Analysis: Alex Ferguson's recent surgery focused attention on a disease which affects many people, but what do we actually know about how and why strokes occur?
Earlier this month, British football's most successful manager Alex Ferguson underwent emergency surgery after suffering a subarachnoid haemorrhage (a relatively rare form of stroke). The event coincided with the fifth anniversary of Ferguson’s retirement from Manchester United, a club he served at for 26 years. In that quarter-century period, he amassed a glittering collection of trophies, including two European Cups, five FA Cups, and 13 Premier League titles.
On the philosophy of winning, he famously said: "I’ve never played for a draw in my life". Perhaps as a result, we shouldn’t be surprised that he is expected to make a full recovery from a type of stroke which kills 10 to 15 percent of patients before they even reach the hospital,
In the days after Ferguson’s surgery, tributes poured in from around the globe. Pundits, ex-players, politicians and even noisy neighbours Manchester City sent him well wishes. Many articles in the days that followed catalogued his contribution to football, but what about some pieces which explain in a simple manner what exactly is a brain haemorrhage.
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From RTÉ Radio One's Morning Ireland, Paul Keogan, Irish Paralympian and stroke survivor, and Chris Macey, Head of Advocacy with the Irish Heart Foundation, discuss the challenges facing younger stroke survivors in Ireland
How deadly is stroke?
Since the dawn of time, humans have struggled to come to terms with the nature of stroke. Hippocrates, the father of medicine, described his patients being "struck down by violence". Only in the 17th century did a Swiss physician correctly speculate stroke was caused by either a clot (approximately 90 percent of cases) or a bleed (less than 15 percent of cases) in a blood vessel serving the brain. Today, we interpret the disease as any prolonged reduction in the supply of blood to a part of the brain. When this occurs, cells starved of oxygen and nutrients quickly die in large numbers.
In 1943, Joseph Stalin, Franklin D. Roosevelt, and Winston Churchill—the three most powerful people alive at the time—met at the Tehran Conference. The goal of the meeting was clear: to open up a second front against Nazi Germany and end the war in a single stroke.
Yet, two decades later, the three leaders had all succumbed to the very same thing. Despite this, and the fact that stroke remains the second-leading cause of mortality worldwide (with 6.5 million deaths annually), it receives limited media attention. "Brain attacks", which can leave survivors with long-term effects like memory loss, speech impairment, and depression, have not garnered the same notoriety as their heart counterparts. Notably, diseases such as cancer also tend to receive greater government and charitable support (with one UK-based report highlighting a staggering 10:1 ratio).
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From RTÉ Radio One's Ray D'Arcy Show, Prof Conor Walsh, head of the Biodesign Lab at Harvard University, talks about designing a robot suit to help stroke victims
What is stroke?
In order to expand the dialogue on stroke, we first need to better understand it. Much like a train station needs passengers, the human brain requires a constant supply of oxygen and nutrients to function. Sometimes, traffic (blood flow) is suddenly interrupted because of broken tracks (clots) or a derailed train (bleeds). If service is rapidly restored, the train station (brain tissue) continues as normal. If not, it ceases to operate.
How can I tell if I’m having a stroke?
Symptoms of all stroke types include dizziness, numbness, blurred vision, and difficulties with speech/movement. In subarachnoid haemorrhage, the subtype suffered by Ferguson, additional complaints such as a stiff neck or severe headache may be seen. In most stroke cases, symptoms are confined to one side of the body, a fact highlighted successfully in the Irish Heart Foundation’s FAST campaign.
How can I prevent stroke?
Risk factors shared between clot-based strokes and brain bleeds include a history of smoking. Separately, people who suffer from diabetes, high cholesterol, or disorders of heart rhythm are at an increased risk of clot-based strokes. Doctors also point to excessive alcohol consumption and illicit drug use as a cause for concern. By far, high blood pressure is the most controllable risk factor for both stroke types. Consistently raised blood pressure, or "hypertension", can lead to the rupture of fatty plaques in brain arteries, resulting in a clot. Hypertension can also cause weakened, ballooning arteries (aneurysms) to burst.
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From RTÉ Radio One's Morning Ireland, Professor Joe Harbison, National Stroke Programme co-lead, on how services remain inadequate for people who survive a stroke
How is stroke treated?
It is estimated that two million brain cells die for every minute a stroke goes untreated. Regardless of cause, time is a crucial factor in the outcome of every stroke. In nine out of 10 cases, the aim is to remove a clot and restore blood flow to the brain as quickly as possible. To achieve this, doctors may opt for clot-busting treatment (thrombolysis) or in certain cases, thrombectomy, where the clot is instead mechanically retrieved. Beyond a narrow time window, however, the risk of bleeding from both treatments grows too great. If hospital staff are not careful, a clot-based stroke can rapidly transform into a haemorrhage.
With an 84% increase in stroke-related deaths, Ireland ranks poorly on a European scale
As seen with Alex Ferguson, brain haemorrhages often require surgery. This allows doctors a chance to drain away pooled blood (reducing pressure on the brain) and repair damaged blood vessels. As with all cases of stroke, the next priority then becomes preventing infection and guiding patients towards rehabilitation through physical, occupational, speech and language therapies.
What is the future of stroke?
Sadly, with an ageing population, stroke isn’t an issue which will vanish from Ireland anytime soon. By 2035, current predictions for show a 59% increase in new cases of stroke. Combined with an 84% increase in stroke-related deaths, Irish trends rank poorly on a European scale. In comparison to the UK, which itself leaves much to be desired from an international standpoint, we also lack dedicated stroke units and rehabilitation specialists.
On a brighter note, when adjusted for age, the rate of new strokes and stroke deaths continues to fall across Europe. Research has also provided us with better brain-imaging techniques, which can diagnose stroke type faster than ever before. Separately, there is increased interest in a class of medication which could limit brain damage after stroke and lead to better recovery.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
