Maura came into the consulting room accompanied by her daughter. "I'm here under orders," she said, her eyes darting in the daughter's direction. "There's nothing wrong with me, but she insisted I came to see you." Maura's daughter had noticed an unsteadiness in her mother's gait and had become especially concerned when Mum dropped a cup several times during a visit the previous day.
Clinical examination was normal, but by listening carefully to Maura's story I could pick out a description of a probable transient ischaemic attack (TIA). TIAs or "mini strokes" can be a warning of an impending stroke. While the symptoms are similar to a full-blown stroke, in a TIA they completely resolve within 24 hours. The key is not to ignore or dismiss this 24-hour period, but to bring it to your doctor's attention. It could literally save your life.
A stroke is the result of damage to the brain because of an interruption to its blood supply. This can result from a blockage in the arteries within the brain or from a clot which travels from the heart or the large blood vessels in the neck to the brain. It leads to a loss of function in the affected part of the brain.
The common symptoms are: loss of power in either the hand or the leg; partial loss of vision in one eye; a temporary loss of speech; a blackout attack; pins and needles or loss of sensation in the limbs on one side. Dizziness, unsteadiness, confusion and memory loss may also occur, but are less specifically associated with a TIA or stroke. Stroke is the third leading cause of death, after heart attack and cancer. Over 30,000 people have a residual disability from a previous stroke.
These figures come from a report soon to be published by the Irish Heart Foundation's (IHF) council on stroke.
One of its key recommendations is that every general hospital admitting patients with acute stroke should have a dedicated stroke unit. Here they would receive care from a dedicated specialist and a full team of rehabilitation experts. The patient should also have access to full diagnostic technology, in particular CT or MRI scanners.
Dr Patricia McCormack and Dr Des O'Neill, consultants in old age medicine at Tallaght Hospital, introduced the Republic's first acute stroke service at the Adelaide and Meath Hospitals in 1996. The death rate of patients admitted to the unit has more than halved in the past four years.
Dr O'Neill, who is chairman of the IHF's council on stroke, points out that for patients treated in dedicated stroke units there is also an improvement in disability rates and a drop in those going to long-term care. "Each of the 38 general hospitals around the country should have a specialised stroke service," he says. "Two-thirds to three-quarters of the resources required are already in place within hospitals."
Dr O'Neill says that "without treatment, 12 per cent of TIA patients will develop a stroke within one year. The incidence is especially high in the first month."
So, for Maura and her daughter, the visit proved to be preventive. I prescribed aspirin to thin out the blood while I arranged some investigations to establish the cause of the mini-stroke. She turned out to have a narrowing in her carotid artery in the neck. The aspirin helped to reduce the chance of a recurrence while she awaited surgery on the blocked artery. She did not develop a full-blown stroke and she has made an excellent recovery.
Things You Should Know about Stroke - a Guide for Patients and Carers is available from the Irish Heart Foundation (01-6685001). Another very helpful publication, Understanding Stroke, is available from the Volunteer Stroke Scheme (01-4559036). Also see: www.compura.com/stroke