Stroke

Published: July 28, 2013

In Australia, strokes are one of the top four medical events where a trauma insurance claim is made. According to the National Stroke Foundation, strokes are Australia’s second leading cause of death after coronary heart disease and also a leading cause of disability (1).

In a recent report (2) by the Australian Institute of Health & Welfare (AIHW), it was reported that approximately 60,000 stroke events occur in Australia each year, that’s roughly one event every 10 minutes!

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As at 2003, an estimated 346,700 Australians had suffered a stroke at some point in their lives (2). To increase stroke awareness, the National Stroke Foundation runs an ongoing campaign called stroke safe, which emphasises the ‘FAST’ test as a simple method that anyone can use to recognise and respond to stroke symptoms when they occur.

F – facial weakness
A – arm weakness
S – speech difficulties
T – time to act fast!

What is a stroke?

In a medical setting, ‘cerebrovascular disease’ refers to any disorder of the blood vessels supplying the brain and it’s covering membranes. Most cases of cerebrovascular-related death are due to a stroke or a ‘cerebrovascular accident’ (CVA) in medical terminology.

A stroke occurs when a blood vessel of the brain is suddenly blocked (ischaemic stroke) or bleeds (haemorrhagic stroke). This may cause part of the brain to die due to the lack of blood, resulting in a loss of brain function and several potential impairments, including limitations in mobility, thought processes and the ability to communicate.

Blockage of a blood vessel in the brain is the most common cause of a stroke, with ischaemic strokes representing approximately 80 per cent of all strokes and haemorrhagic strokes comprising the rest; however, the latter is more likely to result in death (2).

What are the causes and risk factors for stroke?

Several ‘biomedical’ and ‘behavioural’ risk factors associated with an increased risk of stroke include:

  • personal medical history of a previous CVA
  • increasing age
  • a family history of stroke
  • smoking tobacco
  • male gender
  • physical inactivity
  • poor nutrition
  • high blood pressure (hypertension) raised blood cholesterol (hypercholesterolemia)
  • diabetes mellitus
  • specific underlying medical conditions (e.g. atrial fibrillation; thrombocytosis)
  • abuse of alcohol and/or illicit drugs (e.g. cocaine; methamphetamines).

Fortunately, most of the aforementioned stroke ‘determinants’ are also modifiable, so individuals are able to take action to reduce their risk of suffering a stroke.

Transient ischaemic attacks (TIA) explained

In certain cases ‘temporary’ strokes can occur, an event described in medical terminology as a transient ischaemic attack (TIA), also known as a ‘mini’ or ‘little’ stroke. TIAs are a type of CVA/stroke; however, they differ from strokes in that symptoms of a TIA are usually completely resolved within 24 hours from the onset of symptoms, typically with no significant ongoing neurological symptoms, impairment or disability.

Another difference is that ‘complete’ strokes result in permanent damage to brain tissue, whereas such damage rarely occurs following a TIA. In cases where brain tissue injury does eventuate due to a TIA, the extent of any resulting permanent damage is significantly less than with a stroke.

Notwithstanding the above, TIAs are regarded as medical ‘warning signs’ that a patient is at an increased risk of suffering a ‘complete’ stroke, with further medical investigations promptly indicated in such cases (3).

Trauma insurance stroke benefit definitions may also specify exclusions for ‘Reversible Ischemic Neurological Deficit (RIND)’ and/or ‘Prolonged Reversible Ischemic Neurological Deficit (PRIND)’. RIND reflects a transient ischemic event with symptoms lasting for approx. 24-72 hours, whereas PRIND reflects durations from 24 hours to seven days (3). The use of these terms is no longer common in a medical setting (3).

How is a stroke treated?

Urgent medical treatment is always indicated for potential stroke patients admitted to emergency care. Comatose patients may require airway support, including mechanical ventilation, to prevent respiratory failure (4).

If the treating doctor suspects or detects raised intracranial pressure, immediate intracranial pressure monitoring would be initiated and specific interventions may be required to alleviate cerebral oedema. The specific acute treatment approach for each patient will vary according to the type of stroke identified following initial diagnostic testing (e.g. Computerised Tomography scans) (4).

Once a patient is medically-stabilised, the focus of treatment often includes a multi-disciplinary rehabilitation program aimed at improving the patient’s functional capacity, to help restore independence and quality of life.

Stroke rehabilitation is costly and sometimes limited in availability, often due to a lack of specialised healthcare resources. Successful outcomes often rely on the careful placement of a patient into the most appropriate rehabilitation program for their individual circumstances, whilst also considering the severity of their stroke and resulting impact on the patient’s physical and cognitive functional capacities.

Stroke statistics

The National Stroke Foundation had reported that more than 500,000 Australians were estimated to suffer a stroke during the 10 years from 2008 to 2017 (1). If we also consider its financial implications, as at 2005, the economic burden of stroke in Australia was estimated to be approximately $2.14 billion each year (1).

A stroke results in sudden and devastating changes not only to the lives of patients but also to their families, friends, employers and the wider community. Stroke survivors with disability are reportedly much more likely to suffer a ‘profound core activity limitation’ than the average person with a disability, which means that an affected person is unable to independently achieve (or always needs help with) communication, mobility or self-care (4).

The funds from trauma insurance can be used for living expenses, medical needs, rehabilitation, and any changes needed to your home to improve access.

References:
1. National Stroke Foundation 2010. Facts, figures, and statistics. Retrieved online 29/07/2010 from http://www.strokefoundation.com.au/facts-figures-and-stats
2. Australian Institute of Health and Welfare 2010. Australia’s Health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW.
3. Mosso M. and Baumgartner R.W. 2000. Transient ischemic attacks and prolonged reversible ischemic neurologic deficit. Diagnosis, differential diagnosis andtreatment. Praxis (Bern 1994). Mar 23; 89(13):542-8.
4. AIHW: Senes S. 2006. How we manage stroke in Australia. AIHW cat. no. CVD 31. Canberra: Australian Institute of Health and Welfare.

Source: CommInsure August 2010

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