Stroke

Claire Gilchrist

Kathryn Hubbard

Ruth Da Silva

Dr Utpal Naghotra

Dr Idris Ibrahim

� Leading cause of disability in the UK

� 4th most common cause of death in the UK

� Most people are aged 65+

� 150,000 new strokes each year

� 20,000 TIA’s (‘mini-strokes’) each year

Stroke Facts:

� £2.8 billion in direct costs to NHS - more than coronary

heart disease

� £1.8 billion costs in lost production and disability

� £2.4 billion in nursing home & personal care

� £7 billion in Total

Cost to those affected-immeasurable

Stroke Facts:

What is a Stroke?

� A Stroke is a ‘brain attack’, caused by a sudden interruption to

the blood supply to a part of the brain.

� Blood carries essential nutrients and oxygen to the brain.

� Without this brain cells can be damaged or destroyed

(infarction).

� Two main types of stroke:

A blockage (ischaemic stroke)

A bleed (haemorrhagic stroke)

Community Health Services

�A bleed or clot to the

right side of the brain

will generally affect the

left side of the body.

�A bleed or clot to the

left side of the brain will

generally affect the

right side of the body.

Community Health Services

What is a TIA?

�TIA (Transient Ischaemic Attack) is a ‘mini

stroke’ and occurs when the blood supply to

the brain is interrupted for a short time only.

The persons symptoms resolve quickly.

�Don’t wait to see if symptoms resolve – get

help.

Common signs of a stroke/TIA?

� numbness

�weakness

� slurred speech

� poor understanding of speech

� incomprehensible speech

� blurred/loss of vision

� severe headache

� unsteadiness

� confusion

Community Health Services

Signs of a Stroke/TIA

F Facial weakness

A Arm weakness

S Speech problem

T Time to call 999.

Community Health Services

Community Health Services

Risk Factors

� Smoking � Alcohol

� Atrial Fibrillation � High Cholesterol

� Diet � Poor medication compliance

� Diabetes � Ethnicity

� High Blood Pressure � Gender

� CVD � Age

� Lack of exercise � Previous Stroke/TIA

Neither a stroke nor TIA should be ignored – medical

attention is required quickly.

WHY?

To determine whether they have had a bleed or a clot –

If the scan shows a clot and they get to hospital quickly

enough they might be able to have a clot-busting drug

to reduce the effect of the stroke.

From stroke → drug in less than 4 hours.

Community Health Services

Brain Scans

�show whether they had a bleed or a clot.

�which part of the brain has been affected.

�which side of the brain has been affected.

�how much of the brain has been affected.

This all helps to make sure the person gets the right treatment

Community Health Services

Community Health Services

Brain Scan

Other investigations

� BP, pulse, temperature, oxygen levels

� ECG

� Blood tests – cholesterol, clotting, blood sugar levels

� Swallow tests

�Neurological observations (pupil size etc…)

Community Health Services

Key Messages

� If you have strong suspicion of stroke, thinking FAST

will help get the person in your care the best

treatment.

� Stroke Rehabilitation wards are proven to have

increased recovery rate, reduced mortality and

reduced dependency.

Community Health Services

Thrombolysis to thrombectomy

� Clot disruption

� Balloon clotplasty

� Stent deployment

�Merci device

� Penumbra device

� Stentriever

Pre and Post Thrombolysis Scans

Common Problems caused by Stroke

Effects of Stroke

Altered levels of consciousness Limb weakness

Impaired swallowing Changes in vision

Altered thinking processes Changes in behaviour

Feeling emotional Incontinence

Loss of feeling/sensation Altered skin integrity

Altered speech

Organised stroke care

Hyper acute stroke units

• Rapid assessment and diagnosis of stroke

• Timely delivery of emergency stroke

treatment

• Access to thrombolysis / thrombectomy

• Specialist nursing and rehabilitation staff to

manage all aspects hyper acute and acute

stroke

Benefits of HASUs

• Save lives – absolute mortality reduction of

3%

• Improves outcomes – 6% more people

returned home to live independently

• Saves money – London HASU saves £5.2

million each year; improved outcomes saved

the NHS an estimated £456 million between

2007 and 2014

(Bouverie, 2017)

Acute stroke unit

• “an area within a hospital where stroke

patients are managed by a coordinated

multidisciplinary team specialising in stroke

management”

• Benefits of treatment on Stroke unit:

