A recent BBC news article has reported that strokes in working age adults are on the increase (http://www.bbc.co.uk/news/health-32690040). Information from a Stroke Association study found that there has been a 32% increase in hospital admissions for men aged between 40 and 54 in England from 2000 to 2014. Experts say that strokes should not be considered an old age disease.
The increase in working aged adult strokes has been associated with a number of different factors including unhealthy lifestyles with poor diet, lack of exercise and obesity being targeted. This is a major concern because strokes, in all age groups, are the third highest cause of death in the UK, behind heart disease and cancer, affecting 110,000 people each year.
What is a Stroke?
A stroke occurs when the brain cannot get oxygen. There are two main causes:
- A blood clot, the most common cause, where a clot cuts off the blood supply to the brain.
- A bleed, where a weakened blood vessel supplying the brain bursts.
If the brain is starved of oxygen it is likely to cause injury to the brain cells.
A related condition is called a transient ischaemic attack (TIA). This occurs when the blood supply to the brain is temporarily interrupted causing stroke like symptoms that disappear after a short period of time, usually without causing brain damage. TIAs should always be treated seriously because they are often a warning sign that someone is at risk of having a full stroke in the near future.
What are the Symptoms?
Stroke symptoms have been publicised by the NHS in recent years by the word FAST. These are:
- F – Face, has it dropped on one side, by the eye or mouth?
- A – Arms, can they keep both arms lifted? Is their weakness or numbness in one arm?
- S – Speech, is their speech slurred or garbled?
- T – Time, dial 999 if any of these signs or symptoms are present.
More information about stroke symptoms can be found here:
Acting FAST is the key in successfully treating strokes and minimising brain injuries. If a stroke is not diagnosed and the patient referred for immediate review the window for effective treatment will be lost. The type of treatment is dependent on whether a blood clot or bleed has caused the stroke.
If there is a blood clot, thrombolysis may be given to try and thin the blood in an attempt to dissolve the blood clot and restore oxygenated blood flow to the brain. This type of treatment is only usually given within 4 hours of the first onset of stroke symptoms. Some newer research suggests that this 4 hour window can be extended by a matter of hours with successful results but, on the whole, this type of treatment is most effective if given as soon after the onset of stroke symptoms as possible.
Other more advanced treatment options may be available; including CT guided catheter delivery of clot busting medication (direct to the location of the clot) and mechanical thrombectomy (where the clot is broken down by tiny surgical tools and removed through a blood vessel) to try and dissolve or remove the clot as quickly and efficiently as possible after the onset of symptoms.
Other medication may be given to prevent future blood clots, such as aspirin and anticoagulants.
Thrombolysis medication is not given if the cause of the stroke is a bleed because thrombolysis is likely to make the bleed worse and the brain injury more severe. For this reason, a CT brain scan is usually carried out to determine the cause of the stroke before any type of treatment is started.
Treatment for a bleed in the brain may include surgery (craniotomy) and/or medication to reduce further bleeding. Medication may also be prescribed to prevent future bleeds.
Clinical Negligence Claims
Delay in recognising, diagnosing and treating a patient with stroke symptoms may lead to a clinical negligence claim. My own experience is that stroke symptoms are not always immediately recognised and consultant review is not always obtained as quickly as it should be. In these circumstances, the limited timeframe for treatment may be missed, particularly when the cause of the stroke is a blood clot and thrombolysis treatment, if given promptly after a CT scan, can minimise the extent of brain injury, by dispersing the blood clot, and reduce the risk of further clots.
Recognising TIAs and starting a patient on preventative treatment is also particularly important.
If you think you, or someone you know, may have suffered an injury as a result of negligent medical treatment and would like to speak with a member of the Lester Morrill clinical negligence team, please call on 0113 245 8549 or contact us by email at firstname.lastname@example.org .