DISEASE: STROKE (Stroke Risk Self Assessment Chart)

Instructions: Score each line and then add up your total score. The lower your score, the better. The higher your score, the greater your risk of having a stroke. An approximate guide to the risk is:

0 - 4 : Very low risk
5 - 9 : Moderate risk
10 - 13 : High risk
14+ : Very high risk

This is just a guide, but it demonstrates measures you can take to decrease your risk of stroke.

Risk Factors	0	1	2	3	Score
Smoking	never smoked	quit after smoking for less than 5 years	current smoker less than 20/day	current smoker more than 20/day
Exercise	1 hour strenuous activity at least 3 times per week	very active once or twice a week	moderately active once or twice a week	very little physical activity
Diabetes	none known	n/a	family history	diabetic
Blood Pressure	normal	mild high blood pressure	moderate high blood pressure	severe high blood pressure
Age	0 - 44	45 - 64	65 - 74	75 +
Alcohol (male)	0-4 standard drinks/week	up to 4 drinks/day	more than 4 drinks a day 2 or more days a week	more than 6 drinks, 4 or more days a week
Alcohol (female)	0-2 standard drinks a week	up to 2 drinks a day	more than two drinks a day, 2 or more days a week	more than 4 drinks, 4 or more days a week
Weight	about average for height	slightly overweight	moderately overweight	obese
Family History	no strokes known	a relative has had a stroke	a relative has had a stroke while younger than 65	several relatives have suffered from stroke
Cholesterol	below average	average	moderately raised	severely raised

Symptoms of Stroke

The symptoms of stroke usually come on suddenly.  The suddenness of onset distinguishes stroke from other conditions such as migraine or brain tumour.  Every patient is affected differently and the most common symptoms are:

• Sudden numbness or weakness of face, arm or leg, often one side of the body.
  • A lack of muscle strength in any group of muscles, most commonly those on the face, hand, arm and leg on one side (called hemiparesis). At least half of patients suffer some form of hemiparesis, some with a mild form that involves difficulty in controlling movement, rather than weakness.
  • A loss of sensation or feeling in any part of the body.  Numbness of the skin of the face, hand, arm, and leg on one side (hemiananaesthia) is most common.
    
• Sudden confusion, trouble speaking or understanding.
  • Difficulty in speech - slurring of speech (from weakening of face, mouth, throat muscles) may be accompanied by swallowing difficulty. There may be  difficulty understanding others’ speech, finding the right words, understanding written words or in writing (aphasia).
    
• Sudden trouble seeing in one or both eyes.
  • Difficulty with vision - may take the form of total loss of vision in one eye, or loss of vision in half the visual field of each eye, or double vision.
    
• Sudden trouble walking, dizziness loss of balance or co-ordination.
  • Dizziness - injury to inner ear nerves may cause loss of balance, a spinning feeling, of the world moving (vertigo). May cause nausea, unsteadiness on the feet, a tendency to veer to one side or the other, or an unexplained fall.
    
• Sudden severe headache with no known cause.
  • Headache - stroke and TIA do not usually cause headache, but headache may result from stretching or irritation of the membrane covering the brain (meninges) or the blood vessels in the brain.
  • Subarachnoid haemorrhage may be preceded by the sudden (within seconds) onset of an extremely severe ‘thunderclap’ headache (the most intense the patient has ever felt), together with neck stiffness. Irritation from light may also be a problem.  After minutes to hours the headache spreads to the back of the head, neck and back as blood tracks down the spinal subarachnoid space. Subarachnoid hemorrhage may be associated with drowsiness or loss of consciousness and with other stroke symptoms.
    
• Less common symptoms include:
  • Nausea and vomiting- can be associated with vertigo or involvement of the ‘vomiting centre’ (the medulla) of the brain; common at the outset of subarachnoid haemorrhage.
  • Drowsiness or unconsciousness - also not common, but may occur, often briefly, depending on the location of the injury in the brain.
  • Epileptic seizures (10% of patients with subarachnoid haemorrhage).

Symptoms of Transient Ischaemic Attack (TIA)

The symptoms of TIA are not easily distinguished from those of stroke, except that they do not last as long. They may include:

• Short term blindness, blurred vision, double vision, other visual disturbances
• Speech disturbance – often an inability to put thoughts into words, or the substitution of a similar word for another of different meaning (‘I bent on the ball’ for ‘I leant on the wall’), or slurring of speech
• Vertigo – a spinning sensation – usually in conjunction with other symptoms
• Facial numbness or weakness
• Swallowing difficulty
• Arm or leg weakness or paralysis
• Loss of balance
• Nausea and vomiting

A TIA is significant and must not be ignored.  Advice must be sought immediately.
A TIA may be the start of a stroke that can follow the TIA within hours.
A TIA can warn of a future stroke and rapid investigation and treatment can reduce the risk of having a stroke.
If the symptoms disappear quickly, a TIA may be diagnosed and the patient discharged with appropriate instructions for medical follow-up, investigation and treatment to minimise the risk of recurrence.
If the symptoms persist, tests to determine the nature, precise location and extent of the injury to the brain will be started. These are likely to  include Brain scans (Computer Tomography) and MRIs (Magnetic Resonance Imaging).
Treatment to may be started to  rescue damaged brain tissue, to prevent complications such as difficulty swallowing, and to minimise the chance of  further strokes.