It is important to quickly get the right treatment after a stroke
There are some conditions that we know increase our risk of having a stroke – atrial fibrillation (where your heart beats erratically), and high blood pressure for instance, but the health of your siblings could also be relevant. Recent research shows that if one of your brothers or sisters had a stroke you could be 60 percent more likely to have one as well.
The researchers studied the hospital discharge and cause of death records of 30,735 Swedish people who had a sibling who had a stroke and those of 152,391 adults who didn’t. On average, the people in the study were 64 years old when their brother or sister had an ischaemic stroke (when the blood supply to your brain is blocked by a blood clot). These account for about 90 percent of strokes.
The results show that a stroke is 64 percent more likely if a full sibling is affected, and 41 percent more likely if a half sibling has had a stroke. If your sibling’s stroke happened when they were aged 55 or younger, you are 94 percent more likely to have one at a similarly early age.
“Health professionals should pay as much attention to a family history of stroke in siblings as in parents, and make patients aware that a genetic predisposition exists,” said study author Erik Ingelsson, professor of cardiovascular epidemiology at the Karolinska Institutet in Stockholm. “The gender of either sibling did not influence the stroke risk.”
However, he said that the increased risk may not only be down to shared genes, but could also be linked to similar lifestyle habits within families. “If your sibling has had a stroke, it should motivate you to take more preventive actions and to pay more attention to lifestyle habits such as diet, exercise and blood pressure control,” said Ingelsson. The study was published in the American Heart Association journal, Circulation: Cardiovascular Genetics.
Every minute counts
At the moment only about 2 – 5% of people receive thrombolytic (clot-busting) treatment), the only kind currently on offer for acute ischaemic stroke. This low figure is due mainly to the length of time it takes for the patient to reach a hospital: the treatment has to be given within four and a half hours of the first symptoms for it to be effective. And before having the treatment every patient must have CT scans of their brain to confirm that their stroke has been caused by a blood clot.
A study in Germany looked at a different approach to delivering treatment – taking the hospital to the patient. They used a Mobile Stroke Unit (MSU), equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to the hospital, to treat 53 patients with suspected stroke before they reached the hospital. A further 47 patients received optimised standard hospital-based stroke treatment.
Results from this study show that 57 percent of patients received treatment within an hour of symptom onset. This compares with only four percent having treatment within an hour in the hospital-care group. And the time taken from the emergency call to giving thrombolysis treatment was much shorter in the MSU groups – 38 minutes, compared to 73 minutes.
“When a stroke strikes time lost is brain lost, meaning that getting urgent medical attention quickly is absolutely essential,” said Nikki Hill from The Stroke Association. “Treating suspected stroke patients at the site of the emergency is an interesting development and it could help speed up the whole treatment process for some patients.”
“However, this research was conducted in an urban area of Germany, and so it’s difficult to say whether the same method would work in the more rural areas of the UK. A lot more research is needed. For the time being people should remember the Act FAST message and get to hospital as quickly as possible if they recognise any of the symptoms of stroke.”
FAST stands for
Facial weakness – has the person’s face drooped, usually down one side?
Arm weakness – is the person able to lift both arms above their head?
Speech problems – does the person’s speech sound slurred?
Time to call 999 – if one or more of these symptoms are present call an ambulance immediately.
One to watch
The Solitaire Flow Restoration Device is a new development that has just been approved for use in the USA. It’s inserted at the end of a thin tube which is then fed through a blood vessel to the brain, where the device traps the clot, and both are fed back out through the blood vessel, allowing the blood to flow again. It is obviously early days, but the technique worked so well in its last clinical trial that it was stopped a year early.
“The majority of strokes are caused by blood clots which stop the flow of blood to the brain, starving the brain of oxygen and causing brain cells to die or become damaged,” said Dr Peter Coleman, Deputy Director of Research at The Stroke Association.
“These new technologies have the potential to help patients who are not able to receive clot-busting treatments, meaning that more people could benefit from having blocked arteries rapidly reopened, potentially improving the quality of life for thousands of stroke survivors. However, more research is needed to make sure the treatment is safe.”
The Stroke Association - www.stroke.org.uk