GENERAL HEALTH The National Stroke Foundation has launched a campaign to help educate people about the early signs of stroke. Using the ‘FAST’ (face, arms, speech, time) test, you can check for probability of a stroke by asking these simple questions: ARMS SPEECH TIME FACE Check the person’s face. Is their mouth drooping? Can they lift both arms? Is their speech slurred? Can they understand you? Time is critical. If you see any of these signs, call 000 without delay. be used in many people, fi rstly because they present beyond the three hours from onset (people who wake up with a stroke cannot be treated as it cannot be determined when it began); and secondly, there are many contraindications in people at risk of bleeding (such as those on anticoagulants, those with a history of stomach ulcers or recent surgery that could bleed). So overall, the acute treatment for strokes is progressing at a much slower pace than, for example, heart attacks or even cancer. pm urgently with a balloon to open the blocked artery, usually followed by a stent to keep the artery open. The combination of these treatments has decreased the mortality of heart attacks from around 25% down to a mere 4%. What’s more, the survivors (if treated quickly enough) are often left with no heart muscle damage – a very different story from 30 years ago when survivors were left with a legacy of a weak heart and the fear of further heart attacks. Large studies of over 40,000 people proved that a cheap aspirin tablet, costing around six cents, could save one in 79 lives from acute stroke. As the aspirin treatment was effective in treating both heart attacks and stroke, it was hoped that the same clot-busting drugs used to treat heart attacks would also be successful in treating stroke. As strokes are often also blocked arteries in the brain, it was feasible that this theory would not be without merit. “Unfortunately, the concept of a ‘brain attack’ is not really the same as a heart attack,” Dr. Hannah explains. “Brain cells can only survive three minutes without oxygen, while heart cells can often survive for over an hour. This is also why the FAST campaign places so much emphasis on early recognition and medical attention for a stroke.” Furthermore, not all strokes are due to acute clots as they are with heart attacks. Some strokes are actually haemorrhages, and some are a result of old hardened clots from distant sites (emboli) such as the heart. The latter two causes of stroke will not respond to clot-busting drugs. In addition to this, the cause of stroke in up to one third of cases cannot be determined. So where does this leave us now with the acute treatment of strokes? Well, fi rstly we know for sure that aspirin and careful hospital care defi nitely improves stroke outcomes. Many would say that there is little downside to the use of thombolytic drugs within the fi rst three hours of a severe stroke onset, although it has to be said that there is a small risk of actually causing a brain haemorrhage with the treatment. Even with this small risk of haemorrhage though, there is no increase in mortality with thrombolytic treatment. The bad news is that thrombolytic drugs cannot HOPES FOR THE FUTURE INCLUDE • Neuro-intervention – similar to what cardiologists do in acute heart attacks. • Ischaemic Penumbra Assessment – current thrombolytic treatment is very much a ‘shotgun’ treatment and it would be preferable to select the brains which have the largest ischaemic penumbra (i.e. the area of brain tissue surrounding THE NUMBERS the dead stroke tissue that has a borderline blood supply that could be opened up). This would involve special CT and MRI techniques. • Other techniques such as ultrasoundenhanced thrombolysis, where high frequency sound waves are used to break up the clot, are under investigation. Of these: One in three will not survive One in three will recover fully One in three will recover with permanent defi cit such as limb weakness or speech problems One in six people will have a stroke. pindaramagazine.com.au Pindara Magazine 19
Pindara Private Hospital Magazine - Issue One
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