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Monday, 3 October  2005

Presenter: John Inglis

Stroke can happen even to young people and there are signs to watch out for.

At noon on Sunday, May 23rd 2004, Michael Ziadic was at home when he got a call from his daughter's boyfriend. Dee had taken a longer time than usual to get ready to go out. When her boyfriend checked, he found her on her bed. "She was unconscious. She was frothing at the mouth," recalls Michael

Mike arrived at his daughter's at the same time as the ambulance . "She looked bad," he says simply. After an hour's anxious wait at the hospital, a doctor came out to say that something was terribly wrong with her neurological functions. The family was unprepared.. "We thought it was going to be something minor."

Deanna was on life support. As the hours went by, they became more worried. At first, the doctors suspected meningitis but all tests were inconclusive. After five hours, they discovered that Deanna had suffered a "a massive stroke." It was a brain stem stroke with quite extensive damage to her left thalamous as well, Michael explained.

The brain stem is that part of the brain that carries all the life functions. "It is like a big cable that joins to the spine," says Michael. Ninety-five per cent of people die and the rest are in a "locked in syndrome"; intellectually unimpaired because the upper brain is not damaged, but unable to function.

The doctors were unanimous that Dee would not survive. While she was still in intensive care, a priest administered the last rites. The family said their goodbyes and stood holding hands, waiting for the doctors to come back and tell them it was over. Instead, he returned with the news that Deanna was breathing strongly. "We were stunned but also elated."

Still, the prognosis for Deanna was not good. She might not regain consciousness or would be brain damaged. She might not be able to swallow and could drown in her fluids. The drainage that helped keep her alive could easily kill her through infection.

So the Ziadic family didn't expect that Dee would live. When she developed a chest infecton, the family were advised not to allow antibiotics as they could prolong the inevitable. She was given palliative care with as much morphine as she needed.

Deanne proved all the prognoses wrong. She's fully conscious and recovering. She attends TAFE in an electric wheelchair and is studying computers. She can sit unaided on the bed, says her father and has some limited moves in her limbs. "Last Friday, she was able to stand at the bars for 20 seconds."

Financially, Deanna's illness has taken its toll but Michael is hoping that his daughter will get her wish to come home.

As the Ziadic family now knows, stroke can happen to anyone. Five per cent of strokes occur in people under 45, says Dr David Blacker, consultant neurologist at Sir Charles Gairdner Hospital in Perth. Strokes are the third leading cause of death in Australia, after heart disease and cancer, he says. As well, they are one of the leading causes of morbidity, or level of illness in the community.

A stroke occurs when an area of the brain, or sometimes the eye or brain stem, dies suddenly, Dr Blacker explains. The damage may be due to either blockage or a bursting of a blood vessel. "About 80 per cent of strokes are the clotting kind where there's an occlusion or obstruction of blood flow resulting in the death of brain tissue."

What are the signs of stroke? "One of the hallmarks of stroke is that they really come on very suddenly." Clotting strokes, particularly if due to an arterial narrowing in the neck, often are preceded by various symptoms, says Dr Blacker. "The symptoms you need to watch out for are things like sudden weakness on one arm or one leg or part of the face. Or numbness. A sudden break of vision, particularly in one eye or a sudden difficulty speaking."

Avoiding stroke is about leading a healthy lifestyle, says Dr Blacker. Not smoking, keeping a check on cholesterol level and checking for diabetes. "Out of all of the things, the biggest risk factor for stroke is high blood pressure."

If you do think you're having a stroke, don't delay. "No mucking around, it's 000 and come to hospital by ambulance," says Dr Blacker. There are effective treatments for the occlusive strokes but they need to be administered as soon as possible. Early treatment can lessen the long term damage from a stroke.

"There is a core bit at the middle of the stroke damage that is often irreversible because that dies within a few minutes." But the larger area of damage around the core can be saved if treatment can be given quickly. "Time is of the essence in this treatment," stresses Dr Blacker.

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