2StrokeStroke is the 3rd leading cause of death.Every 5 minutes someone has a strokeA woman is 3 times more likely to have a stroke than breast cancer.Women account for approximately 43% of strokes that occur and 61% of stroke deathsStroke risk increases with age. Almost doubles each decade over 55yrs28% of people who suffer a stroke are under 65 yrs old.People with uncontrolled high blood pressure are 7 times more likely to have a stroke than those with controlled high blood pressure.The risk of stroke is 2.5 times higher in people with diabetes
3What is a stroke?A sudden interruption in the blood flow to the brain which is caused by ablockage or bleeding.The brain needs a constant flow of blood as it carries necessary oxygen and nutrients to function.Arteries carry blood from the heart to different parts of the brain. If an artery blocks, blood flow ceases and the brain cells start to die.
4Types of stroke2 main types -Ischaemic stroke1. A blood clot forms in the artery itself. Commonly occurs over fatty tissue/furred arteries.2. A blood clot forms in another part of the body e.g. heart or in the arteries ofthe neck , dislodges and travels to the brain.The clot is made of plaque/debris .3. Ischaemic strokes are the most common-representing 85% of all strokes.Haemorrhagic stroke1. Bleeding within the substance of the brain.2. Haemorrhagic strokes represent approximately 10%.
5The BrainThe brain consists of several lobes, and each lobe has a defined function.When the affected brain cells die, a particular function will be lost.2 million brain cells will die every minute until treatment is received.
6Each lobe in the brain does a different job. The symptoms exhibited will depend on the area of the brain that has had the blood supply cut and which particular brain cells have been affected.Frontal lobe Inability to recognise and regulate emotion.Personality and behavioural changes.Problems with speech(expressive) planning and problem solvingIncontinence.Weakness and mobility issues. Impaired concentration.Parietal lobe Difficulty in recognising objects, with dressing and positioning.Difficulty in ascertaining length, depth and size of objects.calculating, sensation, speech, hand and eye coordination,visual. Confusion of left and right side of the body. Neglects theopposite side of their body.Inattentive, apathetic and bored.Occipital lobe Loss of facial recognition. Visual Illusion – Objects appear largeror smaller; or shape, colour, number disturbance.Cerebellum Balance, posture, coordination, tremorTemporal lobe Hearing, speech (receptive), smell, Interpretation of memory,perception and emotions
7Transient Ischaemic Attack ( TIA or mini stroke)? This is a sudden, temporary interruption of blood flow which can last from a few minutes to no more than 24 hours.This is a warning that something is wrong and if not changed, you could go on to have a full blown stroke in the future.
8F A S T FACE Ask them to smile. Does one side of the face droop? ARMS Ask them to raise both their arms.Does one arm drift downwards?SSPEECHAsk them to speak a sentence.Is their speech slurred or strange?TTIMEWhat time is it?Time to call 999
9SymptomsFacial droopArm or leg weakness on one side of the bodyClumsinessNumbness or pins and needles on one side of your body or face.Speech disturbance; slurred or difficulty getting words out.Visual problems such as double vision, loss of vision or black spotsSudden, severe headacheIf you think someone is having a TIA use the FAST test, if positive dial 999
10If you have had a TIA you will be seen in the TIA clinic on Solomon Ward RSCH. Each referral is triaged and scored by ABCD2.A Age over 60 years of age pointB Blood pressure over 140/ pointC Clinical features:Weakness on one side pointsSpeech disturbance without weakness point0 pointsD Duration:Over 60 minutes points10-59 minutes point0-10 minutes pointsDiabetes pointTOTAL7Score 4 or more and you will be seen in the TIA clinic within 24hrs unless it’s a weekend. Score 3 or less and you will be seen within 7 days. If a TIA you will be started on aspirin 300mg for 2 weeks followed by clopidogrel 75mg thereafter, plus simvastatin 40mg
13Why do these factors increase the risk of stroke? HypertensionThe most important risk factor and the most treatable risk factor. Studiesshow that by lowering blood pressure , the stroke risk is lowered by 30-40%Bp reading comprises of systolic and diastolic.Systolic is the pressure of blood through the heart when it is beating.Diastolic is the pressure created when the heart is at rest.BP rises with age. Diastolic peaks at 50 yrs. old, plateaus and then falls.Systolic rises until 70 yrs. or older.When 60 yrs. or older the systolic becomes the most significant component.
