Strokes are more common among women than breast cancer, but, as Vanessa Leyland explains, there is a lot more that needs to be known
A stroke (cerebrovascular accident) happens when an area of the brain is deprived of blood for 24 hours or more, this is usually caused by a blockage or burst blood vessel, causing vital brain tissue to die. This results in that part of the brain being temporarily or permanently damaged.
Strokes vary greatly in severity from a short period of muscle weakness to a more severe problem that can cause death.
Types of stroke
Ischaemic stroke is the most common type of stroke and occurs when the artery is blocked by a blood clot, which affects the blood supply. This may be due to a blood clot forming in the main artery leading to the brain, which is known as a cerebral thrombosis, or thrombotic stroke, or when a blood clot forms elsewhere in the body and travels to the heart. This is called a cerebral embolism or embolic stroke.
Another cause may be a lacunar stroke, where tiny blood vessels deep inside the brain become blocked. However, this type of stroke is rare.
Cerebral haemorrhage occurs when a blood vessel bursts in the brain and bleeds. The build up of blood then presses on the brain, damaging the delicate tissue, while other brain cells in the area are starved of blood and damaged.
A cerebral haemorrhage is usually the more serious and common cause of unexpected death. Strokes usually give warnings in the form of Transient Ischaemic Attacks (TIAs), also known as mini-strokes. These happen when the blood supply to the brain is interrupted for a shorter period of time, anything from a few minutes to 24 hours, followed by a complete recovery. These should never be ignored: in about one in five people, they can be a sign of a subsequent stroke.
The brain regulates everything your body does and is the most complex organ in the body. It controls breathing, sleeping, waking, moving, sweating, feeling, moods, thoughts and speech. To do all of this, it needs a constant supply of blood that delivers oxygen and nutrients to the brain cells. If this blood supply fails, which is what happens in a stroke, the brain cells become damaged or die - and, unlike any other cells in the body, once brain cells have died, they cannot regrow.
Disease of the arteries is the biggest cause of stroke. Blockage of the arteries results in atherosclerosis - the furring-up and narrowing of the walls of the arteries due to the deposit of a fatty layer, which is made up of a mixture of cholesterol and other debris and is known as atheroma. Strokes are also caused by narrowing of the artery, blood clotting (thrombosis) or physical damage to part of the brain because of internal or external bleeding.
Bleeding into the brain usually happens because of a rupture - a weakened spot on an artery wall starts to stretch until the vessel wall becomes so thin it bursts. Bleeding can occur almost anywhere in the brain and symptoms vary depending on the location. Bleeding in the lower part of the brain is most dangerous as it affects the body's vital functions such as breathing and heartbeat.
A blockage of a blood vessel, known as a cerebral thrombosis, or a small piece of blood or fat tissue obstructing a blood vessel, known as a minor embolism, can result in similar symptoms to a cerebral haemorrhage but is much less severe and has a good recovery rate. Strokes due to thrombosis or embolism may occur in people with atherosclerosis of the neck arteries or the vessels that branch from these arteries; also in people with diseased heart vessels, where small clots form then break loose and are carried to the brain. This can also be due to atrial fibrillation - irregular heartbeat - where, again, a blood clot forms in the heart, breaks off and travels to the brain.
Symptoms of stroke
The first sign is usually a severe headache with sudden onset. This is followed soon afterwards by a loss of function in part of the body such as loss of vision in one eye, paralysis down one side of the body or a major epileptic type seizure.
Other symptoms include:
Weakness on one side of the body. This can lead to difficulty in walking, movement or coordination.
Speech difficulties, this includes understanding, speaking, reading and writing and calculation, known as dysphasia or aphasia.
Temporary loss of vision, or even when vision is not affected, loss of perception in recognising everyday objects, difficulty in interpreting what the eyes see.
Swallowing difficulties: these can result in dehydration, constipation or chest infections, including pneumonia, when food is passed into the windpipe.
Cognitive difficulties: these are caused by damage to areas of the brain that control the thinking, memory, decision-making and forward-thinking process.
Behavioural changes, slow reaction, confusion, irritation, disorganisation.
