after the initial event.”

While people are familiar with the term stroke, many are not familiar with the various categories.

Dr Cooper highlights, there are two broad categories of stroke: ischaemic and haemorrhagic. Moreover, ischaemic strokes are a result of a blood supply being cut-off to the brain. Usually, this is caused by a clot in one of the arteries; similarly, this is what happens in a heart attack.

Whereas, Haemorrhagic stroke cases are less common, but tend to be more severe and have a higher fatality rate; these occur when there is spontaneous bleeding in the brain. There are numerous causes of both types of stroke; however, they equally carry an array of risk factors.

While everyone is familiar with the dangers of smoking, alcohol abuse and an unhealthy diet, these three contribute immensely to one’s chances of suffering from a stroke.

Dr Cooper explains, “Smoking significantly increases the risk of both kinds of stroke, more than diabetes mellitus. Depending on the amount, smoking can double the risk of stroke and contributes to around 15% of strokes globally.”

In terms of alcohol, she illuminates that anything higher than light alcohol intake also increases the risk, particularly with haemorrhagic stroke.

In terms of one’s diet, she states, “Although the evidence is constantly being updated, we know that high salt diets and any diet leading to obesity are known to be risk factors. The “Mediterranean diet” and diets high in fruit and vegetable intake appear to be protective. It must be remembered that a high salt diet doesn’t necessarily refer to adding table salt to your food, but all the hidden salts.”

These “hidden salts” are especially prevalent in ready-made convenience meals, processed foods such as polony, snacks, fast food and even fizzy drinks. These foods are often high in sugar as well, even if it doesn’t taste sweet.

Pointing out a piece of fascinating information, the doctor affirms, “One average takeaway hamburger generally provide at least half the daily requirements for energy and salt for an average adult, before one even adds the fries and soda!”

While one can change their lifestyle habits, there are risk factors which one can do nothing about, such as genetics, age, race (the African population are at higher risk of stroke) and being female.

“Family history may be related to genetics, but isn’t necessarily non-modifiable as often there is a significant behavioural component such as diet and lifestyle. There are many risk factors one can do something about – high blood pressure presents the highest risk, followed by high cholesterol and diabetes mellitus.”

According to Dr Cooper, it is also important to point out, a sedentary (idle) lifestyle increases the risk factor, both on its own and as a contributing factor to metabolic syndrome (the combination of high cholesterol, prediabetes, prehypertension, and obesity). Coupled with specific cardiac conditions, such as atrial fibrillation are all red flags which must be treated and not ignored.

Stroke risk factors work together to multiple your risk, so a combination of these increases your risk of stroke and heart attacks exponentially.

What long-lasting damage does a stroke have on an individual?

The doctor cuts straight to the chase, “Death is the worst outcome – this may be very rapid, especially in haemorrhagic strokes, or even take a few weeks, as a patient with stroke is at risk for other life-threatening complications such as pneumonia.” For patients who survive a stroke, Dr Cooper explains recovery is on a spectrum from complete recovery to severe disability, where the patient is permanently bed-ridden and unable to eat, speak, or attend to their daily needs without constant care.

She says, “Unfortunately, we don’t have any reliable clinical tools to predict which patients will recover completely. Evidence shows that generally those who receive thrombolysis will do better and recover more function than those who don’t, although complete recovery is still possible in patients who don’t meet the criteria to receive thrombolysis.”

As scary as this sounds, exactly how treatable are strokes? Dr Cooper enthuses, “Ischaemic strokes are vastly more treatable than they were even 10 years ago. We now have access to so-called “clot-busting” medication (thrombolytics), which is shown to improve the recovery from ischaemic stroke. In specialised centres, they are performing mechanical thrombectomies, which is a process similar to an angiogram for heart attacks.”

Highlighting, it is essential to remember these interventions are location and time-dependent. The “clot-busting” medication can only be administered within 4.5 hours of the onset of symptoms, while thrombectomy generally needs to happen within 6 hours, a short window of time, considering these precious hours need to include transfer to an appropriate specialised centre which are currently a rarity.

