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Stroke
What are the symptoms?
Ischaemic stroke (caused by an interruption in the flow of blood to the brain) is the commonest type of stroke and accounts for around eighty per cent of all strokes. The causes are predominantly atherosclerotic related manifesting in arterial cholesterol plaques (abnormal patches of fatty substance in the arteries), hardening of the arteries and arterial thrombosis (blood clot). Sometimes this type of stroke can also occur in patients from a dislodged blood clot in the heart making its way to the brain. Other risk factors for this type of stroke include blood clotting abnormalities, excess alcohol intake, smoking and obesity.
Transient ischaemic attack (TIA) is a form of ischaemic stroke often called a "mini-stroke". The distinguishing feature of this type of stroke is that its neurological effects last less than twenty-four hours. Within that time the patient should fully recover. However, this is an arbitrary distinction based on time and the causes for a TIA are similar to a full stroke. TIA should be regarded as a warning shot-across-the-bow and urgent neurological investigations are warranted to prevent further TIA's or full strokes.
Haemorrhagic strokes result from arterial bleeds rather than occlusions (obstructions). The symptoms however are indistinguishable from ischaemic strokes, although the subsequent management is different in terms of investigations, treatment and future prevention.
Young patients also suffer stroke. Approximately twenty-five per cent of patients are below the age of sixty-five years and a percentage are teenagers and children. There are a few differences in the very young patient. The causes of stroke tend not to be the result of diseased atheromatous (fatty degeneration of the inner coat of the arteries or abnormal fatty deposits in an artery) vessels but rather abnormalities of the vessels themselves. These can be related to trauma or congenital abnormalities developed from birth. It is important to realise that this does not necessarily mean that the condition is inherited or that offspring will be affected. Also any vessel malformation tends to be localised and not generalised. Abnormalities of the clotting system can also manifest themselves as stroke and these would be managed directly.
Recovery in childhood stroke tends to be better than in adult stroke as the child's brain attempts to compensate. Nevertheless stroke occurring in children is often met with surprise and dismay. Clinical investigations should be comprehensively taken in a specialised unit. Counselling should be offered to the patient and their family and this may need to be continued as the child progresses through to teenage years and as a young adult.
Background
| Inheritance patterns and prenatal diagnosis 
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