Stroke Service | Counties Manukau

Public Service, Cardiology, Neurology, Older People's Health

Description

A stroke is where the blood supply to an area of the brain is interrupted, causing damage to brain cells. This happens either with a clot in the blood vessel or the blood vessel bursting. The effects of a stroke depend on where in the brain, and how big, the interruption to blood flow is. A “TIA” (or transient ischaemic attack or “mini-stroke”) is a stroke that improves completely within 24 hours (often within minutes).

Most people who have had a stroke or TIA are admitted to hospital. If the stroke has had significant physical effects you may be admitted to our Rehabilitation Unit which aims to increase your independence, prevent complications from stroke and prevent further strokes. For more information on stroke a very useful website is the New Zealand Stroke Foundation site.

Recognising a stroke: remember the memory aid FAST

F - Face: ask the person to smile and see if the face is weak or skew on one side.
A - Arms: ask them to raise both arms and see if they are unable to raise the arm on one side.
S - Speech: ask them to speak and see if they are unable to speak or their words are muddled or slurred.
T - Time: call an ambulance and get them to hospital fast if you think they are having a stroke.

Consultants

Dr Arindam Kar

Stroke Physician - Head of Department
Dr Ajay Kumar

Stroke Physician and Geriatrician
Dr Karim Mahawish

Stroke Physician
Dr Carolyn Providence

Stroke Physician
Dr Tzer Tan

Stroke and General Medicine Physician
Dr Edward Wong

Stroke Neurologist

Referral Expectations

If you think someone is having a stroke call an ambulance to get them to hospital FAST.

It is likely that a person with a stroke or TIA will be admitted to the Emergency Department for further tests and monitoring. From there, they may be admitted to the Stroke Unit (Ward 31) or another ward for further medical investigations and treatment, and assessment and therapy by physiotherapists, occupational therapists, and/or speech and language therapists. Some patients with mild stroke may be discharged directly from the Emergency Department after a short stay in hospital, and will usually require a prompt outpatient appointment for investigations and follow-up.

If the stroke patient requires rehabilitation, they may be transferred to a Rehabilitation Unit. Patients who have been discharged from hospital following a stroke generally will have a stroke follow-up appointment. Please bring all your medication and any X-rays and scans you have to these clinics. You may receive ongoing rehabilitation from the Community Based Rehabilitation Team following discharge.

In hospital, most stroke patients will have blood tests, an ECG (electrocardiogram – electrical test of the heart), and a brain scan (either a CT scan or an MRI scan). Some may also require a scan of the carotid arteries in the neck, usually done with an ultrasound machine or a scan of the heart (an echocardiogram).

Some patients who have had a stroke may receive “clot-busting” treatment (r-tPA). This is only given to stroke patients who arrive promptly to hospital, and who fulfil certain criteria. A drip containing the blood thinning agent, heparin, may be given to certain selected patients with stroke. This is a treatment that is rarely used. Some patients may also receive clot retrieval treatment. This treatment requires transfer to Auckland City Hospital to be performed.

We may recommend that a patient with a stroke have an operation to open up the carotid artery (carotid endarterectomy). This decision is made in consultation with the vascular surgeon, and, of course, the patient and their family.

Most patients will be discharged on a combination of blood thinners, blood pressure treatment and cholesterol-lowering treatment, which will reduce the risk of future strokes. After a stroke or TIA, patients should not drive for at least one month after the stroke.

Fees and Charges Description

There are no charges for services to public patients if you are lawfully in New Zealand and meet one of the Eligibility Directions specified criteria set by the Ministry of Health. If you do not meet the criteria, you will be required to pay for the full costs of any medical treatment you receive during your stay.

To check whether you meet the specified eligibility criteria, visit the Ministry of Health website.

For any applicable charges, please phone the Accounts Receivable Office on (09) 276 0060.

Procedures / Treatments

ECG - Electrocardiogram

An ECG is a recording of your heart's electrical activity. Electrode patches are attached to your skin to measure the electrical impulses given off by your heart. The result is a trace that can be read by a doctor. It can give information of previous heart attacks or problems with the heart rhythm. Depending on your history, examination and ECG, you may go on to have other tests.

An ECG is a recording of your heart's electrical activity. Electrode patches are attached to your skin to measure the electrical impulses given off by your heart. The result is a trace that can be read by a doctor. It can give information of previous heart attacks or problems with the heart rhythm.
Depending on your history, examination and ECG, you may go on to have other tests.