Before commencing this treatment, “A brain scan (either MRI or CT) and other basic investigations need to be performed. Even if patients do not present in time for these interventions, or have other conditions which prevent them from being performed safely, urgent stroke management is still required. We need to identify and treat any risk factors to prevent further damage to the brain, reduce the risk of a repeat stroke, and hopefully minimise disability.”

It must be restated, however, that the best tool medical professionals have in the arsenal to treat ischaemic stroke and prevent permanent disability, is the revolutionary, thrombolysis. There are contraindications to this medication, such as known bleeding disorder, so an extensive history is required to determine if this medication is safe to give.

She emphasises that treatment of haemorrhagic stroke is generally more complex and usually requires referral to a neurosurgeon, together with immediate treatment of precipitating causes such as uncontrolled hypertension. Further treatment of all types of stroke is targeted at controlling risk factors and preventing repeat episodes.  

In order to minimise the damage and impact of a stroke, what must one do if they suspect they or a person is having a stroke?

Dr Cooper stresses that it is essential to act FAST – look for Facial droop, Arm weakness, Speech difficulty, and then it is Time to seek medical attention. “Call an ambulance straight away, or take the patient yourself if they are able to mobilise and you have the means. The most important thing when it comes to strokes, is to come to the emergency centre at the nearest stroke-ready hospital as soon as possible after the symptoms develop. If you aren’t sure, still rather go straight away to the hospital and have the Stroke Team do their assessment.”

As the doctor points out, it is always better to feel you rushed to hospital unnecessarily, than to wait to see if things get better or worse and then arrive too late.

It is important to remember, when you arrive at the hospital, be calm and tell the first member of staff who you encounter that you suspect that the patient is having a stroke.

Dr Cooper adds, “Try to have a clear idea of what time the patient was last seen normal and it helps us if we have a clear history of events, past medical history and chronic medications. At Mediclinic Newcastle, we have a stroke protocol in place to ensure that patients who present with stroke within the 4.5 hour window, are managed within the time limit, so that thrombolysis can be offered.”

Unfortunately, the doctor clarifies she and her team rarely receive patients within this time frame, having travelled far from other areas, or with strokes having happened the previous night, or having gone via the GP or clinic. Time really is of the essence.

In conclusion, what advice can this forerunning doctor give to the community if they begin to experience the symptoms associated with stroke?

As the old adage goes, Dr Cooper reminds the community that prevention is better than cure. “Go for regular check-ups with your GP to identify and treat risk factors such as hypertension. Quitting smoking is probably the biggest other correctable factor, with the risk almost completely gone within two to four years of quitting. Quit or limit alcohol to one to two drinks a week, and ensure you eat a healthy diet, with minimal junk food and lots of fresh fruit and veggies,” she says.

Exercising regularly, at least 30 minutes most days of the week, also helps tremendously. As Dr Cooper points out – this doesn’t mean pricey gym memberships and expensive kit – a brisk walk around the block is an excellent place to start. This becomes especially important if you have a desk job whereby you don’t get your 10000 steps a day.

If you have chronic conditions such as diabetes, she emphasises it is up to you to take your treatment as prescribed and not skip any doses, even when on holiday—adding, “You must go for your 6- or 12-month check-ups with your GP to ensure that the control of your chronic treatment is optimal.”

Furthermore, if you have a family history of stroke or heart attacks, you should make every effort to correct the reversible risk factors. No amount of medication will compensate for an unhealthy lifestyle and poor habits. Adequate effort and focus must be placed on weight loss, diet and exercise as these positive changes can reverse the risk factors without medication. “Even if you do lose weight or quit smoking, never stop any chronic medication without first consulting the doctor who prescribed it,” affirms Dr Cooper.

With an extensive amount of information from Dr Cooper, ensure you follow her advice and minimise your chances of having a stroke.

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