29 October 2023
Strokes strike every five minutes in the UK. It can happen to anyone, of any age, at any time. It’s vital to know how to spot the signs of a stroke in yourself or someone else.
Stroke is a medical emergency. The FAST test can help you recognise the signs.
- Facial weakness: Can the person smile? Has their mouth or eye drooped?
- Arm weakness: Can the person raise both arms?
- Speech problems: Can the person speak clearly and understand what you say?
- Time to call 999: if you see any of these signs.
Other symptoms of stroke
The FAST test helps to spot the three most common symptoms of stroke but there are other less common signs that you should still take seriously. These include:
- Sudden weakness or numbness on one side of the body, including legs, hands or feet.
- Difficulty finding words or speaking in clear sentences.
- Sudden blurred vision or loss of sight in one or both eyes.
- Sudden memory loss or confusion, and dizziness or a sudden fall.
- A sudden, severe headache.
For further details about the symptoms of strokes, the following link contains information from the Stroke Association Symptoms of stroke | Stroke Association.
What is a stroke?
A stroke is an attack on the brain in which the blood supply to part of the brain is cut off, which can result in irreversible damages to that part of the brain. The effect of a stroke can vary depending on which part of the brain is affected and how severe the stroke is, as well as how quickly treatment is provided.
Strokes can also cause bleeding on the brain. The effects of stroke can be permanent although some people make a very good recovery, particularly with timely treatment. Those that have suffered a stroke are also more vulnerable to further strokes. In the most serious cases, a stroke can cause immediate death or death through subsequent secondary strokes.
Stroke Management
It is crucial that anyone suffering with a potential stroke is attended to by a medical professional as soon as possible. The optimal stroke timeline is highlighted as follows:
- Category 2 ambulance should arrive within 18 minutes
- Convey to Hospital within 60 minutes
- Rapid assessment within the A&E Department 10 minutes
- Rapid CT scan 60 minutes
- Decision to administer/thrombolysis within 60 minutes
- Assuming the call to the ambulance is made quickly, the timeline aims to administer thrombolysis within 2 hours
What is thrombolysis and is everyone a candidate for this?
Thrombolysis can break down a clot that is stopping blood reaching the brain. This is done by using a drug called Alteplase. The aim is to restore blood flow to the affected area before irreversible damage is done. Therefore, the quicker the thrombolysis is administered, the better the chance of a positive outcome being achieved.
Thrombolysis is a time critical treatment, and there is an important time window in which thrombolysis is administered. The thrombolysis MUST be administered within 4.5 hours of the onset of stroke symptoms. It is therefore very important to know when the start of the symptoms commenced.
A patient will undergo an assessment under the National Institute of Health Stroke Scale (NIHSS) to calculate whether the patient is a suitable candidate for thrombolysis.
If a patient is not suitable for thrombolysis, then a mechanical thrombectomy may be performed.
Following the thrombolysis, the patient is assessed under the Modified Rankin Scale (mRS) to assess a patient’s stroke outcome. A generally good outcome would be scored between 0-2.
What is a mechanical thrombectomy?
Mechanical Thrombectomy is an emergency procedure performed by a specialist team led by a doctor called an Interventional Neuroradiologist. The doctor uses specialised equipment and guidewires to physically remove the clot from the artery in the brain in order to restore the blood supply. If mechanical thrombectomy is not feasible there is no known better alterative treatment to remove or dissolve the clot. If untreated, the patient’s stroke symptoms can get worse.
Mechanical thrombectomies are only performed at specialist Hospitals.
The criteria for mechanical thrombectomy is widening but in general the best evidence is for:
- Anterior circulation strokes with persisting disabling deficit
- No major pre-morbid disability (mRS 0-1)
- NIHSS 6 or more
- No large area of irreversibly damaged brain on CT
- Large vessel occlusion demonstrated on a CT angiogram
- Treatment within 6 hours of symptom onset
- A local service capable of delivering the treatment
In the event that you or a loved one has experienced an avoidable delay in diagnosis or treatment of a stroke and a worse outcome has been suffered as a result of this, you may be able to bring a claim for clinical negligence. Such a claim cannot change what has happened but it can get you crucial answers as to what happened, as well as seeking to obtain compensation which can assist with rehabilitation.
Our team here at Williamsons have a wealth of knowledge in clinical negligence, and if you feel you have any concerns in relation to your stroke management or the treatment received by a loved one, please feel free to contact us at Williamsons on 01482 323697 to discuss your concerns further.
