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Different strokes for different folks.

While that statement is a bit tongue-in-cheek, when it comes to people who suffer from a stroke, it is accurate. Read on and you will see there are different types of stroke and they can affect the casualty in different ways. Different strokes for different folks

Introduction

Cardiovascular Disease (CVD) is a broad term for many conditions which affect the heart and blood vessels.  Coronary heart disease,  heart failure, and stroke are the most common.

In this blog, we are going to talk about strokes. What they are, what you can do to help someone who is experiencing a stroke, and some actions you can take to help prevent a stroke – maybe even help with preventing CVD.

According to the Australian Institute of Health and Welfare ( AIHW ) in 2019, there was an estimated 67,000 hospitalisations for stroke of those, sadly 8,382 died as a result.

Many were left with permanent physical damage.

And the cost to the community? Once again from the AIHW:

 “ In 2018–19, the estimated health system expenditure on stroke was more than $660 million. The greatest cost was for public hospital-admitted patient services ($364.2 million) followed by private hospital services”

More than 660 million dollars…

The Brain

You are probably aware that the brain is divided in half and each half is divided into other areas.

The left half of the brain – the left hemisphere –  controls most functions on the right side of the body, while the right half of the brain  -the right hemisphere –  controls most functions on the left side.

The different areas control different functions of your body. How you move – walking, standing, holding etc, your senses – touch, sight or smell etc., speech and how you think.

Because different arteries supply different areas of the brain, where the brain is damaged will determine which functions are affected.

So, you can see how a stroke impacts the person will depend on how much, and what part of the brain is damaged.

Different strokes for……you get the picture.

As I have said many times before, prevention is better than cure, and strokes could be prevented. We’ll talk about risk factors as well.

So, what is a stroke?

As a result, the flow of blood downstream from the blockage or bleed stops and brain cells die due to a lack of oxygen and nutrients.

And they die at the rate of around 1.9 million brain cells per minute. In 2018, an estimated 387,000 Australians aged 15 and over (1.3% of the population) had experienced a stroke at some time in their lives, based on self-reported data from the ABS

Different types of strokes

There are two types of strokes and both types stop blood flow to areas of the brain.

One type of stroke is called an ISCHAEMIC (is..key..mick) stroke.

The other is a HAEMORRHAGIC (hem..or..ragic) stroke.

Ischaemic Stroke

This occurs when a blood vessel in the brain becomes blocked by a clot. There are two ways a blockage in these blood vessels can occur.

Embolic

When a blood clot forms in another part of the body and travels around the body in the bloodstream until it reaches the brain.

The clot will then move around the brain until it gets stuck in a blood vessel which is too small for the clot to pass through.

This blocks the blood vessel and prevents blood from getting through. And brain cells begin to die.

Thrombotic

If the blood contains cholesterol-laden plaques, these can stick to the inner walls of the blood vessels as the blood moves through them.

Over time, these plaques can increase in size and narrow or block the artery and stop blood from getting through.

If the blocked blood vessel is in the brain, then no blood will get through and brain cells will begin to die.

In the case of stroke, the plaques most often affect the major arteries in the neck taking blood to the brain.

Haemorrhagic stroke

Once again there are two types. Where they occur in the victims’ brain determines what they are called.

An Intracerebral Haemorrhage (ICH) occurs when an artery inside the brain bursts and bleeds into the brain.

This results in blood flow to part of the brain being reduced or stopped and brain cells begin to die.

Also, as the amount of blood flow into the brain increases, the build-up of pressure can lead to brain damage, unconsciousness or even death.

Then there’s bleeding on the surface of the brain. This can result in Subarachnoid Haemorrhage (SAH). There are 3 layers of membrane (or meninges) that cover the brain.

A subarachnoid haemorrhage is a bleed that happens underneath any of these layers.

Now, there are quite a few medical terms in there but as I said in the introduction – in simple terms a stroke occurs when blood flow to part of the brain stops, for whatever reason, and brain cells die.

Recognising a Stroke

The Stroke Foundation Australia endorses the F.A.S.T. test when you suspect someone has had a stroke.

F – Face look closely at the victim’s face. Has their mouth drooped?

A – Ask them to lift both arms. Can they lift them both?

S – Speech. Ask them something. Is their speech slurred? Do they understand you?

T – Time Is critical. If any of these signs are present call 000 straight away.

This simple test provides an accurate stroke assessment. There are of course other possible signs of stroke.

• weakness or paralysis elsewhere in the body, on one or both sides
• loss of sensation, usually on one side
• loss of vision or blurred vision in one or both eyes
• a sudden and severe headache
• dizziness, loss of balance or an unexplained fall
• difficulty swallowing

A stroke is a medical emergency and the longer it takes to get proper treatment, the more likely there will be long-term stroke-related damage to the brain afterwards. Don’t faff around. Act Fast. Get medical help immediately.

