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understanding a stroke: causes, treatments and the importance of aftercare

it’s estimated a stroke – resulting in a hospital or emergency department admission – happens every five minutes in canada.

by karen hawthorne
published oct 02, 2023
last updated oct 10, 2023
read time 8 minute read
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read time 8 minute read
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understanding a stroke: causes, treatments and importance of aftercare
fast, an acronym used to identify the signs of stroke, is widely promoted to create awareness. it stands for face, arms, speech and time. getty images
as a kid growing up, dr. ted wein would get chances to go to work with his dad to watch what he did for a living. his dad was a neurologist, so wein would be at the hospital seeing the realities of patients in crisis. it made for lasting impressions and ultimately shaped his own career in medicine. “it always amazed me how common it was where we would see people with strokes coming to the hospital and being told, ‘there’s nothing we can do for you,’” he says. “so 35 or 40 years ago, there was no treatment at all. and i always felt like, my god, there has to be something we can do to help people when they have a stroke or just dealing with the long-term complications of stroke. that’s something that stood out to me as a kid, looking at the helplessness of the healthcare profession as well as the patients.”
things have changed exponentially. now, wein is a leading neurologist in the field of post-stroke care and rehabilitation who specializes in what’s called post-stroke spasticity, or pss. this is where muscles become stiff, tighten up and resist stretching. if it’s left untreated, spasticity can lead to muscles shrinking and contracting, which means that along with reduced range of motion, you can have joints that are locked into a single position.

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wein explains that of rising numbers of stroke in canada, 15 per cent of people die from their stroke, but around 60 per cent are left with some form of permanent disability, and spasticity is the worst type of disability.
“if you’ve ever walked down the street or in the hospital and seen people walking with their arm flexed up into their chest and their fingers turning the wrong way, or they’re walking with their foot twisted the wrong way, that’s called spasticity. it really impairs people’s quality of life.”
wein, a physician at the stroke prevention clinic at the montreal general hospital and assistant professor of neurology and neurosurgery at mcgill university in montreal, is transforming the lives of stroke patients with spasticity. he injects botulinum toxin, commonly known as botox in cosmetic practices, to paralyze select muscles to reposition the foot, for example, so the person can be fitted for a brace and be able to walk again. while people have botox injections to smooth wrinkles and facial creases, stroke survivors can regain mobility and independence.
stroke patients may have their arm flexed or their hand clenched where they can’t clean their hand or they’re not able to extend their arm into their shirt sleeve so they can get dressed. the treatment can paralyze certain muscles to bring the arm or the limb or the hand into a better position so that people can get their arm into clothes.
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“people can feel more like themselves, they don’t have to look different from everybody else,” he explains, adding he started working with botulinum toxin during his fellowship training in stroke at uthealth houston in texas in 1997, refining the approach like others in his field over the last 20 years. wein also serves on the steering committee of several ongoing trials looking at the effectiveness of botulinum toxin on spasticity and chairs the canadian stroke best practice recommendations national care guidelines.
“if i can give the patient even one little thing that they weren’t able to do and make them feel more like a person as opposed to a victim, that’s the most rewarding thing. just to see someone walk into my office as opposed to see them in a wheelchair is amazing.”

stroke in canada: stats, facts and figures

it’s estimated a stroke – resulting in a hospital or emergency department admission – happens every five minutes in canada. this is a statistic that has nearly doubled over the past two decades. although stroke remains one of the leading causes of death in the country, there has been incredible progress in recognizing stroke onset and managing post-stroke care. the need is certainly there.
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more younger people are having strokes, attributed to risk factors like high blood pressure, diabetes, obesity, unhealthy diet and lack of physical activity. but one of the biggest risk factors for stroke is age, and given the aging population, the heart and stroke foundation of canada funded research to look at stroke prevalence and flag the increasing need for healthcare services and prevention.
the study, released in 2020, revealed that annual stroke occurrence rates have risen to 108,707, and statistics show the number of people living with stroke and its impacts has increased to 878,000. about half of them need help with daily living activities like eating, bathing and getting dressed.
and stroke is not a “men’s disease,” which can be a misperception. heart and stroke foundation research has shown that women are disproportionately affected by stroke throughout their lives, including during pregnancy. almost 60 per cent of deaths from stroke are women, yet two-thirds of heart disease and stroke clinical research is focused on men.
the fact, though, that more people are surviving stroke is linked to better public awareness of the signs and the need for urgent care, and the emergency treatments now in practice.
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what is a stroke? what causes a stroke? and how is a stroke treated?

