At the first stroke... seek help

It was while he was in his bedroom watching TV one afternoon in July that Billy Mackenzie had a bizarre experience. He says he felt as if something had suddenly touched his brain. In fact, he was having a stroke.

IT was while he was in his bedroom watching TV one afternoon in July that Billy Mackenzie had a bizarre experience. He says he felt as if something had suddenly touched his brain. In fact, he was having a stroke, and what followed were terrifying moments when he realised he couldn't move his right arm and leg properly, and his speech became slurred.

While he had been sitting on his bed watching an episode of Balamory with his three-year-old granddaughter, Keira, she asked him to reach across to the bedside table for her bottle of soft drink. "That's when I realised I couldn't move my arm properly," says Mackenzie, 64, from Newton Mearns.

"I kept trying to reach the bottle, and then I knocked it to the floor. Then my right leg felt paralysed and I couldn't speak properly. It happened in a split second. It might sound odd, but it felt as if something had gone up to my brain and touched it.

"I was terrified, and tried to shout for my wife downstairs. I remember Keira saying to me, Grandma can't hear you.' So I told Keira to go and shout for her grandma. When my wife came upstairs, she phoned the doctor - and when he came to the house he told me I'd had a mild stroke and sent me straight to hospital. I don't know what would have happened if Keira hadn't been there. I like to think she saved my life."

Mackenzie was rushed to the Southern General Hospital and was given a series of scans, from which doctors discovered one of the carotid arteries in his neck was narrowed due to plaque (fatty) deposits, reducing blood flow to his brain. This had caused a mild - or mini - stroke.

"I didn't get any warning before the stroke, apart from feeling very tired beforehand. But I was diagnosed with diabetes in 1984 and I knew that could cause heart problems. I've also had a triple bypass, and I knew about strokes as well," says Mackenzie.

After a successful operation to clean the lining of his carotid artery, he will probably recover most of his movement.

Mackenzie was luckier than most people simply because he recognised he'd had a stroke and acted on it quickly. But, according to the Stroke Association, many people aren't so knowledgeable, even though strokes are the third biggest killer in Britain after cancer and heart attacks.

"Most people don't understand what a stroke is, and often don't take it as seriously as a heart attack," explains a spokeswoman from the Stroke Association. "People see a heart attack as something that has to be dealt with straight away, but I don't think there is the same perception by the general public about strokes."

A recent study by the association in Scotland revealed the shocking fact that the majority of people are more concerned about their wealth than the health of their brain. The research found that the prospect of losing a bank or credit card would prompt immediate action from 86% of respondents, whereas 32%, when asked what they would do if they thought they were having a stroke, said they would wait up to a day before taking action.

To tackle this situation, the association is trying to encourage the renaming of stroke as "brain attack", a strategy already adopted in America and Australia. Its latest advertising campaign - called Leading the Fight Against Brain Attacks - features the startling image of a human head shaped like a bomb with a lit fuse on top.

"Brain attack is a good description of what a stroke is, as some people don't even realise it affects the brain and that it can happen to anyone, any time, without warning. It's a ticking timebomb," says the spokeswoman.

Dr Keith Muir, a consultant neurologist at Glasgow's Southern General, which has one of the best records in Britain for treating strokes quickly, says: "We have known for some time that people have a poor understanding of the symptoms of stroke. Many think it has something to do with your heart, and many of the minor symptoms - such as slurring of speech or weakness in a leg - are things people try to ignore. But these people may well be having a minor stroke. It's important that we see them promptly because there's a risk of the person then having a bigger stroke in the few days after the first."

Dr Muir believes the word stroke has misleading connotations. "In the past, because it was a condition that not much could be done about, it tended to attract a fatalistic attitude among the medical profession, and that diffused through to patients. It's only recently we've really understood why strokes happen and what we can do about them. We've got a lot of work to do to undo years of negative thinking. But calling it a brain attack will increase people's awareness of the symptoms, and the fact it is a medical emergency," he says.

In addition, says Dr Muir, strokes are set to become more common as people live longer. "It will be up there with heart disease very soon - and the thing about a stroke is that if it doesn't kill you, you can be left disabled."

Strokes are less straightforward than heart attacks, he adds. "There are multiple causes, and every person will be different. One in five has had a stroke because of hardening or narrowing of the carotid arteries taking blood up to the brain. There are similar risk factors to heart disease, and some of it you can change, like lifestyle factors - but, additionally, there is an increasing risk with age which is related to genes, and heart rhythm changes which can cause clots to form."

And even otherwise healthy people in their twenties can suffer strokes, though in most cases this is caused by congenital problems that predispose them to having a stroke.

Dr Muir, who is Billy Mackenzie's consultant at the Southern General, says many of those who suffer a stroke because of a narrowed carotid artery will benefit from surgery rather than just medication, especially if the narrowing is severe. Mackenzie was given an operation called a carotid endarterectomy, which removes the fatty deposits from the wall of the artery to prevent recurring strokes. He was fortunate in being operated on within 48 hours of his attack - which was extremely fast, says Dr Muir, but by no means exceptional at the hospital, which he believes has one of the best teams in Britain for treating strokes. "Mr Mackenzie got the sort of treatment we would want everyone to have," he says.

Dr Muir says Mackenzie is also a perfect illustration of how important it is to act quickly with even minor symptoms. "It would have been all too easy for him to have ignored it, for the GP to have referred him to an outpatient department, and for Mr Mackenzie to have had a devastating stroke a few days later and to be have been left hospitalised."

For his part, Mackenzie believes that calling a stroke a brain attack will wake people up to the dangers. "A lot of people think a stroke is a temporary thing, but it's not. While I was in hospital, I saw other stroke patients with a lot worse problems than I've got. That's what can happen if you don't act quickly."