So, what causes a stroke?

What are some of the risk factors? I bet you can guess.

All the usual suspects:

• smoking,
• not enough physical activity,
• unhealthy eating,
• high blood pressure,
• type2 diabetes,
• high cholesterol

The risk factor of some of those can be reduced.

Of course, some risk factors cannot be reduced:

• Your age — Most people who have a stroke (7 out of 10) are 65 years or older.
• Your family history — If one of your parents had a stroke before they were 65, your risk of getting one is 3 times greater than average.
• Your gender — Stroke is more common in men, especially between 65 and 84 years of age.

Head Trauma

According to experts, trauma to the brain through a head injury can contribute to stroke later in life.

There is an association between head trauma and an increased incidence of haemorrhagic strokes in the years that follow as well as an increased lifetime risk of ischemic strokes in the years after head trauma.

Check out our blog on head trauma

Conclusion

As with many things in life, there are some things we can change and others we cannot escape.

As my old friend Publilius always said, “The defect which one period of life fastens upon us, another will remove.”

We could all make changes which may go a long way to remove the defect(s) one period of life has fastened upon us.

All the usual suspects. (see above)

If we wanted to…

But hey, YOLO, right?

Well, that’s that. Until next time….. stay safe

Adrian

Introduction

Because our eyes are two of the body’s most delicate and complex organs we need to avoid eye injuries as best we can.

And here’s an… eye-opener for you, our eyes do not actually see anything!

As the great Roman writer, Publilius Syrus once said “The eyes are not responsible when the mind does the seeing.” Obviously, a man of great…insight. A man of….vision.

As you can… see, in this blog I am talking about our eyes. I am going to…. focus on eye injuries, (and bad puns apparently!).

We are going to look at the many different factors that can cause Injury to the eyes including some of the common causes in our everyday environments such as stones, sporting balls, dirt, and chemicals.

It seems that around a whopping 70 to perhaps 80% per cent of all the sensory receptors in your whole body are in our eyes.

Also, in order for us to see, recognize, and understand something—nearly half of our entire cerebral cortex has to get involved. That’s a lot of brain power.

How do your eyes work?

Your eyes iris will change in size to allow more or less light in. This depends on the amount of light getting reflected into the eye.

We have all stepped outside during a bright day and felt blinded at first before our eyes adjust. This is the process of our iris adapting to lighting conditions.

Depending on how far away the object being viewed is, the lenses will change shape.

To focus your eyes ligaments surrounding your eye pull or release the lenses.  This is called accommodation.

When light enters the eye through the pupil, it strikes photoreceptor cells in the retina called rods and cones.

Rod cells are responsible for peripheral vision and night vision, while cone cells react to brighter light, colour, and fine details.

When light hits its corresponding rod or cone, this activates the cell, causing nerve impulses to fire through the optic nerve — the middleman between the eye and the brain.

The impulses travel from the optic nerve to the visual cortex and then to other parts of the brain.

These image impulses arrive at the brain upside down. The brain must then transform the image to right side up for us to comprehend it.

So, while your eyes do a really good job of capturing light from objects around you, transforming that into information, and sending that information to your brain, your eyes don’t actually “see” anything.

That part is done by your visual cortex and your brain. Neurons in your brain work simultaneously to rebuild the image passed to the brain from the optic nerve.

Your brain actually responds better to shapes and edges first. Colour and shading are used to further differentiate objects from one another. Your eyes are also set slightly apart. This gives you the ability to see in stereo and interpret 3D images. Unfortunately, this also creates an image that needs to be corrected by you guessed it, your brain.

More than meets the eye

As you can see, there is more going on with your visual system than you imagine. Complex parts of your brain that have evolved over aeons to produce a crisp, sharp image are constantly being used to help you see and understand the world around you.

This means that the brain will also fill in the gaps to make sense of the image received. This is why we can be tricked by optical illusions, or people can “see” the same thing but understand it differently.

It also means that any permanent damage to your eyes will have a profound effect on how you perceive your environment.

Eye injuries

An eye injury can be caused by many different factors, but some common causes exist in our everyday environment such as stones, sporting balls, dirt, residue, sand, and wooden splinters. Other common causes include body parts, chemicals,  welder’s flash, ultraviolet light, and smoke.

Eye Injuries caused by foreign bodies

A foreign body is defined as “an object in your eye that shouldn’t be there”. This includes a speck of dust, a wood chip, a metal shaving, an insect, or a piece of glass. The common places to find a foreign body are under the eyelid or on the surface of your eye.

