In the stroke of time

Posted on 23 September 2014

Three hours. That’s the length of a long movie, a road trip to a holiday destination or a hike. And that’s the golden time when it comes to strokes – you need get to the hospital within three hours for treatment. Dr John Gardiner, a neurologist at Mediclinic Constantiaberg, explains.

‘First, let’s define what a stroke is – in essence, it’s a disease of the blood vessels of the brain, which can result in an occlusion (blocking) or a rupture of a vessel. In general, occlusions are more common and occur in about 80% of strokes,’ he says.

It’s also important to understand that age plays a role. Strokes used to be uncommon in young people but there is research that shows the incidence of strokes in younger people is increasing. Smoking is a huge factor too, as it’s becoming fashionable again. ‘In general, strokes are uncommon in young people but if they do occur it’s often as a result of recreational drug use, such as cocaine. We’ll see one or two cases a year caused by recreational drug use in people in their 20s,’ notes Dr Gardiner.

While alcohol isn’t a significant factor in causing strokes, young people who go on alcohol binges can land up having a stroke. ‘We see it occasionally – university students who go on a weekend binge and wake up with a stroke on Monday morning.’

Strokes are one of the leading causes of disability in the western world – in both men and women. A stroke also tends to follow heart disease by about 10 years. ‘The diseases that affect the blood vessels tend to affect the heart and then the brain 10 years later,’ says Dr Gardiner. ‘So, if you have a heart attack in your 50s you become at risk for having a stroke in your 60s.’

Speed is of the essence
In the last 10 to 15 years, the emphasis has moved to time. ‘Some people have even thought about changing the name to brain attack rather than stroke to emphasise that the brain is being affected,’ explains Dr Gardiner. He suggests that you get to a hospital immediately if you think you’re having a stroke. ‘If you can get to the emergency centre in under three hours and have a brain scan to show there is no haemorrhage, you may be a candidate for a thrombolytic drug that breaks the clots down.’

Research shows that patients wait an average of 30 minutes before they tell anyone they’ve had a stroke (or think they’ve had a stroke) and it’s usually their next of kin. More time is wasted while the GP is called, and then an ambulance. ‘The best results I’ve had is when patients are put in the car by their family and brought here immediately,’ says Dr Gardiner.

How do I know if I’m having a stroke?
‘It’s very important for patients to go to their nearest emergency centre if they’re unsure of whether they’re having a stroke. Rather be told you’re not having a stroke than sit at home wasting time,’ says Dr Gardiner. ‘We doctors don’t mind false alarms, because at the end of the day it’s better to have it that way than any other way.’

If any of your neurological systems are affected, you could be having a stroke.
They are:
• Motor (you can’t move your arms)
• Sensory (numbness)
• Coordination (you’re falling over your feet)
• Vision (visual loss or double vision)
• Speech (unable to speak coherently and apparently confused)
If any of these systems are impaired, especially on one side of the body, you should seek medical assistance.

When you arrive at the emergency centre, you’ll have either a CT scan or an MRI. A CT scan is quicker to do and can be done in under a minute, while an MRI takes 30 minutes (or more) and needs the full cooperation from the patient.

Preventative measures
‘We find the patients around the world who do the best have the best premorbid function,’ says Dr Gardiner. ‘In other words, they’re in good shape before the stroke.’

Common risk factors:
• High-blood pressure
• Raised cholesterol
• Diabetes
• Smoking
• Atrial fibrillation (abnormal heart rhythm) – this is one of the leading cause of strokes because it increases the risk of blood clots forming in the heart.

It’s important to look at the risk factors – are you an undiagnosed diabetic, or uncontrolled diabetic? Do you avoid having your blood pressure checked regularly? You need to be in control of your health and know your numbers. Get screened at a Mediclinic hospital near you.

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The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.