Stroke information

mapStroke is the second major cause of death and one of the leading causes of long-term disability worldwide. There are approximately 80 million people in the world living with stroke aftermath at any one time and approximately 14 million new people are affected by stroke every year. In the United States alone, there are about 5.5 million stroke survivors and every 45 seconds someone has a stroke. Every 3 minutes someone in the USA dies from a stroke, and about half of stroke survivors are left disabled. In the USA, approximately 46,000 more women than men have a stroke annually. In Black, Maori and Pacific people the risk of having a stroke is about 1.5 – 2 times greater compared with White people.

The Framingham study recently showed that the lifetime risk of having a stroke after 55 years of age is 1 in 5 for women and 1 in 6 for men. It has been calculated that during the course of their lives, about four out of five families will have someone affected by a stroke. Although the number of people who experience a stroke greatly increases with age, up to 25% of all strokes happen in people younger than 65 years.

This page contains the following sections:


What is a stroke or a TIA?

Picture4Picture4Picture4

A stroke is called a vascular injury of the brain. Damage to the blood vessels could be due to a blood clot or something else blocking the artery and therefore the flow of blood (this may result in ischemic stroke), or due to a blood vessel breaking causing a bleed (this may result in hemorrhagic stroke).

There are two major types of hemorrhagic stroke: intracerebral hemorrhage and subarchnoid hemorrhage. Intracerebral hemorrhage is the bleeding into the brain tissue. Subarachnoid hemorrhage is the bleeding into the subarachnoid space, the narrow space between the brain surface and brain tissue. In White populations, about 85% of all strokes are ischemic strokes, 10% are intracerebral hemorrhages, and 5% are subarachnoid hemorrhages. The proportion of intracerebral hemorrhages in Black people is greater compared with White people.

A person has a stroke if they have symptoms that last longer than 24 hours. If the symptoms last less than 24 hours and then they fully recover, it is called a TIA or transient ischemic attack or mini-stroke. If a person experiences a TIA it puts them at high risk of having a stroke, so they must see a doctor immediately.

What are the warning signs and symptoms of a stroke?

You should call an ambulance immediately if you or someone you know has any of the following signs:

Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body

Sudden complete or partial loss of vision on one or both sides

Sudden confusion or trouble speaking or understanding

Sudden loss of balance, unsteadiness or an unexplained fall

Sudden vertigo, dizziness, swallowing difficulties or memory disturbances

Sudden, severe headache with no known cause

What is a risk factor for stroke?

A risk factor for stroke is anything that increases your chance of having a stroke. Risk factors may include medical (e.g. elevated blood pressure, heart disease, diabetes, elevated cholesterol in the blood, family history), behavioural and environmental factors (e.g. smoking, unhealthy diet, sedentary lifestyle).

Elevated blood pressure or hypertension

Picture7An adult’s blood pressure is considered to be normal if it is below 120/80. That is, less than 120 systolic blood pressure and less than 80 for diastolic blood pressure. Blood pressure above the normal value but below 140/90 is called a borderline hypertension, and blood pressure 140/90 or greater is called hypertension. High blood pressure over time damages the walls of the blood vessels, causing hardening of the arteries and promotes the forming of blood clots and aneurysms.

Heart disease

Picture8People with heart problems are at an increased risk of stroke. Possible heart problems are angina, atrial fibrillation (irregular heart beat rhythm), heart failure, valve disorders, artificial valves and congenital heart defects. Valve disorder, irregular heartbeat rhythms, and sometimes previous heart attack or myocardial infarction can result in blood clots being formed in the heart. These blood clots may get loose or break down into small particles (called emoli) which can travel to the brain and block blood vessels. The blockage of the blood vessels can cause an ischemic stroke.

Atherosclerosis and high cholesterol levels

Picture9An artery is a blood vessel that carries blood. Hardening of the arteries is called atherosclerosis. When the arteries harden, it narrows the middle of the artery where the blood flows. About 20-30% of people who have an ischemic stroke have hardening of the arteries, especially narrowing of the carotid artery in the neck which carries blood to the brain. High cholesterol levels (low-density and very low-density cholesterols) increase your chance of having a stroke very substantially, and therefore should be carefully controlled.