Signs and Symptoms:

• sharp pain in their eye followed by burning and irritation

• feeling that there is something in their eye

• watery and red eye

• scratchy feeling when blinking

• blurred vision or loss of vision in the affected eye

• sensitivity to bright lights

• bleeding into the white of the eye

Most injuries from a foreign body in the eye are minor and usually heal without further problems given the right care. However, possible complications from eye injuries include:

• infection and scarring – if the foreign body is not removed from your eye, it may lead to infection and scarring.

• corneal scratches or abrasions – a foreign body may scratch the cornea, which is the clear membrane on the front of the eye. Commonly, the foreign body is trapped under the upper eyelid.

• ulcer – sometimes a scratch on the cornea doesn’t heal. A defect on the surface of your eye (ulcer) may form in its place.

• penetration of the eye – sometimes a projectile object can pierce the eye and enter the eyeball, causing serious injury and even blindness

• corneal scarring – this can cause some degree of permanent visual impairment.

Management

As with all First Aid incidents you should apply the initial action plan of DRSABCD and use proper PPE if available.

For eye injuries, if First Aid is applied immediately when irritation or injury occurs you decrease the possibility of infection or loss of sight enormously.

If the eye injury involves foreign irritants such as dust getting in the eye, you may follow these general procedures for flushing out irritants

• Keep the casualty calm and reassured.

• Use clean running water to flush out irritants in the eye.

• Make sure the eye is open throughout the procedure.

• Allow the casualty to blink.

• Avoid rubbing or otherwise disturbing the affected eye, and it is recommended to see an eye doctor

In cases where there is a penetrating wound in the eye and the object is still embedded in the injury, you must follow the following procedures:

• Do not remove the penetrating object

• Reassure the casualty and advise them to minimise eye movement. Placing a patch over both eyes, if the casualty is willing, can reduce the injured eye movement

• Wrap a bandage around the protruding object or form doughnut-shaped dressing to place over and support the protruding object when dressing and bandaging the injury. This will avoid putting pressure on the object with the bandage

• Be sure to immobilise the object.

• Seek medical assistance Call 000

Eye injuries due to burns

Burns to the eye are serious as they can cause partial or complete loss of sight. The worst type of eye injury

They can be caused by chemicals, heat (flames or radiant heat), a welding flash, ultraviolet lights, glues, and solvents. If chemicals contact the eye, you must apply First Aid as soon as possible

Signs and Symptoms

Burns to the eye will cause

• immediate pain and swelling

• become red and watery

• your casualty may be more sensitive to light.

However, if the burn is caused by a welder’s flash it will not be until several hours afterwards that they will start to feel the effects and realise they have an eye injury

Management

• Calm and reassure the casualty

• Open their eyelids carefully

• Carefully wash the eye or eyes with cold flowing water for 20 minutes

• Place an eye pad or soft, clean dressing over the injured eye

• Call 000

Wounds causing eye injuries

Fighting or playing sport can cause direct impact to the eye and serious eye injuries such as cuts and bruising around the eye.

Cuts to the eyelid can bleed freely so you will need to apply a dressing to the eyelid to halt the bleeding as soon as possible.

It’s important you apply the dressing with extreme care to avoid additional pressure on the eye which may cause more damage.

Don’t forget to reassure the patient and advise them not to move their eyes. Make them as comfortable as possible even lie them on their back.

And, of course, use DRSABCD and CALL 000

Postscript

If you lose a sense, such as eyesight, do your other senses get stronger to compensate for the loss?

What I found really interesting while I was researching for this blog was just that.

While I figured that would be the case, there is a lot of scientific evidence now which indicates that due to a serious eye injury you no longer need to use that part of the brain to process images, more energy and processing power is shifted to the other senses especially hearing.

Improved hearing enhances the ability to move through the world. For example, visually impaired either through eye injuries or from birth, individuals often use a technique called “clicking.”

By making small clicking sounds and then interpreting the echo they hear they can make sense of the environment around them.

Using this echolocation technique can even allow people to determine individual objects and walk normally without bumping into walls or obstacles.

The heightened sense of hearing allows the brain to differentiate the echoes that return after these clicks. For those of us who typically rely on our eyes, this seems impossible.

But get this, even more remarkable, brain scans of visually impaired individuals “clicking” reveals that the sounds are not only processed by the auditory cortex, but also in the visual cortex, despite not being able to “see.”

Truly, the human brain is incredible!

You can see some more quotes from Publilius here: https://www.brainyquote.com/authors/publilius-syrus-quotes

“It is folly to punish your neighbour by fire when you live next door.” Publilius, the wise.

Well, that’s that. Until next time….. Stay safe

Adrian