Stroke Dr Jane Molloy Clinical Lead Stroke Services

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Stroke Dr Jane Molloy – Clinical Lead Stroke Services SRFT

Stroke Dr Jane Molloy – Clinical Lead Stroke Services SRFT

Stroke Background: What is a stroke? How do we ‘know’ there’s a stroke? Why

Stroke Background: What is a stroke? How do we ‘know’ there’s a stroke? Why do people have strokes? What can we do to prevent a stroke? What should we do – is there any treatment? Salford Stroke Services

What is a stroke? • Brain is the ‘control centre’ – – – –

What is a stroke? • Brain is the ‘control centre’ – – – – – Planning Thinking Movement Sensation Memory Balance Speech Language Hearing, vision

What is a stroke? • Delivery of oxygen, glucose • Taking away ‘waste’

What is a stroke? • Delivery of oxygen, glucose • Taking away ‘waste’

What is a stroke? 8 out of 10 due to blood clot 2 out

What is a stroke? 8 out of 10 due to blood clot 2 out of 10 due to bleeding

How do we ‘know’ there’s a stroke? FAST Video

How do we ‘know’ there’s a stroke? FAST Video

How do we ‘know’ there’s a stroke? SUDDEN loss of function what is lost

How do we ‘know’ there’s a stroke? SUDDEN loss of function what is lost depends on which blood vessel is affected we can only tell if there was bleeding by doing a scan Loss of: power = movement feeling = numbness vision = one eye / to one side balance speech – slurring vs wrong words blackout unusual

How do we ‘know’ there’s a stroke?

How do we ‘know’ there’s a stroke?

Is Stroke Important? • 1 stroke every 5 minutes – England & Wales •

Is Stroke Important? • 1 stroke every 5 minutes – England & Wales • 3000/year Greater Manchester • 50% dead or disabled at 6 months • 1: 4 of those living >80 years • In women – 3 x deaths from breast cancer 2002

How can we prevent a stroke?

How can we prevent a stroke?

Modifiable Risk Factors Risk factor High Blood Pressure Smoking Ischaemic Heart disease Cholesterol Diabetes

Modifiable Risk Factors Risk factor High Blood Pressure Smoking Ischaemic Heart disease Cholesterol Diabetes Excess alcohol Physical inactivity Weight/diet Excess stroke risk 4– 6 1. 5 – 4 3– 4 *Unclear 2 5 1. 6 – 3. 3 Variable

Blood Pressure • • • Blood pressure <140/85 BP gets higher with age Reduce

Blood Pressure • • • Blood pressure <140/85 BP gets higher with age Reduce salt Reduce weight Tablets Self monitoring

Smoking • Don’t! • Smoking cessation – advice & support – signposting

Smoking • Don’t! • Smoking cessation – advice & support – signposting

Cholesterol • What’s yours? • Statins reduce death from heart attack and stroke by

Cholesterol • What’s yours? • Statins reduce death from heart attack and stroke by 1/3 • Dietary changes can help cholesterol but not always

Atrial Fibrillation

Atrial Fibrillation

Weight & Diet

Weight & Diet

Exercise • • • Controls weight Improves cholesterol Prevents diabetes Improves mood and helps

Exercise • • • Controls weight Improves cholesterol Prevents diabetes Improves mood and helps depression Improves energy levels Improves sleep Improves sexual function Is fun Why don’t we do it?

Preventing Strokestroke

Preventing Strokestroke

And if despite all that. . • Admit to a hospital with a specialist

And if despite all that. . • Admit to a hospital with a specialist stroke unit • Urgent brain scanning and assessment • Clot busting treatment if possible – Time is Brain • Stroke Unit Care

Stroke Services – Greater Manchester From this… 2006

Stroke Services – Greater Manchester From this… 2006

To this…from 2010 Salford Bury All others Stockport

To this…from 2010 Salford Bury All others Stockport

30 Day Mortality Over Time 30 25 20 % of patients who died within

30 Day Mortality Over Time 30 25 20 % of patients who died within 30 days 15 10 5 0 Year of Audit 2004 2006 2008 2010

Life After Stroke • Rehabilitation – In hospital – Early Supported Discharge – Community

Life After Stroke • Rehabilitation – In hospital – Early Supported Discharge – Community rehabilitation • Life after Stroke Care • Secondary Prevention

Stroke at SRFT • 8 consultants • Service for Greater Manchester • 24/7 acute

Stroke at SRFT • 8 consultants • Service for Greater Manchester • 24/7 acute specialist stroke assessment – Specialist nurses & Drs • >500 patients thrombolysed • Daily TIA clinics – direct referrals

Thank you Questions?

Thank you Questions?