QUESTION: I really need some guidance for my husband who refuses to take my advice. Recently, while we were on a weekend wedding trip to Robertson, he had a scary episode of being slightly off balance, with mild weakness of his right hand.
He spoke slowly and seemed confused for a while.
Nothing big happened and he felt normal after lying down for a few hours.
I am extremely worried that he may have had a stroke and now he says he doesn’t need to see the doctor anymore. He is under pressure all the time in the construction business and almost never takes weekends off.
He just had a two-week break in December, but continues to work really long hours as the year started at a fast pace.
We used to exercise together many years ago, but now he says there isn’t time.
I feel he is a disaster waiting to happen. He has picked up almost 12kg over the past two years and doesn’t play tennis with our son at all any more.
He is only 48 years old and has hypertension and familial cholesterol problems. Lately he complains of worsening tiredness, and can’t even finish a walk in the mall without becoming short of breath.
Where do I begin to try and get him motivated to make a plan? Is he at risk (of having a stroke) and how quickly do I need to get him to the doctor.
ANSWER: I understand your concern for your husband. It is warranted and what you describe sounds like he is at risk of developing a more serious event, like a stroke. Your husband certainly has sufficient risk factors for this.
He appears to have had a TIA – a transient ischaemic attack or a passing stroke. The highest chance of developing a stroke after the TIA is in the first 13 days after the attack. Often a carotid Doppler is done in these patients to identify atherosclerosis or stenosis (the narrowing of the carotid artery).
I often refer to a stroke as a “brain attack”. Most people fear a heart attack and run to the emergency room when they experience chest pain. The problem with strokes or cerebrovascular accidents is just that – it’s an accident.
Nobody prepares for them, and they occur suddenly, with no warning – just like a car accident.
People are also often ignorant of the warning signs that someone is having a stroke and that speedy action is required for the best possible outcomes.
Who is at risk of stroke?
Those suffering from:
* Hypertension.
* Diabetes.
* High cholesterol.
* Family history of heart attacks or strokes at young ages.
* High stress levels.
* Smokers.
Remember that the more risk factors you have the higher the exponential risk of developing a stroke.
There are two main categories of strokes:
* Ischaemic: where there is a blockage in the blood vessels supplying oxygen and nutrients to the brain tissue.
* Haemmorhagic: basically a brain bleed where the blood vessel leaks or is torn or damaged, with the effect of decreased blood supply as well as pressure effects on the brain.
Both of these lead to insufficient perfusion of the brain cells and permanent damage if not corrected rapidly. Dead brain tissue leads to loss of function.
Symptoms of a brain attack
Symptoms occur in direct correlation to the brain area involved. The functions of the different parts of the body are controlled by different parts of the brain.
The size of the damaged area also plays an important role in the presentation and prognosis. The key feature of a stroke is that the symptoms develop suddenly and usually include one or more of the following:
* Weakness of an arm, leg, or both. This may range from total paralysis of one side of the body, to mild clumsiness of one hand.
* Weakness and twisting of one side of the face. This may cause you to drool saliva.
* Problems with balance, co-ordination, vision, speech, communication, or swallowing.
* Dizziness or unsteadiness
* Numbness in a part of the body
* Headache
* Confusion
* Loss of consciousness (occurs in severe cases).
A simple screening tool used in many countries as part of public education is the FAST protocol:
Face: Ask the person to smile. Does one side of the face droop?
Arms: Ask the person to raise both arms. Does one arm drift downwards?
Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
Time: If you observe any of these signs, call emergency services immediately.
* Information: courtesy of http://www.strokeassociation.org.
What to do if anybody develops these signs?
* Help the patient to safe position – so they do not fall and further harm themselves.
* Call emergency services in your area or those approved by your health insurance: summon an ambulance and give clear history of acute stroke symptoms. Find out your emergency services number now.
* Time counts because if the cause is a clot in a blood vessel, there is a chance this can be dissolved with certain medication if the patient gets help in time.
* Any chronic medications or information should accompany the patient to the hospital.
Treatment
The approach to treatment is based on the cause of the stroke.
Differentiation between a bleed and a blockage is crucial to management and this is done by an urgent CT scan of the brain.
The most common associations of embolic stroke are arrhythmias and specifically poorly managed or missed atrial fibrillation of the heart – where an irregular heartbeat facilitates the development of a clot which is spread to the brain vessels.
Other things that lead to emboli are trauma and dissections.
When we consider ischaemic stroke causes, I always teach causes outside the blood vessels like tumours or masses, inside the blood vessel wall like dissection or simply blocking the space with a clot or atherosclerosis.
The latest evidence shows that the anticoagulation medication given to dissolve embolic clots can improve outcome of the stroke if given early.
Initially it was thought within the first three hours, then it was shown that there is benefit up to four and a half hours after onset of symptoms.
People should also be aware that there are certain contraindications to using this blood thinner and the risk/benefit ratio should always be discussed before administration.
Dr Darren’s take home message:
* The best outcomes of stroke are those who get help as soon as possible.
* Recognise early signs and act immediately.
* Know your emergency numbers.
* Manage the risk factors like smoking, blood pressure and diet.
* Effective stress management.
* Regular exercise.
* Know your family history – act accordingly.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues. He features on 567CapeTalk.
If you have medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.