Handbook for successful ageing - 9.3.2

9.3.2 Stroke, TIA and prophylaxis of arrhythmia
   

A stroke is mostly caused by a blood clot in the brain. Warning signals can be migraine, as well as elderly people dozing off unintentionally in the middle of the day.
   

In many cases previous illnesses are the cause, which, however, can be avoided or treated, such as blood pressure, diabetes, increased LDL, arteriosclerosis, closure of peripheral arteries (refer to 9.3.25) for viscous blood, disturbance of the heart's rhythm (arrhythmia), cardiac defect or bleeding in the brain. Arteriosclerosis can be reduced or completely avoided by, among other things, healthy nourishment, a lot of exercise and refraining from smoking (refer to 1 and 2). Ensure that the other possible causes are treated early in order to reduce the risk of apoplexy or stroke.
  

Check with your doctor now already as to whether you require more magnesium now (refer to 1.9.1).
  

Typical symptoms of a stroke are:

- A sudden feeling of faintness, numbness and signs of paralysis: a person who is having a stroke often cannot move the arm, hand and/or leg properly anymore. Apart from the feeling of weakness, some people have feeling disorders such as tingle or a feeling of paralysis. Sometimes it can feel as if for example the arm or the foot is asleep. A drooping corner of the mouth is also typical. In most cases the dysfunctions rather appear on one side of the body than on both sides.

- Speech disorders: Many persons affected suddenly have difficulties finding the right words; their sentences are clipped. Sudden mumbling and speaking in a faded way or slurring can be a sign of a stroke. Sometimes there are communication problems; the person affected may be able to hear others but does not understand the meaning of what is said.

- Failure of the visual field: A stroke can reduce the ability to see. Then the affected persons do no longer perceive things on one side of the body, the visual field is restricted to the left or the right hand side. Others see everything double. When they want to grab something, for example a cup, in most cases they miss it.

- Dizziness and problems with walking: affected persons may have problems keeping their balance. Either they feel like everything is turning like on a carousel or that it is rocking like on a boat.

- Strong headache: a sudden and unusually strong headache can also point to a stroke. The reasons for the headache are acute disturbances in blood supply in the brain or a haemorrhage in the brain due to a ruptured or burst vessel. The headache can appear alone first and then be followed by other symptoms like paralysis or disturbance of consciousness. Nausea and vomiting can also occur.
   

Often the affected persons cannot, or only in a limited way, communicate with others. Therefore, it is important that others, who notice something, explain the existing symptoms, the circumstances and if possible also the previous illnesses in detail to a doctor. The following information is particularly important:

- When did the symptoms occur?

- What was the affected person doing? Did he/she for example himself/herself?

- Which symptoms of a stroke did occur and how did they evolve?

- Which medicine is the person taking at the moment?

- Does the person suffer from arrythmia, atrial fibrillation in particular?

- Did the person already have similar symptoms at some point or was already treated because of a stroke?
  

Bear in mind that a stroke is an emergency. Do not be afraid of dialling the emergency number 112 (or to set off the internal emergency, see below). Do not wait to see if the symptoms go away - doing so you can lose precious time. An appropriate examination and treatment can only take place in a hospital. And nobody will reproach you if it turns out to be a "false alarm" (Taken from www.gesundheitsinformation.de, "signs of a stroke").
    

Until the doctor comes try to calm the affected person, and make sure there is fresh air. If he/she can still speak, raise the upper part of the body. The person should not eat or drink since he/she could choke on it. If he/she is unconscious, put him/her on one side with the neck extended and make sure that he/she neither rolls on the stomach nor on the back- maybe with the help of a pillow.
    