Diabetes

Having a diabetes mellitus doubles the chance of having a stroke. Therefore people with diabetes should try to keep their blood sugar level under very tight control and make sure that all aspects of their health are carefully controlled.

Family history and genetics

A person’s genetics, inherited from their parents, is rarely a direct cause of stroke on its own. But genes do play a large role in some stroke risk factors such as hypertension, heart disease, diabetes, and malformed blood vessels.

Unruptured intracranial aneurysms

Picture10An aneurysm is caused by a weak point in the wall of an artery. As the wall of the artery is under pressure due to the blood pressure, the wall at the weak point may balloon out. This ballooning out of the blood vessel is called an aneurysm. If the aneurysm is inside the head, it is called an intracranial aneurysm. The problem is if the aneurysm bursts or ruptures, as it will cause a bleed resulting in a subarachnoid or intracerebral haemorrhage. Whether an aneurysm ruptures is dependent on the size of the aneurysm, if the person smokes or has high blood pressure, and other factors.

Unhealthy diet

Picture11An unhealthy diet is a major risk factor for stroke. An unhealthy diet is a diet with a lot of products that have high amounts of fat, cholesterol and salt. This is a diet with a lot of fast food takeaways, red meat, dairy products like butter and cheese, pies and baked goods like biscuits and pastries. These foods should be eaten in moderation. A healthy diet contains a mixture of vegetables, fruits, fish, nuts and cereals. A healthy diet lowers the risk of developing atherosclerosis and lowers blood pressure, both major risk factors for stroke.

Alcohol

Picture12Mild alcohol consumption of less than 2 standard drinks per day lowers the risk of stroke. However, drinking any more alcohol or binge drinking raises the risk of stroke.

Smoking

The importance of stopping active smoking cannot be underestimated, no matter how long a person has smoked or the number of cigarettes smoked. It is a common misconception that if a long-term smoker stops smoking it will do them more harm than good. This is not true; the sooner a person stops smoking the more their health will benefit, and they will lower their risk of stroke immediately.

Physical activity

Picture13People who do less than 30 minutes of exercise three times per week double their risk of stroke compared to people who do exercise regularly. Lack of exercise can lead to being overweight and diabetes which are important risk factors for stroke. It can also lead to the development of atherosclerosis.

Why is urgent hospitalisation vitally important?

Picture14It is extremely important to ensure that a person who is experiencing the symptoms of a stroke gets to hospital via ambulance urgently. This is because ‘time is brain’: namely, getting a person to hospital early will allow quick diagnosis and treatment which may not only save the person’s life, but may also improve their recovery. There are now effective medications and surgery that a doctor can provide if they feel the patient is suitable for that treatment.

What is the risk of death from a stroke?

Some strokes result in death whereas others cause permanent or temporary disability. About 2 out of 10 people who have a stroke die within the first month, 3 out of 10 die within the first year, and 5 out of 10 die within the first 5 years. The more time that passes after a stroke, the less is the risk of dying from it. People who have a subarachnoid or intracerebral hemorrhage as the cause of their stroke are more likely to die than people who have an ischemic stroke.

What are the possible medical complications after a stroke?

If a person does survive a stroke, as many people do, they may have permanent or temporary disability due to the damage to the brain caused by the stroke.

Possible after-effects of a stroke are:

Approximately two thirds of stroke survivors have partial or complete loss of movement and strength in a hand and/or leg on one side of the body. Partial loss of movement and strength is called paresis, complete loss is called paralysis

80-90% suffer from confusion, and problems with thinking and memory

30% have communication problems such as an inability to speak or understand spoken language

30% have difficulty swallowing, called dysphagia

10% have vision problems such as complete or partial blindness, or double vision

10% have impaired coordination, called ataxia

30% have problems in right-left orientation

Up to 70% suffer from mood disorders, including depression

20% develop pain in the shoulder

Less that 10% may develop seizures or epilepsy, especially after an intracerebral hemorrhage

Without adequate prevention, 20% develop a chest infection within one month of stroke and 10-20% develop bedsores and/or skin infection.