– Better survival rates

– Better chance of returning home

– More likely to regain independence

Benefits of stroke units

Outcome Stroke unitConventional

care

Extra events per 100

patients treated (95%

confidence interval)

Home (independent) 44% 38% 5 (1, 8)*

Home (dependent) 16% 16% 0 (-2, 3)

Institutional care 18% 20% -2 (-5, 0)*

Dead 22% 26% -3 (-6, -1)*

Benefits of stroke units

Treatment

No. of extra

independent

survivors(if all stroke

patients eligible)

Proportion of stroke

population eligible

for treatment

No. of extra

independent

survivors (based on

stroke patients

eligible for

treatment)

Aspirin in acute

ischaemic stroke25 80% 20

Thrombolysis in

ischaemic stroke

- within 3 h

- within 3 to 4.5 h

280

125

10%

10%

28

12

Basic stroke unit 125 80% 100

Early supported

discharge / home

rehabilitation

120 35% 42

Based on a population of 2500 stroke patients over 1 year. Independent = Rankin score of 0-2

Early supported discharge

“Extended stroke unit care to cover the

immediate post discharge period” (Langhorne,

2018)

• Accelerates discharge home

• Provides support and rehabilitation at home

• Improves long-term disability outcomes

Stroke Pathway Gateshead

RVI: Hyper-acute stroke unit

• Rapid assessment and imagery within first hour of

arrival in hospital

• Assessment by specialist stroke consultant and

stroke trained nurses and therapists within 24

hours.

• Access to thrombolysis, thrombectomy and neuro

surgery if required.

• Discharged home with Community Stroke Team or

transferred to the Queen Elizabeth Hospital within

72 hours.

Stroke Pathway Gateshead

Ward 4 QE: Stroke Unit

• 28 bedded stroke ward

• Predominantly stroke patients ≈20

• Patient transferred from ward 41 at RVI

• Multidisciplinary team with stroke specialist

training and experience

• Daily board rounds to discuss each patient

Multi-disciplinary team

Stroke Team

Doctors

Occupational therapists

Physio therapists

Nurses

Speech and

Language therapists

Dietician

Leaving hospital….

• Medically stable

• Able to transfer safely

• Home environment is safe and accessible

• Has support set up to assist with daily

activities as required e.g. getting dressed

• Community stroke services notified

Community Stroke

Rehabilitation Team

Specialist

Nurse

Secretary

Occupational

Therapist

Physio

Therapist

Technical

Instructor

Speech and

Language

Therapist

Community

Stroke

Team

Referrals

�Ward 41 RVI

�Ward 4 QEH

�Stroke/TIA Clinic

�GP Surgeries

�6 Month Follow ups

�Self referral back into service

Gateshead Community Stroke

Rehabilitation Team

Multidisciplinary Team

April 2017 – Present = 529 referrals

395 - inpatient referrals

245 (62%) Stroke Unit (Ward 4) QEH

136 (34%) Ward 41 RVI

134 - Other, including GP’s, self-referrals,

out-patients

Criteria

�Anyone who has had a Stroke and is registered with a

Gateshead GP.

� Potential for rehabilitation.

What We Do

� Hospital and home visits

� Secondary prevention and Information leaflets about stroke

� Rehabilitation physical and cognitive

� Patient centred goal setting

� Re-housing application and major adaptations

� Support to deal with practical and emotional issues

� Referral to other organisations

� Act as Advocate as necessary

� Refer on to support groups and other social activities

� Carers Support

What do we do?

• National Helpline

• 9am-5pm Monday, Thursday and Friday

• 8am-6pm Tuesday and Wednesday

• 10am-1pm Saturday.

• 0303 3033 100

• Campaigning

• Research

• Training

• Fundraising

• Volunteering

• Awareness / prevention

• Life After Stroke Grants

• Services

Gateshead Services• Stroke Recovery

Information, advice and emotional support for stroke survivors and families

• Communication Support

One to one and group support for people who have difficulty with speaking,

reading or writing

• Moving Forward After Stroke

12 week exercise and education programme and support to continue

physical activity

• Community Integration

Continuing support for people who need help or advice returning to work,

education or leisure activities

• Community Development

Stroke awareness and long term stroke clubs

• My Stroke Guide

Online information and peer support

For more information

Helpline: 0303 3033 100

Website: stroke.org.uk

Thank you for listening

Any questions?