RadioScope
Mind Matters - Strokes
RTÉ Radio 1, Thursday, March 9th, 8.02pm
As anyone familiar with the Presocratics will tell you, the concept of a stroke is by no means a modern phenomenon. In fact, over 2,400 years ago, Hippocrates, that venerable old medical master and his assembled Hippocratic Corpus (a sort of medical school-cum doctor-factory) were the first to write up the occurrence of what the Greeks called apoplexy, meaning "struck down with violence", the assumption that in those early days of civilisation affected patients often lost consciousness and collapsed without warning.
Each year in Ireland, over 14,000 people experience a stroke - that's over 40 people a day. Stroke is the single greatest cause of permanent disability and can affect anyone, although it's more likely to affect males and, in particular, males from an Afro-Caribbean background.
Others prone to strokes include the obese, alcohol abusers and some who can inherit the disability. In this, the last programme in the Mind Matters series - produced and presented by the affable Ella McSweeney - the narrative focuses on the causes, telltale signs, preventions and possible cures to what the programme-maker has correctly identified as "a rather passive term for what is in effect a heart attack for the brain".
The programme opens with Pat, a 49-year-old who lives with his wife and two children in Dublin, describing what it was like to suffer a stroke six months ago, which has left him partially blind.
His description is lucid and informative, taking us through all the stages from collapse to recovery with a good account of how in retrospect he remembers oddities in his health. Pat explains how the surgeon performed a craniotomy, where part of the skull (cranium) is removed to access the brain and opened up "a two-and-a-half or three inch window - a little door - in the back of my head and took out what was at that stage, thank God, a clot. I've a vague memory of a few words with the doctor who said 'well, at the moment we're trying to stop the bleeding in your head'."
Unfortunately for Pat the clot has lodged in the area of the brain that deals with sight. "The surgeon was very good in his description of it in fact. He said 'if you can imagine the back of a camera, well basically, we've opened the camera and torn out half the film and thrown the film away and then shut the camera again and that's your sight".
Like many people who suffer strokes, Pat had a warning. As a migraine sufferer since he was 15, he recalls getting "different manifestation of his migraine" in recent times as if "someone was pressing their thumb on the top right hand side of his eye".
Another of the programme's contributors, Dr David Henshall, a neuroscientist at the Royal College of Surgeons in Ireland, highlights a number of these signs: "It's thought that before you have a big stroke there are sometimes very brief disruptions to the bloodflow to the brain. Somebody may have trouble with their vision, trouble seeing in one or both eyes, a loss of balance, dizziness, problems with walking or sudden severe headaches with no obvious cause. The best known is numbness or weakness on the side of the face or body." One in five people will experience these warning signs.
So what exactly is a stroke? Henshall describes the process as "occurring when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or it bursts". The result is that the part of the brain that is being fed by that blood vessel starts to die. There are two main types of stroke - thrombotic embolic stroke and haemorrhagic stroke.
Haemorrhagic stroke occurs when a blood vessel in the brain ruptures and you get bleeding inside the brain.
Thrombotic embolic stroke occurs when some part of a blood clot, for example, blocks a major artery in the brain.
The programme, however, is not all doom and gloom with some interesting insights into the resourcefulness of the brain and its ability to recover or regenerate itself and the benefits of quick thinking intervention, neuro-psychology and sustained physiotherapy.
(Paul O'Doherty)