The importance of stroke awareness and research in improving outcomes

Posted: 26/05/2022

Around 100,000 people in the UK suffer a stroke each year and it is one of the leading causes of death, with 38,000 people losing their lives. Of those who survive, two-thirds find themselves living with a disability.

‘Stroke Research Means Everything’ is a campaign launched by the Stroke Association as part of Stroke Awareness Month. This is a campaign to raise awareness of the lack of funding available for research projects which focus on improving treatment options for stroke patients and supporting survivors with their recovery.

What is a stroke?

A stroke is a serious and life-threatening condition that occurs when the blood supply to part of the brain is cut off or restricted, and brain cells begin to die. There are two main causes of a stroke:

• Ischaemic – where a blood clot blocks the blood supply to the brain.
• Haemorrhagic – where a weakened blood vessel supplying the brain ruptures and bleeds into the surrounding tissue.

The majority of strokes are ischaemic, accounting for 85% of all cases. Ischaemic strokes can largely be categorised into two types:

• Thrombotic stroke – a blood clot that develops within the arteries inside the brain. This type of stroke often occurs in older people with high cholesterol, atherosclerosis (build up of fat on the walls of blood vessels) or diabetes. They are sometimes preceded by transient ischaemic attacks (TIAs). TIAs, also known as ‘mini-strokes’, have similar symptoms to a stroke, but the symptoms only last from a few minutes, up to 24 hours. Most peoples’ symptoms resolve within one hour, but TIAs are often a warning sign that the person is at higher risk of having a full stroke in the near future and therefore needs careful management.
• Embolic stroke - a blood clot or plaque debris that develops elsewhere in the body and then travels to the blood vessels in the brain. This type of stroke often occurs as a result of heart disease or heart surgery and can happen suddenly, without any warning signs. Around 15% of embolic strokes occur in people with atrial fibrillation, an abnormal heart rhythm.

There are also two types of haemorrhagic stroke:

• Intracerebral haemorrhage – a burst blood vessel within the brain, which accounts for around 10% of strokes. This is usually caused by high blood pressure and happens suddenly so there are often no warning signs.
• Subarachnoid haemorrhage – a burst blood vessel between the brain and the membrane that covers the brain. These account for around 5% of strokes. There are two main causes:
  • An aneurysm – a weakened, ballooned area in the artery wall which may either be congenital or caused by high blood pressure or atherosclerosis.
  • Arteriovenous malformation (AVM) – a congenital disorder causing a tangled web of veins and arteries.

What are the risk factors?

Certain conditions and lifestyle choices can increase the risk of having a stroke including:

• High blood pressure
• High cholesterol
• Irregular heartbeat
• Diabetes
• Smoking
• Obesity
• Excessive amounts of alcohol

What are the signs?

A stroke is a medical emergency that requires urgent treatment. It is therefore essential that people recognise the signs and symptoms and act quickly to get help. 

The FAST test for recognising the most common symptoms of a stroke has been well publicised in recent years. FAST stands for:

• Facial weakness
• Arm weakness
• Speech problems
• ‘Time to call 999’

While facial weakness, arm weakness and slurred speech are the three most common symptoms, there are other signs that should also be taken seriously:

• Sudden weakness or numbness in one side of the body.
• Difficulty finding words or speaking in clear sentences.
• Sudden confusion, memory loss or difficulty understanding others.
• Dizziness or problems with balance and coordination.
• Sudden blurred vision or loss of sight.
• Sudden severe headache.
• Difficulty swallowing.
• Loss of consciousness.

Anyone with these symptoms should call 999. The earlier someone suffering from a stroke gets treatment, the better their chances of survival and recovery.

Treatment  

The treatment provided for a stroke depends on the type of stroke and which part of the brain has been affected. Strokes are usually treated with medication to prevent and dissolve blood clots, reduce blood pressure and/or reduce cholesterol levels. In some cases, surgery is required to remove clots, repair blood vessels or reduce the pressure on the brain. 

The quicker treatment is provided for a stroke, the more likely it is that the patient will make a good recovery. It is therefore vitally important that GPs, paramedics and hospitals work together to ensure patient safety. A recent report by the Healthcare Safety Investigation Branch (HSIB) considered the stroke emergency care pathway and co-ordination between services when paramedics were trying to transfer a stroke patient to hospital for further investigation and treatment, but were delayed because they were ‘bounced’ between two NHS trusts.

Sarah Hibberd, a clinical negligence specialist at Penningtons Manches Cooper, comments: “We are regularly instructed to represent stroke patients whose care has fallen below an acceptable standard, whether that be a failure to provide treatment, a delay in providing treatment, a misdiagnosis or a failure to perform appropriate investigations. 

“We recently represented a client whose GP failed to adequately monitor and treat high blood pressure, such that persistent high blood pressure caused an intracerebral haemorrhage and ongoing disability. We also represent clients who have suffered delayed diagnosis of subarachnoid haemorrhage or whose TIAs have not been properly investigated, leading to a full stroke, and sadly both scenarios can have devastating consequences. 

“While it is vital to raise awareness of stroke symptoms so people seek urgent medical assistance, it is also imperative that prompt and appropriate treatment is provided as this can make the difference between the patient making a full recovery or suffering a life-changing disability. It can also make the difference between life and death.”

If you are concerned about the treatment that you or a family member have received, please contact a member of the clinical negligence team for a no obligation discussion.

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