How to spot when someone is having a stroke – and what to do next…

The number of 999 calls for possible stroke has increased by 55% since the launch of a powerful awareness campaign.

The television adverts, which were launched in February 2009, show the arresting image of someone with fire burning in their head, quickly followed by the Face, Arm, Speech, Time (FAST) test, which was developed by leading stroke physicians. The aim of the campaign by the Department of Health was to promote this simple test to make people more aware of the signs of stroke, and be able to act quickly. See below for what FAST means…

What is a stroke?
Stroke accounts for 9% of deaths in men and 13% of deaths in women in the UK. It’s more likely to occur in older people, although it can happen at any age.

Swift action can limit the damage to the brain and dramatically increase a person’s chances of surviving. But what exactly is a stroke? 

A stroke is usually caused by a blockage or burst blood vessel depriving the brain of its blood supply, and causing a part of the brain tissue to die.
It’s essentially the same as what happens in the arteries leading to the heart when someone has a heart attack – which is why a stroke is now sometimes described as a ‘brain attack’.

The result is that the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, to formulate or understand speech, or to see one side of the visual field.

This is because if brain cells lose their supply of oxygen from the blood, they may be damaged or die – and dead brain cells can’t start working again. However, surrounding these dead cells is an area of tissue where blood supply is poor but not lost completely, so the nerve cells are receiving barely enough oxygen
to stay alive.

One of the main aims of treating a stroke is to act quickly enough to save this threatened brain tissue. This is done by restoring blood flow to the area and minimising damage. As the inflammation and swelling caused by the stroke subsides, brain cells near the dead cells may recover and begin working again.

Different types of stroke
There are two main types of stroke. Ischaemic stroke is the most common type, when the artery is blocked by a blood clot, interrupting the brain’s blood supply. This may be due to a cerebral thrombosis, when a blood clot forms in one of the main arteries leading to the brain; or a cerebral embolism (sometimes called an embolic stroke), in which a blood clot forms elsewhere in the body and is swept into the arteries serving the brain. 

The other main type is haemorrhagic stroke, when a blood vessel in or around the brain ruptures. The build-up of blood presses on the brain, damaging delicate tissues. Other cells in the area are also starved of blood and damaged. 

What are the causes? 
There are several different reasons why stroke can occur. The main reason is diseased arteries. Blockage of the arteries is usually the result of atherosclerosis, which is the furring and narrowing of the artery walls with a mixture of cholesterol and other debris. Another cause is an aneurysm – a weakened spot on an artery wall which causes it to stretch. The vessel wall may become so thin it bursts, causing bleeding into the brain (haemorrhagic  stroke). Another major causes of stroke is atrial fibrillation, which is when the heartbeat is irregular (arrhythmia). This can cause a blood clot to form in the heart, which then travels to the brain.

The treatments 
Once the type of stroke has been diagnosed, drug treatment is the first option to prevent complications and further strokes. Medication includes blood thinning drugs such as aspirin, clot-dissolving and anticoagulant drugs, which reduce clotting.

Surgery is an option, particularly for those who’ve had a transient-ischaemic attack (TIA) or stroke caused by severe narrowing of the carotid artery. They may benefit from an operation called carotid endarterectomy to remove the narrowing, or insertion of a stent (a steel mesh tube) into the artery to keep it open. This may significantly reduce the risk of having a full-blown stroke or another stroke.

Many people suffer some sort of disability following a stroke, but the brain is remarkably adaptable and in the months or years after a stroke, many cells that have been damaged recover some of their function. At the same time, other areas of the brain take over the functions performed by the cells that have died. This is why rehabilitation is so important, including help to aid physical recovery, as it can make a real difference to quality of life as the months progress.

F.A.S.T
Face: Has their face fallen to one side, and can they smile?
Arms: Can they raise both arms above their head and keep them there?
Speech: Is their speech slurred?
Time: Time to call 999 if you see any one of these signs.

Photographs: getty images