14Ideal blood pressure should be 120/80 mmHg . Consistent BP of 140/90 mmHg or more is mild hypertension.Mild hypertension systolic is mmHgModerate hypertension is mmHgSevere hypertension is equal to or greater than 180 mmHgHypertensive individuals are at 7 times the risk of stroke than those with normal BP.
15Why are we concerned if you have high blood pressure? Leading cause of stroke.Heart has to work harder under greater pressure to circulate blood to the brain.Causes damage and weakening of the blood vessels. Risk of haemorrhage increased.Cardiac factors increase the risk of stroke.eg. Atrial fibrillation (AF) ; increases the risk up to 17 times therefore a predictorof stroke .Blood clots can form.AF causes blood clots to be thrown off from the heart due to irregularelectrical impulses.Warfarin reduces stroke risk by 60-70%. INR of 2.0 is optimal.
16Diet /Obesity. - Obesity increases the risk of high blood pressure, high blood cholesterol, diabetes and stroke.- Remove salt from your diet as much as possible. Salt raisesyour blood pressure. Max 1.5g/100g (o.6g sodium).- Avoid processed food. Eating 5 servings of fruit/veg reducesrisk.- Fats such as high saturated fat, trans fat and cholesterol raisesthe blood cholesterol level. Eat low fat, low sugar food, and takeexercise.High cholesterol Cholesterol is a fat that is produced by liver and found in food.- Cholesterol travels round your body and sticks to the bloodvessel walls narrowing them ( atherosclerosis).- Raised cholesterol levels above 5 mmol/l increase a person’sstroke risk2 main lipoproteins:(LDL) Low density lipoprotein( bad) – causes damage to the heartand circulation by leaving the fatty deposits in the bloodvessels.(HDL) High density lipoprotein (good) – Leads the cholesterol tothe liver to be excreted in the CBD.Simvastatin 40mg and dietary advice is needed for those with levels greater than5.0mmol/L until reduced by 30% or LDL (bad) less than 2.0 mmol/L.
17Nutrients that increase cholesterol Monosaturated fats are the healthiest fats.They decrease your total blood cholesterol but maintain your HDL (good) cholesterol.Ideally, most of the fat in your diet should come from this group, which includes: almonds, avocadoes, cashews, canola oil, hazelnuts, macadamia nuts, natural peanut butter, olive oil, olives, pecans, peanuts, peanut oil, pistachios, sesame oil, sesame seeds, and tahini paste.Polyunsaturated fats are somewhat healthy fats.They decrease your total blood cholesterol by lowering both the LDL (bad) cholesterol and the HDL (good) cholesterol. Lowering your total cholesterol is great, but because these fats also lower your HDL (good) cholesterol, you should only enjoy them in moderation. You'll find polyunsaturated fats in corn oil, mayonnaise, pumpkin seeds, and sunflower seeds. Omega 3 fats are heart-healthy and can be found in:high-fat fish (albacore tuna, mackerel and salmon), other seafood (herring, lake trout,oysters, sardines, shellfish and shrimp), and plant sources (butternuts (whitewalnuts), flaxseed, flaxseed oil, hempseed, hempseed oil, soybean oil, and walnuts).Remember that these fats are still high in calories. So limit your total fat intake to less than30% of your total calories each day. This is about grams each day (more or lessdepending on your calorie needs)
18To lower your cholesterol, avoid these unhealthy fats: Saturated fat is unhealthy fat.It increases both your total cholesterol and your LDL (bad) cholesterol.No more than 10% of your calories should come from saturated fats—that's about 15-25 grams daily, depending on your calorie needs. Keep this number as low as possible.Try to limit or avoid these sources of saturated fat:Bacon, bacon grease, beef, butter, cheese, cocoa butter, coconut, coconut milk, coconutoil, cream, cream cheese, ice cream, lard, palm kernel oil, palm oil, pork, poultry, sourcream, and whole milk. Trans fat is the unhealthiest fat you can eat!It increases your total cholesterol and your LDL (bad) cholesterol while lowering your HDL (good) cholesterol.Even eating a small amount of trans fats significantly increases your risk of heart disease—especially if you already have risk factors like high cholesterol.Limit your intake of trans fats as much as possible. Experts haven't established any level of trans fats as safe, so keep you intake near 0 grams.Food products that contain trans fat include:vegetable shortenings, hard stick margarines, crackers, candies, cookies, snack foods,fried foods, doughnuts, pastries, baking mixes and icings, store-bought baked goods,and more.REMEMBER: You do not have to be fat to have high cholesterol.