Other possible complications are falls, joint deformities and contractures (where joints cannot fully bend or stretch), urinary tract infection, constipation, pulmonary embolism and heart attack (myocardial infarction)

What are the chances of having another stroke?

Whether a person will have another stroke depends on a persons age, the reason for the first stroke, and other medical conditions. The first 6-12 months is the time when a person who has experienced a stroke is at highest risk of another stroke. About 10% of stroke survivors have another stroke within a year, and 30% within 5 years after their first stroke.

What are the chances of recovery?

Recovery from stroke is a long process that can continue over several years. Most of the recovery occurs in the first 2-3 years, and especially the first 6 months. Rehabilitation needs to continue in hospital, rehabilitation services, home and residential care.

Approximately one-third of stroke patients recover their lost functions fully or almost fully, and get back to their pre-stroke activities within a year.

About 50% of stroke survivors under the age of 65 return to work.

However at one-year after a stroke, about two-thirds of stroke survivors will have some level of disability, ranging from light and moderate to very severe.

Time is brain

Picture14Although two-thirds of strokes occur without any warning signs, approximately one-third of strokes do have warning signs, including transient ischaemic attack (TIA or mini stroke). An ambulance should be called immediately if any of the following symptoms occur (especially symptoms with sudden onset):

loss of strength (or development of clumsiness) in some part of the body, especially on one side, including the face, arm or leg;

numbness (sensory loss) or other unusual sensations in some part of the body, especially if one-sided; complete or partial loss of vision on one side;

inability to speak properly or to understand language; loss of balance, unsteadiness or an unexplained fall;

any other kind of transient spells (vertigo, dizziness, swallowing difficulties, acute confusion, or memory disturbances);

headache that is unusually severe, abrupt in onset, or of unusual character (including unexplained change in the pattern of headaches);

unexplained alterations of consciousness or convulsions.

These warning signs may occur alone or in any combination. They may last a few seconds (typical TIA) or up to 24 hours and then disappear (atypical, most severe TIA), be a single episode during a day or repeated. By definition, at the onset of signs and symptoms and during the first 24 hours it is impossible to know for sure if symptoms are due to stroke or due to TIA. However, symptoms can indicate a hidden problem with blood flow in the brain, which, if ignored, could result in a stroke.

F.A.S.T.

FASTF.A.S.T. is an easy way to detect some sudden signs and symptoms of stroke and prompt immediate action.

F.A.S.T. stands for:

Face

Arm

Speech

Time

If any of the F.A.S.T. signs described here come on suddenly, it is highly probable that the person has a stroke and you need to call an ambulance immediately. Early hospitalisation could save the life of the person concerned, improve his/her recovery and reduce the burden of stroke on their family.

Recommended resources

The Hazel K. Goddess Fund for Stroke Research in Women
785 Park Avenue
New York, NY 10021-3552
Phone: (212) 713-6789
Fax: (212) 288-2160
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Website: www.thegoddessfund.org/

The Internet Stroke Center
Website: www.strokecenter.org/pat/index.html

Community contacts in New Zealand:

The Stroke Foundation of New Zealand
Telephone: 0800 STROKE (787653)
Website: www.stroke.org.nz
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Evidence-based stroke guidelines: www.nzgg.org.nz

Community contacts in Australia:

National Stroke Foundation
Suite 304, Level 3
167-169 Queen St
Melbourne VIC 3000
Phone: 61 3 9670 1000
Fax: 61 3 9670 9300
Freecall: 1800 787 653
Website: www.strokefoundation.com.au

Community contacts in UK:

Stroke Association 
Stroke House, 240 City Road, London, EC1V 2PR
Telephone: 020 7566 0300
Website: www.stroke.org.uk

Chest, Heart and Stroke Scotland
65 North Castle Street, Edinburgh EH2 3LT
Tel.: +44 (0) 131 225 6963
Fax: +44 (0) 131 220 6313
Website: www.chss.org.uk

Northen Ireland Chest, Heart and Stroke Association
21 Dublin Road, Belfast BT2 7HB
Tel.: +44 (0) 28 9032 0184
Fax: +44 (0) 28 9033 3487
Website: www.nichsa.com