CT Scan - Computer Tomography

This is a special x-ray examination which, with the help of a computer, produces cross-wise picture slices of your body. These pictures are displayed on a TV screen and can also be shown on x-ray film. CT is used to view all body structures but especially soft tissue such as body organs (heart, lungs, liver etc.). What to expect? You will be asked to remove all metal objects from the area to be scanned. You will lie down on a narrow padded moveable table that will be slid into the scanner, through a circular opening. You will feel nothing while the scan is in progress, but some people can feel slightly claustrophobic or closed in, whilst inside the scanner. You will be asked to remain still and hold your breath on command. There are staff present, they will not necessarily remain in the room, but will speak with you via an intercom system and will be viewing the procedure constantly through a windowed control room, from where they will run the scanner. If you are having a scan of your stomach and intestines (CT abdomen), you may have to take a special liquid to drink beforehand to give a clearer picture. If you are having a scan of your bowel (CT colonography), you will be sent detailed instructions on what you should eat and drink the day before the examination. You will not be able to eat or drink anything for 6 hours before your appointment. Some procedures will require Contrast Medium. Contrast Medium is a dye that makes the image of the CT scan clearer. It will be injected into a vein usually on the inside of your elbow or the back of your hand. Before you are given the injection, you will be asked some questions to make sure that it is safe for you and asked to sign a form agreeing to receive the dye. The scan time will vary depending on the type of examination required, but as a rule it will take around 30 minutes.

CT is used to view all body structures but especially soft tissue such as body organs (heart, lungs, liver etc.).

What to expect?

You will be asked to remove all metal objects from the area to be scanned. You will lie down on a narrow padded moveable table that will be slid into the scanner, through a circular opening.

You will feel nothing while the scan is in progress, but some people can feel slightly claustrophobic or closed in, whilst inside the scanner. You will be asked to remain still and hold your breath on command. There are staff present, they will not necessarily remain in the room, but will speak with you via an intercom system and will be viewing the procedure constantly through a windowed control room, from where they will run the scanner.

If you are having a scan of your stomach and intestines (CT abdomen), you may have to take a special liquid to drink beforehand to give a clearer picture.

If you are having a scan of your bowel (CT colonography), you will be sent detailed instructions on what you should eat and drink the day before the examination. You will not be able to eat or drink anything for 6 hours before your appointment.

Some procedures will require Contrast Medium. Contrast Medium is a dye that makes the image of the CT scan clearer. It will be injected into a vein usually on the inside of your elbow or the back of your hand. Before you are given the injection, you will be asked some questions to make sure that it is safe for you and asked to sign a form agreeing to receive the dye.

The scan time will vary depending on the type of examination required, but as a rule it will take around 30 minutes.

MRI Scan - Magnetic Resonance Imaging

What is MRI? Magnetic Resonance Imaging (MRI) is a unique way of showing structures in the body using a strong magnetic field and harmless low energy radio waves. NO X-RAYS ARE USED. What Happens During the Scan? You lie on a special table which moves into the tunnel of the machine. You need to keep very still during the examination. The scan can take from 30 minutes to an hour. At times the machine makes loud knocking noises. Some people find the tunnel in the machine confining. Please inform staff at the time of your booking if you know you are very claustrophobic (uncomfortable in small spaces). Is Any Special Preparation Necessary? All loose metal objects, safety pins, hairclips, watches and credit cards must be left outside the scan room. Lockers are provided. Patients will be required to complete a questionnaire. If you answer "yes" to any questions it is very important that you inform staff at the time you make your appointment.

What is MRI?

Magnetic Resonance Imaging (MRI) is a unique way of showing structures in the body using a strong magnetic field and harmless low energy radio waves. NO X-RAYS ARE USED.

What Happens During the Scan?

You lie on a special table which moves into the tunnel of the machine. You need to keep very still during the examination. The scan can take from 30 minutes to an hour. At times the machine makes loud knocking noises.

Some people find the tunnel in the machine confining. Please inform staff at the time of your booking if you know you are very claustrophobic (uncomfortable in small spaces).

Is Any Special Preparation Necessary?

All loose metal objects, safety pins, hairclips, watches and credit cards must be left outside the scan room. Lockers are provided.

Patients will be required to complete a questionnaire. If you answer "yes" to any questions it is very important that you inform staff at the time you make your appointment.