Dr S K Gupta
Today 29th October is world stroke day which calls for the attention and public awareness of signs and symptoms of stroke as early as possible, since it is a major cause of death and is leading cause of serious long term disability in the World as well as in India. Also to highlight the serious nature and high rate of Stroke, raise awareness for the prevention and treatment to ensure better care and support.
Stroke is rapidly developing clinical symptoms and signs of focal disturbance of Cerebral Functions with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of Vascular Origin.
I would like to share some basic principles of stroke and to educate the masses to take care of their brain attack or stroke.
* Stroke is treatable and preventable catastrophe.
* It is third leading cause of death after Ischaemic heart disease and cancer
* It is major cause of disability in the world as well as in India.
* One in six people worldwide will have a stroke in their life time.
* Approximately 20 million people experience a stroke each year and 6 million of them do not survive worldwide and five million or more are left with chronic disability.
* In India Prevalence rate of stroke ranges from 115-203 per lac people and the incidence rate of stroke in India is from 105-124 per lac people.
* Women have higher life time risk of stroke than men (1 in 5 vs 1 in 6) because of longer life expectancy in Women. The female population not only carries a higher burden of stroke during their life span – but they also account for majority of stroke deaths.
* Strokes are common after the age of fifty years.
* 20% of strokes are seen below the age of 45 years and they are known as young strokes.
* Stroke can strike suddenly and can be fatal if assistance is not sought immediately.
Considering the seriousness of the disease the World Stroke Organization (WHO) and Indian Stroke Association (ISA) are calling for immediate attention to address the epidemic of stroke. WSO and ISA are advocating for a comprehensive continuum approach from prevention to treatment and towards rehabilitation and long term support of these patients.
There are two types of major strokes
1. Ischaemic Stroke
2. Haemorrhagic Stroke
In the first type blood clots block the blood to particular area of brain – known as Ischaemic Stroke which contributes to 80% of cases. In the second type there is rupture of blood vessels and blood leaks into the brain or in the subarachnoid space, and is called as Haemorrhagic Strokes which contributes about 20% of all strokes.
MINOR STROKES: A minor stroke is also called as Transient Ischaemic attack or TIA. The features of minor stroke may be similar to those of major strokes but they are milder and lasts only for a short time usually less than an hour. Often the person recovers without treatment. These “minor strokes” are warning signs so one should not ignore them.
Survivors of a TIA have an increased risk of another stroke which is a major one and of increased morbidity and mortality so one should not ignore them. Prevention is of utmost importance in lowering the public health impact of stroke.
Some important things to note
* Know your personal risk factors – high blood pressure, diabetes and high blood cholesterol.
* Be physically active and exercise regularly, walking 30 minutes a day on most of days of the week.
* Avoid obesity by keeping to a healthy diet.
* Avoid Cigarette Smoking and Stress.
* Limit Alcohol Consumption.
* Learn to recognize the warning signs of stroke.
STROKE WARNING SIGNS
* Sudden numbness or weakness of face, arm or leg on one side of body.
* Sudden confusion or difficulty in speech or understanding language.
* Sudden trouble in seeing in one or both eyes or having double vision.
* Sudden vertigo.
* Sudden trouble in walking and loss of balance.
* Sudden severe headache and with no apparent cause.
* Sudden fainting or unconsciousness.
If one notices these warning signs act fast. Stroke is a medical emergency and get to a hospital immediately. Don’t lose time and act fast.
Even if the symptoms disappear in a few minutes still consult the neurologist immediately, because it may be your last opportunity to prevent a potentially forthcoming major stroke. Since stroke is a medical emergency, every minute counts when someone is having a stroke. The longer the flow is cut off to the brain, the greater the damage, hence immediate treatment can save people’s lives and enhance their chances for successful recovery.
Tests like Doppler Study, Echo, CT Scan, MRI and certain blood tests can help to achieve the diagnosis. In emergency situation, the most common test is CT Scan which tells us clearly the type of stroke and therefore, helps us about deciding the treatment.
Ischaemic strokes, the most common type of strokes can be treated with a drug rt-PA which dissolves blood clots. The time is very important and the window of opportunity to start treating Ischaemic stroke is 4 to 4.5 hours so one has to get into the hospital within shortest time.
Haemorrhagic stroke is usually treated conservatively with decongestive therapy or sometime with decompression.
The best treatment for stroke is prevention
There are several risk factors that increase your chances of having a stroke.
* High Blood Pressure
* Diabetes
* Heart Disease
* High Cholesterol
* Smoking and Obesity
One should take care of above risk factors which increases the chances of having a stroke.
Preventing or keeping them under control will greatly reduce your chances of having a stroke.
Stroke is a leading cause of adult disability worldwide.
Stroke survivors need appropriate long term care and support.
Stroke survivors may also experience following disorders
– Pain
– Depression
– Cognitive Decline
– Spasticity
– Seizures
These disorders require special attention and treatment.
Rehabilitation after Stroke :
Physical occupational Therapy
Most persons those who survive a stroke have some degree of post-stroke disabilities. They require good exercise and help of physiotherapist and speech therapist and athough rehabilitation does not reverse brain damage, it can substantially improve functions leading to better quality of life. Persons who have had a stroke are in need of long term follow up for preventive strategies, risk factor control and regular check up for their disabilities.
To improve the quality of life and to facilitate rehabilitation, it is essential that they have access to professional help as well as receive sustained emotional support from their families and friends.
It is strongly suggested to recognize the stroke and act fast to prevent disability and loss of life.
Prevention is better than cure, so by taking care of risk factor one can prevent brain attack in their life time. Regular exercise, good food habits, eating plenty of vegetables and fruits, controlling the blood pressure and blood sugar, avoiding excess of alcohol, quit smoking and keep normal body weight. Follow the instructions of Neurologist or family physician on blood thinning drugs which are essential to prevent potentially disabling strokes.
Theme of the world stroke day is act fast, recognize fast and treat fast.
(The author is a Neurologist)
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