23Diabetes An independent risk factor Diabetes An independent risk factor. Diabetes puts you at increased risk asit raises BP and cholesterol levels and weight.BP needs to be <130/80mmHg.Meticulous control of blood sugars required.Atrial fibrillation This is a type of irregular heart rhythm and represents an importantrisk factor for stroke. Because the heart does not beat properly,there is a risk of blood clots forming in a chamber of the heart,which may subsequently break up. Fragments of clot may thenlodge in the brain, causing stroke.Smoking Makes the blood stickier and more prone to clotting, damages andconstricts the artery walls.Increases the bad cholesterol in the blood and reduces the goodDoubles the risk of stroke.
24Exessive AlcoholRaises BP, thins the blood, raises cholesterol and homocysteine levels (clotting factor) and triggers AF. There is a strong relationship between heavy drinking and stroke. Risk doubles.DOH recommends : 2-3 units per day for women or less than 14 u/week3-4 units per day for men or less than 21u/week1 or 2 alcohol free days per weekTo calculate: Multiply the volume by the % and divide by 100Example: ml bottle of wine at 12%750x12 = = 9 unitshas an online unit calculator for the most common drink brands.
25Bottle of wine (12% ABV)…………. …9 Units Large can of strong cider……………..4 UnitsPub measure (50 ml) of :Port, Sherry, Martini …………………...1 Unit
26Anterior-posterior projection left internal carotid artery injection showing cross-filling via the anterior communicating artery with occlusion of the M1 segment of the right middle cerebral artery at the level of the anterior temporal artery. The occlusion is shown by the arrow.
27Insufficient blood flow to the brain leads to poor oxygen supply ( cerebral hypoxia) This results in brain cell death(cerebral ischaemia).Approximately 2 million brain cells will die every minute.CT scan of a normal brainRight hemispheric cerebral infarctLeft hemisphere cerebral haemorrhage
28Can YOU help prevent this process? Smoking constricts blood vessels and causes clogged arteries. This can lead to impotence in men.Quit smokingSmoking constricts your arteries.Cholesterol blocks your arteries.A blood clot forms in your arteries .Blood flow is reduced in your arteriesArtery with Thrombus
30How can I reduce my risk of having a stroke ? Controlling high blood pressure is crucial. In general, blood pressure should be below120/80.Methods for controlling blood pressure include a low-sodium diet, weight control, and/ormedication.• Monitoring elevated blood cholesterol and controlling via diet and lifestyle modificationsor medication.Treat atrial fibrillation if necessary. Take anti-clotting and antiplatelet drugs to thin theblood and lower the risk of blood clots forming.• Stop smoking.• Dietary improvements include avoiding excess fat, particularly saturated fat, avoidexcess sodium and avoid excess alcohol intake . Maintain a healthy weight.• Exercise regularly - the recommendation is at least 20 to 30 minutes of aerobic exercise atleast five times a week in order to achieve and maintain an improved level of fitness.• In patients with diabetes, it is important to maintain good control blood sugar levels, asthis group of patients is at particular risk of cardiovascular disease.
31STROKE High Blood pressure Smoking Diabetes High cholesterol Alcohol DietPhysical InactivityTHINK BRAIN: Can you reduce the risk of stroke yourself?
32FAST so: Take your prescribed medication Eat healthily Stop smoking Take exerciseSee your doctorIf concerned dial 999FAST
33Karen KayStroke CoordinatorRoyal Sussex County Hospital