Strokes affect many people in Anguilla and many survivors require extensive rehabilitation that can be very costly and burdensome to themselves and their families. Uncontrolled high blood pressure is a leading risk factor for strokes in Anguilla. Unfortunately, stroke is also a leading cause of death in Anguilla.

What is a stroke?
A stroke happens when a part of the brain loses its blood supply. A stroke is a type of cardiovascular disease. It affects the arteries leading to and within the brain. A stoke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens part of the brain cannot get the blood (and oxygen) it needs and it starts to die. A stroke can affect how the body works, including behaviour and communication. There are many different types of strokes.

Types of strokes
The three main types of strokes are:
• Ischaemic (clots)
• Haemorrhagic (bleeding)
• Transient ischaemic attack (TIA)
Ischaemic strokes occur in 80% of all cases and results from an obstruction. A blood clot causes impairment to a part of the brain. The underlying cause is the development of fatty deposits lining the blood vessels walls also called atherosclerosis.
Haemorrhagic strokes - A weakened blood vessel ruptures and bleeds into surrounding brain tissue. The blood accumulates and compresses the surrounding brain tissue.
Transient ischaemic attacks - These are termed minor strokes or warning strokes. A small blood clot causes a temporary obstruction to brain tissue. Blood clots usually resolve through normal mechanisms and there are no long term permanent effects. This is usually a warning of the development of a major stroke later if preventative measures are not taken by the individual.

Risk factors for strokes
Many individuals can prevent the development of a stroke if they know their risk factors and do something about them. Not all risk factors can be corrected but often some can be modified. A risk factor for a stroke is a trait or lifestyle habit that increases the risk of you getting a stroke.
Risk factors for a stroke include the following:
High blood pressure. A blood pressure of 140/90 or greater is one of the most important risk factors for a stroke. High blood pressure usually has no specific symptoms that is why health professionals advise everyone to get his/her pressure checked regularly and if elevated get it under control.
Tobacco use. This is an important risk factor for strokes. If you are a woman over 37 years and smoke, and also use the combined oral contraceptive you are at an even greater risk for a stroke. To stop smoking would markedly decrease your risk for developing a stroke.
Diabetes Mellitus is a risk factor for a stroke especially if the diabetes is not well controlled.
Other risks include:
• Peripheral vascular disease and carotid artery disease
• Sickle cell disease
• High cholesterol levels
• Physical inactivity and obesity
• Excessive alcohol use
• Some illegal drugs particularly cocaine

Do you have warning signs of a stroke?
Some individuals do have warning signs for a stroke while others do not.
Individuals with warning signs should see their doctor immediately. Warning signs include the following:
• Feeling weak, numb or paralyzed
• Unable to speak or understand simple phrases
• Blurred vision in one or both eyes
• Sudden intense headaches
• Dizziness or loss of coordination

Diagnosis
Your doctor will take a history, perform a physical and neurological examination and perform some tests. Very often the diagnosis is straight forward but the type of stroke may be difficult to establish. A CT (computed tomography) scan is usually performed to determine the type and extent of the stroke. A MRI (magnetic resonance imaging) may be done as well.

Treatment
Treatment for a stroke will depend on the type of stroke. In ischaemiac strokes the removal of the obstruction and restoration of the blood flow is the aim of treatment. Clot busters e.g. tPA are usually effective if given within three hours of onset of symptoms.
In Haemorrhagic strokes doctors usually induce an obstruction to prevent rupture or further bleeding. Surgery is usually necessary.
Rehabilitation is part of the treatment of all stroke survivors. All stroke survivors should also be fully evaluated by a neurologist for individual treatment and care.

How bad is a stroke?
The severity and extent of a stroke will vary from one patient to another. Severity depends on two things: the part of the brain affected and the size of the affected brain area. While a stroke can result in death many individuals survive and regain some function.

Conclusion
Strokes affect many people in Anguilla. It is recognized that a stroke can have an adverse impact on the individual as well as on families and friends. Knowing your risk factors for developing a stroke and seeking to modify or reduce these factors, can drastically reduce your chances of developing a stroke. If you are concerned about a stroke you should see your doctor as soon as possible.

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