Thursday, 23 May 2013


…it pays to know what to do. Expert Dr Patrick Gompertz offers his top tips

Written by Dr Patrick Gompertz
What is a stroke?
A stroke is caused when you have a blockage of a blood vessel into the brain, or bleeding into the brain. This causes the part of the brain that is affected to stop working. If it is a part of the brain that controls moving the arm and the leg on one side, then those limbs could be paralysed. Or, if it’s the part of the brain involved with speech, you might lose speech.

What does it feel like to have a stroke?
It depends how you have been affected. If it is the speech area, it’s often a feeling of having something on the tip of your tongue and being unable to think of it. If it affects the limbs, it’s as if they won’t do what you want them to do.

What makes you more likely to have a stroke?
There are risk factors, such as smoking and a diet high in salt – but most important is high blood pressure.

How does a doctor identify a stroke?
The diagnosis is clinical: that is, looking at the patient, getting their story and examining them. There are no 100% tests for a stroke. We use CT or MRA scans for the brain as these can indicate the cause of the damage. But the best thing is looking at the patient.

How would we know that someone is having a stroke?
Think F.A.S.T. – Face. Arms. Speech. Time to call 999. It is about looking for differences between the two sides: if the face is drooping on one side; if one arm is paralysed but the other isn’t; if there is slurred speech; difficulty speaking, any one of these. If you suspect a stroke, call an ambulance as soon as possible. While you are waiting for the ambulance, get the patient into a comfortable position and make sure they can breathe. Paramedics usually give advice down the phone when you call and they will give the call the same priority as a heart attack, so they should get to you fast.

Is the risk genetic?
Strokes are a bigger cause of death in women than, say, breast cancer. In the UK, strokes are the biggest cause of disability in adults. If something is common, then you can have two people in the same family affected simply by chance. The underlying problem in most strokes is hardening of the arteries, which is related to blood pressure, cholesterol, activity, age and so on. Some of that may well be vaguely genetic but there isn’t a defi nite hereditary component to strokes.

How is a stroke dealt with in hospital?
If someone with a stroke is coming in, the ambulance will have notifi ed me in advance, and an urgent call goes out to the stroke team to be in A&E. We need to get the patient treated as quickly as possible, so we work as a team – somebody will get a drip going, somebody else will be getting the story from the ambulance crew, another will be looking after the patient and talking to the family. We organise a brain scan as quickly as we can, then we try to start treatment within minutes.

What is the treatment?
The emergency treatments we use are clot-busting drugs, because 85% of strokes are caused by a clot that has blocked a blood vessel. The area of the brain where the blood supply has been cut off owing to a blocked blood vessel, switches off temporarily, which is what causes the paralysis, but the brain is still alive. If you can get the oxygen back to that area of the brain quickly then it will switch back on again, and you can get complete recovery by dissolving the clot and opening up the blood vessel again.

What is the recovery process?
Unfortunately a lot of people do have disability after a stroke, in spite of receiving the best treatment, but there’s a lot we can do for them. I admit people to a stroke unit, we get them started on therapy as soon as possible, get them out of bed, walking and exercising very quickly, and they tend to do quite well. I’ve seen a lot of people devastated by strokes, and rehabilitation makes the best of a bad job, and achieves very good results.

Can a stroke be prevented?
The risk of stroke at any age is going down; we’ve been very successful in the past 20 years or so in preventing strokes. We’ve also been successful in treatment, so death and disability rates from strokes are much better than when I started. GPs are better at recognising high blood pressure and treating it.

But people need to know their blood pressure. You don’t get symptoms from high blood pressure, so you won’t know if it’s high until you get it checked. If it is high, you can take steps to bring it down. 

Dr Patrick Gompertz is Clinical Director for Stroke Services at The Royal London Hospital, Barts Health NHS Trust.

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