When your brain is under attack

Dr. Ruvini Abeygunaratne Karunaratne

A brain attack is a stroke. We are all familiar with this term used frequently in layman's language, but how well is this condition understood?

A stroke occurs when the brain or part of the brain is deprived of its blood supply. Blood to the brain carries nutrients and oxygen to it and removes harmful substances. Cutting off this supply can lead to the damage or death of brain cells.

As the brain controls the functions of the whole body, this will affect the body's normal functioning. Since the brain controls not just the physical aspects but also mental functions, communication and understanding, these may also be affected. Therefore a stroke, if extensive, can cause significant disability, which will affect a person's quality of life and well being.


There are two main causes of a stroke. One, the blockage of an artery by the formation of a blood clot, thereby reducing or restricting the blood to that region of the brain. This is called an ischaemic stroke. The blockage maybe from a formed clot (thrombus) or from an embolism, where a blood clot, air bubble or fat globule formed from somewhere else in the body travels to the brain vessels and blocks it. Small ischaemic strokes can also develop when the very tiny vessels are blocked; these are also called lacunar infarcts.

Blood unable to pass clot
Pic courtesy

The second kind of stroke is called a haemorrhagic stroke; this occurs when a blood vessel bursts and the bleeding causes damages to the surrounding brain tissue. This can occur in the vessels which are close to the surface of the brain (subarachnoid haemorrhage) or deeper vessels (intracerebral haemorrhage).

Symptoms and signs

The signs and symptoms depend on where the damage occurs in the brain and the extent. But the signs are generally sudden in onset. The symptoms of a stroke or a transient ischaemic attack (TIA, mini stroke, a stroke which lasts less than 24 hours) may include:

  • Numbness, weakness or paralysis of one side of the body (generally on the opposite side to the part affected in the brain)
  • Slurred speech
  • Confusion
  • Loss of vision or blurred vision
  • Severe headache

You can carry out a simple test to recognise if someone has had a stroke or a mini-stroke. (TIA). This is called the Face-Arm-Speech Test (FAST).

  • Facial weakness: Can the person smile? Has their mouth or an eye drooped?
  • Arm weakness: Can the person raise both arms?
  • Speech problems: Can the person speak clearly and understand what you say?

If these are positive you should seek urgent medical attention.

What happens when you have suffered a stroke?

If the stroke is extensive, there is a high chance that the patient will be left (if they survive) with a significant disability. When admitted to the hospital, the main aim is to oxygenate the brain adequately so that more damage doesn't occur. If the patient doesn't breathe by himself, he could be assisted by putting in a breathing tube. The patient's condition will be monitored.

Surgery may be considered if the stroke is a haemorrhagic stroke and is causing significant pressure effects. Surgery cannot repair the damage that is already done, but may prevent death. Surgery is considered only in special circumstances and conditions. If the stroke is caused by an abnormal vessel such as an aneurysm, surgery is a good indication.


This is important and is a multidisciplinary approach. The patient may not be the same person he or she was prior to the stroke. His or her personality may change. There maybe problems with comprehension and speech- he or she may understand what you are saying but be unable to speak- this causes frustration and despair.

Good understanding is required when treating these patients. Rehabilitation and the quality of this will determine to some extent the rate and extent of recovery. Doctors, nurses, physiotherapists, occupational therapists, speech therapists, psychologists and the patient's family should all work as a team in providing support and guidance for the patient's recovery. The patient may not recover fully but with the right help will be able to reach a point where he or she may have a good quality of life.

Who is at risk?

A stroke is a common condition. It can affect anyone at anytime, anywhere, but there are certain factors which increase one's risk. Some of these risk factors can be changed to decrease the likelihood of having a stroke. Other risk factors can't be changed. Being male and over the age of 55 are two such factors as is having a family history of strokes. This is probably because conditions such as diabetes and high blood pressure that are directly linked to an increased incidence of strokes tend to be found in family members. It is also known that your ethnic background has an impact on the risk, being Asian or Afro-Caribbean increases the chance.

Doctors can help with some factors, but good control of blood pressure and diabetes with medication and lifestyle advice is important and can reduce the risk significantly.

What can we do?

Diet: Being overweight increases the chance of having a stroke. Reduce the amount of fatty foods consumed, especially saturated fats. This increases the amount of cholesterol in the blood stream increasing the clogging up of the blood-carrying vessels. This causes an increased strain on the heart, increased blood pressure and reduced blood supply to the brain, a stroke. Eat plenty of fresh fruit and vegetables.

It is also essential to reduce your salt intake.

Alcohol:Everything in moderation! Drinking large quantities in one sitting will significantly increase the chance of having a stroke. If you do like the odd glass of red wine, a small glass occasionally may even be beneficial.

Smoking:What can I say? Stop now.

Exercise: Not only is exercise essential for reducing the risk of a stroke but is an essential factor for a person's wellbeing. At least an hour per day should be part of your lifestyle. Trust me, you will feel fitter mentally as well as physically.

Control of blood pressure: This is important. Maintenance of blood pressure within the normal range is essential. This is important to all, but especially for those suffering from Diabetes.

Strokes are common; prevention is the mainstay of management. If a stroke does occur, rehabilitation is a path to recovery.

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