Community contacts in the USA

American Stroke Association
7272 Greenville Ave
Dallas, Texas 75231
Tel.: 888-4-STROKE, 800-553-6321
Website: www.strokeassociation.org

National Family Caregivers Association
10400 Connecticut Ave
#500, Kensington, MD 20895-3944
Tel.: 800-896-3650
Website: www.thefamilycaregiver.org

National Stroke Association
9707 E. Easter Lane
Englewood, CO 80112-3747
Tel.: 303-649-9299, 800-STROKES
Website: www.stroke.org

National Institute of Neurological Disorders and Stroke Education
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Voice: (800) 352-9424 or (301) 496-5751
Website: www.ninds.nih.gov/disorders/stroke/stroke.htm

Community contacts in Canada:

Heart and Stroke Foundation of Canada
222 Queen Street, Suite 1402
Ottawa, ON K1P 5V9
Telephone (613)569-4361
Fax (613)569-3278
Website: ww2.heartandstroke.ca/Page.asp?PageID=97#Info

Community contacts in South Africa

The National Heart Foundation
PO Box 15139, Vlaeberg 8018
Telephone: (021) 447 4222
Fax: (021) 447 0322
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Website: www.heartfoundation.co.za/contactus.asp?mode=contact

Stroke Riskometer

The Stroke RiskometerTM app is an award winning and easy-to-use tool for measuring your individual risk of a stroke in the next five to ten years. It is developed and owned by the Auckland University of Technology, Auckland, New Zealand

A video about the app - here is the DropBox weblink to the video:  https://www.dropbox.com/s/z0rkb8pmxix1mgl/Valery%20Feigin_1080HD.mov?dl=010

Stroke RiskometerTM app is currently available in both iSO and Android formats in the following languages:

Bengali

Brazilian-Portuguese

Croatian

Czech

English

Farsi

French

German

Hindi

Italian

Japanese

Malay

Mandarin (also available on Chinese baidu website)

Portuguese

Russian

Spanish

Glossary of stroke terms

acute stroke – a stage of stroke starting at the onset of symptoms that lasts for a few hours thereafter

agnosia - impairment of ability to recognise, or comprehend the meaning of, various sensory stimuli (e.g. finger, colour, visual, tactile, position, visual-spatial agnosia)

agraphia – inability to write

alexia – inability to read

aneurysm - a weak spot in the artery wall that balloons out

aneurysm clipping – a surgical procedure for treatment of brain aneurysms, involving clamping an aneurysm from a blood vessel

angiography – an x-ray of vessels after the injection of a radiopaque contrast material

anosognosia – the lack of awareness or denial of disease (e.g. the patient denies anything being wrong with the stroke side)

anticoagulants – drugs used to prevent the formation or growth of blood clots by inhibiting the coagulation actions of the blood protein thrombin. Some common anticoagulants include heparin and warfarin

antiplatelet agents – drugs used to prevent the formation or growth of blood clots by inhibiting the accumulation of platelets. Some common antiplatelet agents include aspirin, plavix, aggrenox

antithrombotics – a generic term related to either anticoagulants or antiplatelet agents

aphasia – inability to understand or create speech

apoplexy – an old Latin term for stroke defined as “a stroke of God’s hands”

apoptosis – a form of programmed, genetically triggered cell death involving shrinking of the cell and eventual disposal of the internal elements of the cell by the body’s immune system

apraxia – inability to perform skilled or purposeful voluntary movement even though the person is physically able to do it

arrhythmia – an irregular heart beat

arteriography – an x-ray of arteries after the injection of a radiopaque contrast material

arteriovenous malformation (AVM) – a congenital disorder characterised by a complex tangled web of arteries and veins

artery – a blood vessel that carries blood away from the heart

aspiration – the act of inhaling solid or liquid materials into the lungs

aspiration pneumonia – chest infection (pneumonia) resulting from the inhalation of foreign material, usually food particles or vomit, into the bronchi; pneumonia developing secondary to the presence in the airways of fluid, blood, saliva, or gastric contents

