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STROKE (cerebrovascular accident)

Occurs when part of the brain is deprived of its blood supply. It is the third biggest cause of death in the UK and the largest single cause of severe disability. The two main types of stroke are:

  • ischaemic stroke (c. 7 in 10 cases), usually caused by a blood clot blocking an artery that supplies part of the brain.
  • haemorrhagic stroke, caused when a damaged or weakened artery ruptures and bleeds.

Atrial fibrillation (AF) is a major cause of stroke. Approximately 10% of ischaemic strokes occur in people with undiagnosed AF. A state of hypercoagulation develops during AF, due to stasis and turbulence in the atria. This can lead to the development of clots which go on to cause thromoembolic events. The risk of stroke can be significantly reduced with anticoagulant treament. Calculate risk using CHA2DS2VASc

Patient. Stroke Patient information. https://patient.info/brain-nerves/stroke-leaflet

Patient. Cerebrovascular events. Professional reference; 2019 https://patient.info/doctor/cerebrovascular-events

After a stroke, symptoms and disability vary greatly depending on, for example, the part of the brain affected, how quickly treatment was given, and the extent of brain damage. Rehabilitation to maximise return of function and quality of life is an important part of treatment.

NICE NG128. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management; 2019 https://www.nice.org.uk/guidance/ng128

Royal College of Speech & Language Therapists. Dysphagia – guidancehttps://www.rcslt.org/members/clinical-guidance/dysphagia/dysphagia-guidance/

STROKE IS A MEDICAL EMERGENCY

Prompt treatment improves outcome.

The FAST test, advocated by the Stroke Association, assesses three specific symptoms of stroke:

Facial weakness – can the patient smile? Has their mouth or eye drooped?

Arm weakness – can the patient raise both arms?

Speech problems – can patient speak clearly and understand what you say?

Time to call 999 if a person fails any one of the tests

Chest, Heart and Stroke Scotland https://www.chss.org.uk

Stroke Association https://www.stroke.org.uk

Primary Care Neurology Society https://p-cns.org.uk

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