Strokes are the fourth largest cause of death in the United Kingdom after cancer, heart disease and respiratory disease, and have the potential to cause a greater range of disabilities than any other condition.
A stroke, also known as cerebrovascular disease, occurs when blood flow to the brain is interrupted, usually because a blood vessel bursts or is blocked by a blood clot. This causes damage to brain cells because they stop getting the oxygen and nutrients they need to function. The impact of a stroke depends on the level of damage caused to the brain. A severe stroke can cause physical disablement, mental impairment and in some cases, sudden death. During a stroke a person might not be able to ask for help or understand what is happening. The person might become vulnerable and cause a risk to themselves or others, depending on the task and activity they were performing at the onset of a stroke.
Types of stroke
Strokes can happen to anyone and are usually classified in two major categories; ischaemic stroke and haemorrhagic stroke.
Ischaemic strokes represent about 80 per cent of stroke cases and are caused by a blood clot that blocks a blood supply to the brain. This usually happens in one of two ways:
- Embolic stroke - a blood clot that has formed somewhere else in the body travels through the bloodstream to the brain, and gets stuck in a small blood vessel, blocking blood flow.
- Thrombotic stroke - A clot forms in blood vessels that are clogged by fatty deposits. These deposits usually clog major blood vessels in the neck and reduce blood flow to the brain.
Haemorrhagic stroke is caused by a blood vessel in the brain that breaks, leaking blood into the brain. These types of stroke account for about 20 percent of all strokes and usually happen in one of two ways:
- Intracerebral haemorrhage - In this type of stroke, a blood vessel in the brain bursts and spills blood into the brain tissue, damaging cells. Brain tissues in the surrounding area also get deprived of blood and are also damaged.
- Subarachnoid haemorrhage - In this type of stroke, bleeding starts in a blood vessel on or near the surface of the brain and spills blood into the space between the surface of the brain and the skull.
There is also a related condition known as a transient ischaemic attack (TIA), often known as a mini stroke. This is caused due to a brief delay or decrease in the supply of blood to the brain. Like an ischaemic stroke, a TIA occurs when a clot or debris interrupts or blocks blood flow to a certain part of the brain. It often goes unrecognised as the symptoms are slight and last for a short period of time. The cumulative effect of several TIAs can be as disabling as a severe stroke.
The main symptoms of a stroke are sudden weakness or numbness of the face, arm, or leg (especially on one side of the body). Other symptoms include sudden confusion, slurred speech and vision, difficulty walking, dizziness, loss of balance or coordination, severe headache, fainting or unconsciousness. Immediate medical attention is essential to help save lives and limit long term disability problems from a stroke.
The best treatment for a stroke is prevention. Making healthy choices and exercise in everyday life reduces the risk of a stroke. There are several risk factors that increase the chances of having a stroke, such as; genetics, age, weight, high blood pressure, heart disease, smoking, diabetes and high blood cholesterol levels.
Each year, approximately 152,000 people suffer from stroke in the UK, resulting in around 50,000 deaths. It accounts for 10 per cent of all deaths in women and 7 per cent of deaths in men. 25 per cent of stroke victims are people under the age of 65 years and are therefore at working age. In the UK alone, it costs the economy an estimated £9 billion per year.
The Health and Safety at Work etc Act 1974 requires employers to secure the health, safety and welfare of employees at work. This includes providing a safe place of work, safe systems of work, information and training.
The Management of Health and Safety at Work Regulations 1999 (as amended) require suitable and sufficient assessments of health and safety risks at work to be carried out.
The Workplace (Health, Safety and Welfare) Regulations 1992 require employers to provide adequate welfare for their employees.
The Equality Act 2010 imposes a duty on employers to make reasonable adjustments and provide legal defence against discrimination on the grounds of disability, including disability relating to stroke.
The law places duties on the employer to assess risks posed to their workers and, where necessary, to take action to safeguard health and safety, including health surveillance if appropriate. This could be achieved by carrying out a comprehensive risk assessment.
Although no one can predict when a stroke might occur or to who, it would be sensible to consider what to do if one occurred to one of your employees or visitors.
If an employee has suffered a stroke, the employer needs to arrange a phased return to work, once they have recovered. It may also be necessary to make some reasonable adjustments (such as changes to their working pattern, changes to a work station or location or time off for physiotherapy or occupational therapy) so that an employee who has developed a disability from a stroke might be able to return to work. The employer should discuss these issues with the individual once they are well enough and before they return to work. Some of the leaflets and links in the following section might be useful.