asteriognosis – inability to identify an object by touch

ataxia – lack of coordination, unsteadiness

atheroma - fatty cholesterol deposits inside of artery walls (synonym – plaque)

atherosclerosis – a disease of arteries characterised by deposits of lipid material which make the artery hard, thick (narrow) and brittle (atherosclerosis and arteriosclerosis are often used interchangeably)

atrial fibrillation – irregular beating of the left atrium, or left upper chamber, of the heart

bilateral – both sides of the body

blood-brain barrier – an elaborate meshwork that surrounds blood vessels and capillaries in the brain and regulates which elements of the blood can pass through to the neurons

brainstem – the stem-like, lower part of the brain that connects the brain’s right and left hemispheres with the spinal cord

brainstem stroke – a stroke that that strikes the brainstem

capillaries – tiny blood vessels whose wall consists of endothelium and its basement membrane

cardiac – relating to the heart

cardiovascular – relating to the heart and blood vessels

caregivers – individuals (typically family members or friends) who provide unpaid assistance to see that the physical, psychological, and/or social needs of another person are met

carotid artery – an artery, located on either side of the neck, that carries blood to the brain

carotid endarterectomy – the operation to remove atheroma from the narrowed carotid artery (usually the internal carotid artery)

carotid stenosis – narrowing of the carotid artery

catheter – a medical device (tube) used to control urinary incontinence using a receptacle bag

central pain – pain caused by damage to an area in the mid-brain called thalamus

cerebellar stroke – a stroke that strikes the cerebellum

cerebellum – the part of the brain at the back which is responsible for coordinating voluntary muscle movements

cerebral – relating to the brain

cerebral blood flow (CBF) – the flow of blood through the arteries that lead to the brain

cerebral cortex – the outer layer of the brain

cerebral infarct – an area where brain cells have died (synonym – ischemic stroke)

cerebral haemorrhage – bleeding into the brain tissue (intracerebral haemorrhage) or into surrounding areas (subarachnoid haemorrhage)

cerebral oedema – swelling of the brain

cerebral hemisphere – one of the two halves of the brain

cerebral thrombosis – the closing off of an artery in the brain by blood clotting

cerebrovascular accident (CVA) – an old term used for stroke (the term is falling into disuse because stroke is no longer viewed as an accident)

cerebrovascular disease (CVD) – encompasses all abnormalities in the brain resulting from pathologies of its blood vessels (narrowing, blockage)

cholesterol – a waxy substance, produced naturally by the liver and also found in foods, that circulates in the blood

cognition – higher intellectual (mental) functioning associated with thinking, learning, perception, and memory

cognitive impairment – a deficiency in a person’s short or long term memory, orientation as to place, person and time, thinking and judgment

coma – a state of deep unconsciousness when the person is not responsive or able to be aroused

compensation – the ability of a person with impairments from stroke to perform a task (or tasks) either using the impaired limb with an adapted approach or using the unaffected limb to perform the task

confabulation – filling gaps in memory with imagined events

continence – the ability to control urinary bladder and bowel functions

contracture - static muscle shortening so that the muscle cannot be lengthened and loss of motion of the adjacent joint occurs

contralateral – the opposite side of the body

coordination - the harmonious working together of several muscles or muscle groups in the execution of complex movements

computed tomography (CT) scan – a series of cross-sectional x-rays of the brain and head; also called computerized axial tomography (CAT)

dementia – loss of intellectual ability (e.g. vocabulary, abstract thinking, judgment, memory loss, physical coordination) that interfere with daily activities

depression – a reversible psychiatric disorder characterized by an inability to concentrate, difficulty sleeping, feeling of hopelessness, fatigue, the “blues”, and guilt

diplopia – double vision

duplex carotid scan – an ultrasound scan of the carotid arteries in the neck

dysarthria – a motor disorder of the tongue, mouth, jaw or voice-box resulting in difficulty in producing speech

dyslipidaemia – abnormality in blood lipids

dyslexia – difficulty with reading

dysphagia – inability or difficulty with swallowing

dysphasia – difficulty with understanding or creating speech

dysphonia – impairment of the voice

dyspraxia – difficulty with performing skilled or purposeful voluntary movement even though the person is physically able to do it