Incontinence, urinary and faecal, can usually be improved or overcome by medical help and physiotherapy
Mood changes, mood swings such as laughing or crying when not necessarily happy or sad, lack of appetite, low self-esteem, insomnia and anxiety that can lead to depression
Epilepsy: between 7% and 20% of people develop epilepsy following a stroke. This can be treated with medication.
When a major stroke occurs, often consciousness is lost and may never be regained, most people affected in this way die within a few hours or days; those who recover consciousness often suffer paralysis, which can be severe.
It is worth bearing in mind that most people who have strokes do not experience all of the symptoms outlined. With treatment from medical specialists, most of these symptoms can be reduced or overcome.
As the swelling in the brain reduces, so do the short-term effects of the stroke. Long-term effects caused by the death of brain tissue, while never going away, can be modified with rehabilitation.
The brain is divided into two halves, left and right, each of which controls the opposite side of the body. The left side controls thinking, language, movement and sensation on the right side of the body, the right side controls visual skills, size and form together with movement and sensation on the left side of the body.
Symptoms can last anything from several minutes to 24 hours or longer. No matter the severity, it is vital to get medical help as quickly as possible: the quicker a stroke is diagnosed and treated, the less damage there is likely to be and the better the chances of a good recovery.
During the first few days following a stroke it is important that the patient is well hydrated and nourished, and that as normal a life as possible is resumed: this is recovery through rehabilitation. Specialists such as physiotherapists, speech therapists, occupational therapists, doctors and nurses help with this process.
A person who consistently tries to walk following a minor stroke is more likely to recover mobility than someone who chooses to remain in bed.
Prevention
A healthy lifestyle with regular exercise, a good diet, good weight control and regular blood pressure checks are the best way to reduce the risk of a stroke, as is not smoking. Smokers have more arterioscleroses than non-smokers do.
High blood pressure is also one of the main factors. People who have a high risk of blood clots may be prescribed drugs such as aspirin or warfarin. Migraine also increases the risk: this is usually worse in women and is associated with fluctuating oestrogen levels. The combined contraceptive pill can make migraine more severe and increase the risk of stroke.
Vanessa Leyland is life and disability underwriter at Scottish Equitable Protect
10 things you should know about stroke
Stroke is the greatest cause of severe disability in the UK. It can lead to partial or total dependence in activities of daily living in 25% to 50% of stroke survivors. About 25% return to normal lifestyle but are at increased risk of further stroke.
Every five minutes someone has a stroke.
Stroke is the third biggest killer in the UK. Stroke survivors frequently die from heart attacks or complications of heart disease.
Almost one in four men and one in five women can expect to have a stroke if they live until 45.
Stroke is most common in people aged over 55.
More than three times more women die of stroke than of breast cancer in the UK.
The signs of stroke are facial weakness, arm or leg weakness, speech problems or loss of sight in one eye. These signs may only last a few hours but must not be ignored.
Eating healthily, taking more exercise, not smoking and ensuring blood pressure is normal can prevent a stroke.
South Asians, Africans and African-Caribbeans are at a higher risk of stroke.
Diabetes doubles the risk of stroke.
Underwriting implications
Due to the medical implications following a stroke, only life protection could be offered. The date the stroke occurred would need to be established, as well as the results of all investigations, the cause, and details the client's current treatment, and residual problems. To do this, a GPR would be needed and sight of any hospital letters. Cover for the six-month period following a stroke would not be available.
From the GP's information and hospital reports it should be determined whether the stroke was:
Minor: symptoms persisting no more than 24 hours and full recovery within six months
Moderate: symptoms lasting no longer than six months, applicant fully mobile and able to live independently
Major: symptoms impact on applicant's daily life, impaired cognition, possibly the need of a wheelchair and unable to live independently.
Other factors to consider are whether the applicant is a smoker and their blood pressure and cholesterol control. An applicant with diabetes would be declined life protection if they had experienced a stroke. Ratings can vary from 75% loading on the premium up to a decline, which is why it is so important to collate as much information as possible to make a prudent decision.
Sources:
www.bbc.co.uk/health
www.netdoctor.co.uk
www.stroke.org.uk
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