A stroke denotes the onset of a neurological deficit, most frequently the paralysis of one side of the body with or without an effect on the contralateral side of the face. This weakness may develop within minutes and is usually associated with an arterial problem or may develop over a much longer period of time, even months, which may be indicative of a disease process, most commonly a tumour. Ninety-five per cent of strokes are caused by a lack of oxygen due to a blood vessel in the brain being blocked by a clot, closing up because of atheroma or, rarely, going into spasm through some neurological or chemical influence. Atheroma may also cause a fragility in the blood vessel, which leaks causing a haemorrhage that then clots and obstructs blood flow beyond that point.

Thus, most strokes are cerebrovascular accidents, either haemorrhagic or infarctions . A stroke is further classified by considering whether the event is completed or still evolving. Finally, in categorizing stroke, the type and severity of the neurological problems will give a clue as to where the arterial damage occurred. This is mostly of diagnostic value because the treatment is the same and based entirely upon the deficit.

Any condition that can lead to vascular damage will predispose to a stroke. High blood pressure may burst the small vessels in the brain, although the mechanism to protect brain blood pressure is one of the most evolved mechanisms in the human being. Atheroma and the eventual clogging up of the arteries, with the increased tendency for a clot to form in such blood vessels, is much more likely to cause a stroke, and small emboli may fire off atheroma plaques in other vessels or come from diseased heart valves to occlude the arteries. Preventing any of these factors is the primary concern in fighting stroke and even if a stroke has taken place, active therapy against these conditions may prevent a worsening or a recurrence of the problem.

Stroke is the third most common cause of death in the Western world, behind heart disease and cancer. It is, however, the commonest cause of severe chronic disability and happens to two out of every 1000 people each year. Three-quarters of this number are over the age of 65 and the event is twice as common in Blacks as it is in

Whites. It is worth looking at these figures because conditions such as hypertension are actively fought regardless of the risks of side effects of these drugs. Very simply, and not absolutely accurately, these figures suggest that 1 in 500 adults at the age of 65 or more will have a stroke. We are told that if one has hypertension the risk is six times greater, which brings the risk to one in 83 people. Whilst this is a marked increase, the chances are still 82:1 that an individual with high blood pressure will not have a stroke. I mention this simply because so many people are frightened by their high blood pressure because of the risk of stroke, but the chances are still low even if the problem is not treated. More people on antihypertensive drugs will end up having a stroke than those who do not use such drugs, but this matter is discussed more fully in the section on hypertension .

Prevention is the key word in stroke because full recovery from neurological deficit is rarely possible. Most individuals who have anything other than a major stroke will have some degree of recovery. If the correct treatment is undertaken, an indication of the repair process can be gleaned at about three months when 90 per cent of lost abilities will have returned.

Immediate first aid and orthodox emergency medicine reduce the risk of death and a knowledge of cardiopulmonary resuscitation is always advisable because a stroke may affect breathing and cardiac response.

Avoidance by correct control of atheroma and hypertension at an early age is the best form of treatment .

Full assessment by a neurological specialist is mandatory and push the point to discover whether the stroke is caused by a haemorrhage or an occlusion . Treatment varies depending upon the cause.

Treatment of a stroke is dependent upon the cause. There is strong recommendation for the use of prophylactic aspirin because this prevents clotting but of course will make the situation worse if the stroke is caused by a haemorrhage. Many people are mistakenly taking aspirin because they have heard that it reduces the risk of stroke but it may do the opposite.

Stop taking the oral contraceptive pill if you are at risk or have a family history of cardiovascular disease or stroke. The pill increases the risk of blood clots.

Physiotherapy is an integral part of rehabilitation but all forms of Eastern medicine, principally Chinese, Tibetan or Ayurvedic in origin, have physical, acupuncture and herbal treatments that have been used for thousands of years with great effect. Do not ignore Western therapy techniques but use them in conjunction with an experienced Eastern medical practitioner.

Herbal treatments such as Ginkgo biloba are frequently recommended, but increasing blood flow in the brain of those who may have a tendency to haemorrhagic strokes is unwise.