Is it possible to fully recover from a stroke?
The Heart and Stroke Foundation of South Africa estimates that 10 people suffer a stroke in South Africa every hour. There are ways to minimise the effects of a stroke – providing you act fast. Neurologist Dr Marcelle Smith, practising at Mediclinic Sandton, explains.
What is a stroke?
A stroke is a brain attack, or cerebrovascular accident – a medical emergency caused by an abrupt interruption of blood supply to the brain. Without blood, brain cells are deprived of oxygen, causing those in that specific area to die.
Dr Marcelle Smith, a neurologist at Mediclinic Sandton, says the symptoms of a stroke depend on which vascular territory is involved, and where in the brain the blood vessel is occluded or blocked.
There are two types of strokes:
This is the most common form of stroke and occurs when a blood vessel carrying blood to the brain is blocked. Sometimes a blood clot may form elsewhere in the body and be transported in the blood vessels to the brain where it gets stuck, blocking blood flow. Ischemic strokes can also be related to heart problems, such as atrial fibrillation (irregular heartbeat), or if the heart does not pump strongly enough, it might form blood clots in the heart, which then travel via the arteries to the brain.
Other blockages that cause a stroke are the result of the formation and build-up of plaque on the artery walls, narrowing them and restricting blood flow to the brain. Sometimes a piece of plaque breaks off and shoots to the brain, causing a stroke.
This occurs when a blood vessel in the brain bursts, causing bleeding in the brain. This is often a result of weakened or thinning blood vessels because of high blood pressure or blood-thinning medication.
Symptoms of strokes
“If the occlusion is on the left side of the brain, the dominant side of the brain, the person might have a sudden onset of difficulty speaking – not slurred speech, but more likely trouble finding the right words and articulating exactly what they want to say. This is because the language centre of the brain will have been affected,” explains Dr Smith. “Strokes on the left side of the brain also often cause physical weakness on the right side of the body – the face, arm and leg.”
Other symptoms of strokes include anything out of the ordinary, such as sudden onset of double vision, deviation or squinting of the eyes, and lack of coordination.
How a person is affected by a stroke depends on the extent and location of the brain damage, and how rapidly the episode is treated.
“Brain cells do not regenerate. Once there is damage to the brain, that damage is permanent. With the right rehabilitation, however, plasticity can be achieved – a process where the healthy nerves in the brain can take over the functions of the damaged areas,” explains Dr Smith.
Importantly, post-stroke damage can be limited if treated immediately, particularly if the stroke is caused by a blood clot (ischemic stroke).
“During the first few hours from onset of symptoms, there is ongoing damage to the brain. As time passes, the damaged area increases in size. If the patient is able to get to a hospital, there is a window period of 4½ hours during which a clot-busting agent can be administered to disperse the clot, enabling blood supply to return to the brain. This treatment is called thrombolysis.”
However, not all patients are eligible for this treatment and imaging of the brain – most commonly a CT scan – will need to be performed first.
Prevention is better than cure
The best way to manage and avoid a stroke is by addressing its risk factors, emphasises Dr Smith. Know your cholesterol level and your blood pressure – if they are abnormal, then seek professional help with treating them. A healthy diet and active lifestyle are essential.
“Smoking is an absolute no-go. Many people still believe it’s a myth that smoking causes heart disease and stroke, but medical science has proven it to be one of the major risk factors,” says Dr Smith.
“Strokes can be prevented. Know your risk factors and manage them accordingly. That way is far simpler and more effective than waiting until something happens, and trying to manage the consequences.”