echocardiogram - ultrasound scan of the heart

electrocardiogram (ECG) – a test that measures electric activity and rhythm of the heart

electroencephalogram (EEG) – a test used to record electrical activity in the brain by placing electrodes on the scalp

embolic stroke – a stroke caused by an embolus

embolism – blockage of a blood vessel by an embolus

embolus – a clot of the blood that travels in the bloodstream

emotional lability – a condition in which the mood of the person swings rapidly (unreasonably) from one state to another (such as laughing, crying or anger)

enteral feeding – feeding using a tube connecting with the stomach

epidemiology – the study of factors that influences the frequency and distribution of a disease in a population

epilepsy – seizure or fit activity involving parts of or the whole body

extracranial-intracranial (EC-IC) bypass – a type of surgery that restores blood flow to a blood-deprived area of brain tissue by rerouting a healthy artery in the scalp to the area of brain tissue affected by a blocked/narrowed artery

flaccid – absence of muscle tone, flabby or floppy muscles

gait – manner of walking

geriatrician – a doctor who specializes in the care of the older people, primarily those who are frail and have complex medical and social problems

glia – supportive cells of the nervous system that also play an important role in brain functioning; also called neuroglia

haematoma – a collection of blood forming a definite swelling which compresses and damages the brain around it

haemorrhage – bleeding

haemorrhagic – relating to bleeding

haemorrhagic stroke - bleeding into the brain (intracerebral haemorrhage) or into surrounding areas (subarachnoid haemorrhage)

handicap – reduction in a person's capacity to fulfill a social role as a consequence of disability/impairment

hemianaesthesia – loss of sensation down one side of the body

hemianopia – loss of half the field of vision in each eye

hemiparesis – weakness on one side of the body

hemiplegia – complete loss of movements on one side of the body

hemisphere – one half of the brain (synonym – cerebral hemisphere)

hemispheric stroke – a stroke that strikes one of the brain’s hemisphere

hemi-inattention – ignoring space on the side of the body; sometimes called unilateral neglect

heparin – a type of anticoagulant

high-density lipoprotein cholesterol (HDL-C) – a compound consisting of a lipid and a protein that carries cholesterol in the blood and deposits it in the liver; also known as the “good” cholesterol

home care – provides a range of supportive services in the home from intensive medical support to assistance with activities of daily living to housekeeping

homeostasis – a state of equilibrium or balance in the body with respect to various functions and to the chemical compositions of the fluids and tissues

hypertension – abnormally high blood pressure

hypotension – abnormally low blood pressure

impairment – a physical or mental defect at the level of a body system or organ

impotence – inability to obtain or maintain penile erection

incidence – describes the frequency with which cases of a disease occur during a certain period of time in a population

incontinence – inability to control urinary bladder (urinary incontinence) or bowel functions (bowel incontinence), or both

infarct or infarction – area of dead or dying tissue

intracerebral haemorrhage – bleeding into the brain

intravenous – in a vein

involuntary – something that happens without being willed or intended

ischaemia – a loss or reduction of blood flow to tissue

ischaemic cascade – a series of pathophysiological and biochemical events lasting for several hours to several days following initial ischaemia

ischaemic penumbra – area of damaged, but still living, brain cells arranged in a patchwork pattern around areas of dead brain cells

ischaemic stroke - an area where brain cells have died (synonyms – cerebral infarct, cerebral infarction)

lacunar infarction – a small area of dead brain often caused by stenosis or occlusion of the small arteries in the brain (from the French word “lacune” meaning “gap” or “cavity”)

large artery disease – stenosis or occlusion of the carotid arteries, often due to atherosclerosis

lipoprotein – small globules of cholesterol covered by a layer of protein

low-density lipoprotein cholesterol (LDL-C) – a compound consisting of a lipid and a protein that carries cholesterol in the blood and deposits the excess along the inside of arterial walls; also known as the “bad” cholesterol

magnetic resonance angiography (MRA) – an imaging technique involving injection of a radiopaque contrast material into a blood vessel and using magnetic resonance technique to create an image of brain arteries and veins

