Heart disease and Stroke together account for most deaths in the UK and the Western world. A recent international study (PROGRESS) has added another strategy to the secondary prevention of stroke. The activities of the NMSC now stretches across the four hospitals that make up the Pennine Acute Hospitals Trust and the approximately 1m people it serves.

We thank Louise Rooney for writing about the experience of living with her grandfather's stroke.

Finally, we would like to pay immense tribute to the late Mr Maurice Cooper for the very generous and substantial donation left for the benefit of Stroke patients in North Manchester.

Stroke is the second leading cause of death in the world. It is also the commonest cause of adult disability. In North America, over half a million new strokes occur each year, adding to the five million people who have had previous strokes. Stroke is also responsible for a substantial proportion of deaths and disability in developing countries. Stroke can be prevented by dealing with its many causes such as smoking, excessive alcohol, poor diet, obesity, physical inactivity, high blood pressure, diabetes, high cholesterol and heart disease.

Stroke is an acute medical emergency requiring urgent admission of all patients to hospital. Immediate care of Stroke patients in an Acute Stroke Unit and subsequent rehabilitation in a Stroke Rehabilitation Unit significantly reduces death and disability from stroke. In the UK, the National Service Framework (NSF) for Older People / Stroke (Department of Health) recommends that all hospitals caring for Stroke patients develop these Stroke Units as part of an Integrated Stroke Service.

The risk of stroke due to heart disease can be reduced by eating a healthy (low in saturated fats and cholesterol) diet. If your blood cholesterol is very high, you may need to have treatment from your doctor in order to lower it. An irregular heart beat can be detected by a test called an electrocardiogram (ECG), which monitors the heart beat. Once detected, the chance of stroke due to atrial fibrillation can be reduced by treatment with Warfarin, a drug which reduces the tendency of blood to clot. It is important to have regular blood tests whilst taking Warfarin to check how 'thin' the blood really is. There are other things you can do yourself to reduce your risk of stroke : give up smoking; eat fruit and vegetables each day; reduce your alcohol intake and avoid binge drinking; increase your level of physical activity. Your doctor will also check for, and help deal with other causes of TIAs (mini-stroke) and Stroke such as high blood pressure, diabetes, and carotid artery disease (narrowing of the blood vessels on either side of the neck).

My mind is trapped in my body,
My independence has been taken away
I'm no longer able to do things for myself,
Because my brain has become inflamed
And has bled on one side.
My left side is weak,
My arm just flops around.
My swallowing is very difficult,
As I dribble on my clothes.
I don't remember where I am,
I often get confused.
My dignity has been taken away,
As I am unable to use the toilet without help.
I lay in bed wondering how I'm going to get up,
Wet and cold, shivering
And smelling unpleasant from the urine.
Now I'm rehabilitated and on my way home.
I never thought this day will come,
Even though I will never walk again.

Representatives from the four hospitals in this new Trust have been meeting (SuperTrust Stroke Services Group) over the past year in order to develop and recommend (to the new Board and PCTs) a strategy for providing high quality evidence-based stroke care to the (1m) population it serves. Meanwhile, the activities of the North Manchester Stroke Council (a local stroke charity whose main organ is this newsletter) now extends to all the hospitals in the new Trust as well as the community of north & greater Manchester (thanks to many of our colleagues).

Stroke Research - a recent report (Stroke 2002;33:319-20& www.strokeaha.org) suggests that taking a combination of Perindopril + Indapamide following a stroke significantly reduces the chance of a recurrence (PROGRESS). Another (BMJ 2002; 324:699-72& www.bmj.com) reports on the use of Ramipril (HOPE) in preventing stroke.

Stroke Audit - the third National Stroke Audit (RCP, London) which aims to determine stroke service organisation and quality of stroke care in UK hospitals has just been completed. Results to be reported later.

North West Regional Stroke Task Force-Acute Stroke Care Basics course (several venues & dates) :
please contact Kalina Townson
tel : 01772 893806; fax : 01772 892995; e-mail : ktownson@uclan.ac.uk

11th European Stroke Conference :
29th May - 1st June 2002, Geneva, Switzerland; www.eurostroke.org

Next Event :
Thursday 25 April 2002, 7-9 p.m., tel : 0161681 5035
(Marion Sharkey)

Greater Manchester Stroke Club Forum
(The Stroke Association)
Tuesday 9 April 2002, 7-9 p.m., Homewood Unit, North Manchester General Hospital, tel : 0161 707 6143

National Service Framework - Stroke (Department of Health) April 2001, www.doh.gov.uk/nsf/olderpeople.htm

• Stroke Helpline (for patients discharged from NMGH)
  telephone 0161 720 2709
  
• Stroke Association
  telephone 0161 788 7000; www.stroke.org.uk
  
• Different Strokes
  telephone 0161 655 4245; www.differentstrokes.co.uk
• TIA / Stroke Clinic
  North Manchester General Hospital-contact Dr U Ahmed (details below)

Dr U Ahmed (Editor)

• Telephone 0161 720 2790
• FAX 0161 720 2613
• E-mail usman.ahmed@mail.nmanhc-tr.nwest.nhs.uk

Tuesday 16 April 2002 12.30 - 1.30 p.m.
Stroke Rehabilitation Unit (Homewood) Seminar Room, North Manchester General Hospital, Crumpsall, Manchester.

ALL WELCOME