If the symptoms subside after the first 24 hours already, then you do not have a stroke but a transitory (temporary) ischaemic (accompanied by anaemia or poor blood supply) attack (TIA), which, however, in most cases is also based on a weaker stroke, if it lasts more than 30 minutes. Signs for a TIA are, apart from the symptoms of a stroke, also a failure in doing a routine job and balance or coordination disturbances. If you are not taken to a stroke centre but to an internal medicine ward, then you should also ask for a MRT (magnetic resonance tomography) to be done immediately, as it will be more convincing than if it is done at a later time. The TIA can be caused by both, plaques from the carotid artery and a blood clot in the left auricle. To check the former, your carotid arteries will be examined via ultrasound. Furthermore, you should ask for this to be done not via a Doppler sonography but via a duplex sonography as the result of this will be more reliable. If no plaques have travelled from the carotid arteries to the brain, then it can be blood clots from the left auricle. Therefore, you should ask for the examination of your heart and possibly your thyroid gland as well. Blood clots can arise if you suffer from CHD, high blood pressure or an overactive thyroid. In this case, check once a day if your heart beats regularly by putting your thumb on the one hand and your other fingers on the other hand of your carotid arteries, to check the regularity of your pulse.
  

We may not know why an overactive thyroid can also lead to the building of blood clots in the left auricle, but it is a fact. As soon as you notice irregularities concerning your heartbeat, you should contact a cardiologist in order to hopefully prevent arrhythmia and a potential TIA. Do not trust in the ECG that is made during the annual check-up, not even in a long-term ECG, as the pulse may be regular for a whole day but totally irregular on another day.
  

If the symptoms of a TIA lasted only a few minutes, then you should still have your carotid arteries, your heart and maybe your thyroid examined afterwards.
  

If you live alone and you suffer from another TIA at the same time of the day, then you should ask someone to call you at this time, every day to check if you answer the phone and if you do so, to see if you are able to speak clearly or not, so that he/she can call the rescue coordination centre if necessary (see below, 1) and 2)).
  

If someone might have suffered from a stroke or a TIA while you are present, ask him/her to give you their crossed hands and to press your hands strongly. If the person is able to do so, then he/she has neither had a stroke nor a TIA, but maybe suffers from arrhythmia. In this case speed is of the essence, too, but here the family doctor might be able to help with an infusion if he/she is available; otherwise you also call 112.
   

If you had a stroke, ask for an internal emergency number and tell the rescue coordination centre in advance where your "instructions for the rescue coordination centre" can be found; a list of the medication you take at the moment, your advance directive, and a suitcase which contains everything that should be taken to the stroke centre. The signal head which you wear around your neck or your wrist is waterproof so that you can also wear it while taking a bath or a shower. You should have the basic device for the communication with the emergency call service (?) (microphone and speaker) installed relatively central, so that you can communicate with the personnel of the emergency call service from all rooms, and you should make sure that the door of the room which you are in is open. If you can’t speak anymore due to a stroke, someone will nevertheless be with you as soon as possible or inform one of your neighbours.
   

To make sure that someone will find you quick if you become unconscious, you should make an agreement with neighbours of yours who are often at home during the day: buy radio-controlled baby alarms; ask them to keep the receiver at their place and say "I’m still here" or similar things into the baby alarm every two hours between getting up and going to bed. Furthermore, hang up a sign with two sides with different colours on your front door, turn it round right after getting up and then turn it again every two hours until you go to sleep, write down on your door at which times which of the colours has to be visible. Give a key to your flat to the neighbours you trust, ask them to check if the sign is hanging correctly when they pass by and if it is not, then they should go into your flat and call the rescue coordination centre. Ask friends to call you regularly If you live in a terraced house or if all your neighbours are working.
   

Additionally to No. 1 and 2: in-house emergency call and metabolic syndrome and provisions for the journey/ for being on the way.
   

If you are in danger of a heart attack or stroke or you already had a TIA in Germany you can have an emergency calling system prescribed by the doctor installed in your home, even if you are, as a rule, not alone at home. A signal transmitter will then be attached to your neck and can reach the rescue coordination center under any circumstance. Bear in mind that this has to be treated with utmost urgency. The faster the treatment, the help offered can be more effective.
   

Nicotine, obesity, diabetes, high blood pressure and high blood lipid concentration (higher LDL and/or Triglyceride level) are the five causes which can result in a heart attack or stroke. If three of these are present, doctors talk about a metabolic syndrome and the danger is particularly high.
  

If you have a mobile phone, mark the numbers of those persons who should be contacted if you suffer from a heart attack or stroke while you are on the way with the letters ICE (in case of emergency). The people of the rescue service will then know what they have to do. If you are travelling abroad, don’t forget to replace the first 0 of the area code by the international area code of your country.      

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