magnetic resonance imaging (MRI) scan – a type of imaging involving the use of a powerful magnetic field to generate and measure interactions between pulsed magnetic waves and hydrogen nuclei (such as those in water) within the head tissues

monoparesis, monoplegia – weakness, paralysis of one limb only

mortality – describes the number of persons who die during a certain period of time

motor – relating to movement

nasogastric tube – tube put down the nose into the stomach

neuron – the main functional cell of the brain and nervous system, consisting of a cell body, an axon, and dendrites

neuroprotective agents – medications that protect the brain from secondary injury

neglect, one-sided – a term sometimes used for lack of awareness to one side

nursing home – a generic term for a skilled nursing facility

oedema – swelling

orthosis - an external orthopaedic appliance, as a brace or splint, that prevents or assists movement of the spine or the limbs

papilloedema – swelling of the optic disc in the eye

paraesthesia - an abnormal sensation, such as of burning, pricking, tickling, or tingling

paralysis – loss of movement

paraparesis, paraplegia – weakness, paralysis of both legs (can happen with bilateral strokes or spinal cord problems)

paraphrasia – producing unintended phrases, words or syllables during speech

paresis – muscle weakness

PEG tube – percutaneous endoscopic gastrostomy feeding tube inserted through the abdominal wall into the stomach

perception – the ability to receive, interpret and use information

plaque – a mixture of fatty substances, including cholesterol and other lipids, deposited inside of artery walls (synonym – atheroma)

plasticity of the brain – the ability to adapt to deficits and injury when intact brain cells take over functions of damaged cells

platelets – blood cells that are known for their role in blood coagulation

prevalence – the number of cases of a disease in a population at any given point in time

randomised controlled trial – a clinical study in which persons are assigned to the experimental or control group by a random selection procedure

recombinant tissue plasminogen activator (rt-PA) – a genetically engineered form of t-PA, a thrombolytic, anti-clotting substance made naturally by the body

rehabilitation – restoration of the disabled person to the greatest possible independence

rest home – a generic term for a group home, specialised apartment complex or other institution which provides care services where individuals live; sometimes referred to as a private hospital, residential care facility or a care home

small artery disease - a disease of small arteries in the brain, often due to hypertension

stenosis – narrowing

spasm – involuntary contraction of a muscle

spastic paralysis – paralysis with increased muscle tone and spasmodic contraction of the muscles

spasticity – abnormally increased tone in a muscle

spinal cord - the elongated cylindrical portion of the cerebrospinal axis, or central nervous system, which is contained in the spinal or vertebral canal

stroke - an acute vascular injury of the brain

stroke unit – a hospital facility for management of patients with acute stroke by a multidisciplinary team of specialists

subarachnoid haemorrhage (SAH) – bleeding between the brain surface and one of the thin layers of tissue that cover the brain

tactile – relating to touch

thrombolytics – drugs that dissolve the blood clot

thrombosis – the formation of a blood clot

thromboembolus – a clot which has traveled in an artery or vein

thrombus – a blood clot

thrombotic stroke – a stroke caused by thrombosis

tinnitus – “ringing” in the ears

tone – the degree of tension in a muscle at rest

total serum cholesterol – a combined measurement of a person’s high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)

t-PA – see “recombinant tissue plasminogen activator”

transient ischaemic attack (TIA) – a short-lived stroke that lasts from a few minutes up to 24 hours; often called a mini-stroke

transcranial magnetic stimulation (TMS) – a small magnetic current delivered to an area of the brain to promote plasticity and healing

vascular – relating to the blood vessels

vasospasm – spasm of a blood vessel; a dangerous side effect of subarachnoid haemorrhage

vein – a blood vessel that carries blood back to the heart

vertebrobasilar arteries – the two arteries on the back of the neck which supply blood to the brainstem and cerebellum

vertebral artery – an artery on either side of the back of the neck within the bones of the spine and carrying blood to the brain

videofluoroscopy – a video x-ray of swallowing mechanism

visuospatial disorder – inability to recognize or perceive time, distance, areas of space