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Stroke

Cure sometimes, treat often, comfort always- Hippocrates

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Transient Ischaemic Attack & Stroke Acute Neurological symptoms

Make a habit of two things: to help; or at least to do no harm - Hippocrates

Understanding stroke is important with the frequency of cardiovascular disease. A ‘mini-stroke’ is also known as a Transient Ischaemic Attack (TIA) and essentially is a warning that one is at risk of a stroke, as you may experience stroke symptoms but these resolve rather quickly (although may take up to 24 hours to resolve).

Background

Stroke falls under the broad spectrum of cardiovascular disease. It is the third leading cause of death worldwide and the leading cause of disability.
The human and economic burden is massive.  Of all stroke victims, 50% who survive are mentally or physically disabled and need lifelong care.

Eighty percent of strokes are due to a blockage in the artery and 20% are from bleeding. This ‘blockage’ is most commonly the result of arterial plaque from atherosclerosis in the carotid arteries breaking off and lodging in a smaller artery within the brain.

What do I experience if I’m having a stroke or TIA?

This depends on where the blockage occurs and on which side of the brain. If the plaque lodges in the artery supplying the eye, you may experience the feeling that a curtain is being closed over the eye.

If one of the bigger branches are blocked, then you experience weakness or numbness on an arm or leg or the side of the face. The speech may also be affected, and you may slur or drool.

Other less common symptoms like being unable to name objects or unable to speak may also occur depending on where the blockage is affecting.  Page break

What is actually happening inside my brain?

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The brain is supplied by 4 main vessels

  • Two carotid arteries
  • Two vertebral arteries

The carotid arteries divide into the: Internal carotid artery and the external carotid artery. It is typically at the point of division that plaque builds up.

Although the vessel may become narrowed it is not the narrowing that causes a problem in the carotid as the brain can get enough blood supply from the other vessels.
The problem is if the plaque is what we call ‘unstable’ and pieces can break off and travel up to the brain.

What causes an unstable plaque to develop?

The plaque buildup is the same process as atherosclerosis.  Risk factors for developing atherosclerosis and plaques in the blood vessels are:

  • Diabetes
  • Smoking
  • High blood pressure
  • High blood lipids

What can I do to prevent a stroke if I have never had one?

If you have never had a stroke and have the risk factors above, then you need to control the risk factors.  You need to understand you risks, your degree of disease, your medications and your goals.

If you need help with this – call the vascular centre to find out more or to book an appointment.

Certain patients benefit from an operation to remove the plaque build-up with the aim of preventing stroke.  This is only necessary for a highly select group of patients as having the operation also puts one at risk of a stroke.  If you have appropriate risk factors, you will require a duplex doppler scan (see below) and the results of this will determine further treatment.  To see whether you are a candidate or to find out more, contact the Vascular Centre.

What do I need to do if I have a stroke?

A stroke is a medical emergency and you should seek medical attention from your nearest medical facility.  Depending on your symptoms, you may need immediate investigation such as a brain scan or immediate treatment.  Your doctor will decide on what is best for you.

What do I need to do if I have a mini-stroke or TIA?

If your symptoms have gone away and were mild then this is less of an emergency than a stroke.  Your doctor will ask you more questions to ascertain that this was in fact a TIA.  If it is then he/she will assess how urgently you need to be investigated – meaning within 24 hours or within 7 days.  This depends on your age, blood pressure,type of symptoms and duration of symptoms.  You will need to be investigated as to the cause of the TIA and this will start with a duplex doppler.

Investigating with Duplex Doppler Ultrasound

strokedopplerPart of the investigation of determining the cause of a stroke involves looking at the carotid arteries to see if there is plaque that has broken off or that is causing a significant narrowing of the arteries.

This may be done by a duplex doppler ultrasound.  This is a painless, non-invasive and safe investigation. It is similar to a pregnancy scan but is done on the neck and the waveforms of the blood vessel are assessed.  Depending on the plaque type and plaque narrowing, treatment will be decided upon.

You may need a brain scan to assess if any areas of the brain are inactive.  This is a more invasive and requires you to go to hospital so that a drip can be placed in your hand or arm in order for a contrast solution to be injected that highlights the brain.  

What is the treatment of stroke?

The treatment of a stroke caused by a blockage in the carotid artery depends on what the duplex doppler ultrasound imaging finds.

  • You may require medical management.
  • You may require surgical management.

What is the surgical management?

If you are a candidate for an operation all the details including the risks and benefits will be explained to you and you must be sure you understand what you will experience.

The operation is called: Carotid Endartrectomy.

carotidwoundAn incision is made in the neck in order to access the carotid artery, which has the plaque.  The artery is handled very carefully while it is opened up and the plaque removed.  The artery is then stitched back together. If it is narrow a patch will be sutured into the artery to widen it.  The neck incision is then closed up.  

 

Contacts

Room 1521 Christiaan Barnard Hospital, Cape Town, 8001.

  Cape Town Switchboard:  021 201 1119