a stroke is a brain attack where something blocks blood supply to part of the brain, so the artery is blocked, which is called an ischemic stroke, the most common form. or a blood vessel in the brain bursts, so you bleed into the brain, known as a hemorrhagic stroke. when either happens, parts of the brain are damaged or die, causing brain damage, long-term disability or even death.
fast, an acronym used to identify the signs of stroke, is widely promoted to create awareness. it stands for face, arms, speech and time: if someone’s face is drooping, if they can’t raise both arms and if their speech is jumbled or slurred, it’s time to call 9-1-1 immediately. evidence suggests 1.9 million brain cells die every minute following stroke onset.
acute care makes all the difference in survival. patients in the er with stroke-like symptoms start with an urgent ct scan of the brain to identify a blood clot. since about 1997, wein says stroke patients are given medication by intravenous that essentially breaks up the blood clot. typically, it has to be given within four-and-a-half hours of the stroke to be effective and offers a 33 per cent chance of being more independent, wein adds.
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another newer procedure, performed in designated stroke centres, is a thrombectomy, where a catheter is inserted in the groin and passed up to the brain to suck out the blood clot that’s causing the stroke. the treatment is recommended for eligible patients where the clot is identified in larger, accessible arteries within six hours or even up to 24 hours in some patients.
“if you have the thrombectomy, one in two to one in three people sometimes walk home from hospital and don’t even have to go to rehab and are left with no disability,” he says.
hemorrhagic stroke, which is equally complex, can be treated by locating the source of the bleed and surgically “clipping” it, draining the skull to decrease pressure in the brain and blocking off any sources of bleeding.
the canadian institutes of health research reports that canadian researchers are at the centre of “ground-breaking and revolutionary” stroke treatment. and post stroke care and rehabilitation is part of the success story, wein notes, although more needs to be done. canada’s vast geography creates challenges for prompt transport to hospital. a canadian geospatial analysis found that most canadians live within six hours by road to stroke centres that provide these time-sensitive acute treatments, and recommends further coordination of systems of care and ambulance services to improve access to care.
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stroke aftercare and the importance of monitoring

wein points out that one of the biggest limitations is people not coming in for follow-up. the world stroke organization advises all patients who’ve experienced stroke to see a stroke specialist every six months to see if there’s anything that can be done to help improve their quality of life.
“if we look at a stroke survivor two years after their initial stroke, if you were to re-evaluate them thoroughly and properly, one-third of them will be found to have correctable problems. really, there’s so many things we can do for one in three people, which is a huge statistic on a disease that people originally said there was nothing that could be done,” he says.
“that includes addressing physical challenges like bladder problems, mobility issues and hygiene along with the psychological and emotional impacts of stroke. many people struggle with less visible issues of memory loss, depression and fatigue. a patient’s rehab team can include physiotherapists, counsellors, nutritionists and others.”
aftercare also involves controlling risk factors, most importantly blood pressure, blood sugar for those with diabetes, and cholesterol. wein stresses that a normal cholesterol level before stroke is not the same target cholesterol level after you’ve had a stroke or heart attack.
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“we want it to be much lower. there’s a lot of what we call modifiable risk factors here that are important. you really need to make sure the right criteria are being applied.”

how to prevent a stroke

prevention is, of course, the best medicine for everyone. wein emphasizes blood pressure control, and also limiting alcohol consumption, not smoking, exercising at least 30 minutes a day in a way that gets your heart rate up, and keeping your waist circumference low. those are the five things that can reduce your risk of stroke by as much as 80 per cent, which significantly stacks the odds in your favour, he says. a 2020 study in china found that individuals who adhered to an overall healthy lifestyle had a lower risk of early-onset stroke – in people age 50 or younger – compared to those who did not.
“you need to have a healthy lifestyle to really decrease your risk of stroke. to me that is the best therapy. this is a preventable disease,’” wein advises.
but if you’ve survived a stroke, there are steps forward. he highlights another acronym in stroke public awareness. react focuses on managing post-stroke spasticity:
r – restricted movement
e – early detection and intervention is best
a – altered function
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c – change in muscle stiffness or posture
t – talk to your doctor
“my job is to try to maximize my patients’ function, so i don’t want people to have this pessimistic, negative attitude that there’s nothing to do because the reality is there’s a lot we can do.”
educational resources for canadians managing post stroke care – including assessments and clinic locator – include beyondstroke.ca and the march of dimes canada after stroke program. or visit the heart and stroke foundation of canada for more information.
karen hawthorne is a toronto-based writer.
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karen hawthorne
karen hawthorne

karen hawthorne worked for six years as a digital editor for the national post, contributing articles on health, business, culture and travel for affiliated newspapers across canada. she now writes from her home office in toronto and takes breaks to bounce with her son on the backyard trampoline and walk bingo, her bull terrier.

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