BY PROF.(DR) BASHIR AHMAD SANAIE and DR. TANVEER HASSAN BABA
Every year, on October 29th, the world unites to observe World Stroke Day, an important occasion dedicated to raising awareness of the serious nature and high rates of stroke, talk about prevention and treatment and ensure better care and support for survivors. Stroke is the second most common cause of death in India. About 1,85,000 stroke cases are reported every year in India with nearly one stroke every 40 seconds and one stroke death every 4 minutes.
A stroke, also known as a “brain attack”, occurs when the blood supply to the brain gets blocked or a blood vessel in the brain bursts. According to doctors, strokes lead to damage or death of parts of the brain and this condition can cause lasting brain damage, long-term disability, or even death. There are two main types of stroke : Ischemic and Haemorrhagic.
Ischemic strokes: These strokes occur as a result of an obstruction in a blood vessel supplying blood to the brain.
Haemorrhagic strokes: Haemorrhagic strokes happen when a weakened blood vessel ruptures and bleeds into the brain.
Transient Ischemic Attack (TIA or mini-stroke): A TIA is caused by a temporary disruption in the blood supply to an area of the brain. It can cause symptoms similar to a stroke, but unlike a stroke these symptoms pass quickly and usually fully resolve within 24 hours.
Spot the Stroke (Be Stroke Smart and “BE FAST”)
When it comes to strokes seconds count, as “Time is Brain”. The risk of death and disability from stroke can be lowered with timely treatment. “BE FAST” and recognize the signs or symptoms of a stroke. Don’t wait to see if symptoms go away. Rush to the hospital as every minute counts. Any sudden onset disturbance in dekhna, dikhana, hath, pair, bol or chal should raise suspicion of stroke and indicate prompt medical consultation. A commonly used acronym is BE FAST. “Bachav” (B – Baazu, A – Aawaz, Cha – Chehra, V – Vakt) could be an easy urdu pneumonic.
Causes and Risk Factors:
Understanding the causes and risk factors for stroke is crucial for prevention. Some common factors that increase the risk of stroke include:
High Blood Pressure: High blood pressure (hypertension) is the single largest cause of stroke and is associated with half of all strokes. It weakens blood vessel walls, making them more prone to rupture or clot formation.
Smoking: The chemicals in tobacco smoke can damage blood vessels and increase the likelihood of clots.
Diabetes: High blood sugar levels can damage blood vessels and increase the risk of stroke.
High Cholesterol: Elevated cholesterol levels can lead to the buildup of plaque in arteries, which may result in clot formation.
Atrial Fibrillation: This irregular heart rhythm can lead to the formation of blood clots that may travel to the brain.
Stress and Depression: Around 1 in 6 strokes are linked to depression and stress.
Physical inactivity: 1 million strokes a year are linked to physical inactivity.
Family History: A family history of stroke may increase an individual’s risk.
Prevention and Lifestyle Changes:
1 in 4 of us will have a stroke in our lifetime, but almost 80 to 90 percent strokes can be prevented. Many strokes can be prevented through lifestyle modifications and proactive healthcare. Here are some essential steps to reduce your risk:
Maintain a Healthy Diet: A diet rich in fruits, vegetables, whole grains, and low in saturated and trans fats can help lower the risk of stroke. Avoid excessive intake of salt, sugar, red and processed meat, sweets, sweetened drinks and foods.
Exercise Regularly: Exercise plays an important role in reducing several stroke risk factors including hypertension, diabetes, cholesterol, obesity ,depression and stress. Just 30 minutes of exercise five times a week can reduce your risk of stroke by 25%.
Manage Blood Pressure: Regular check-ups and medication, if necessary, can help control high blood pressure.
Stop Smoking: Quitting smoking can significantly reduce your stroke risk.
Limit Alcohol Consumption: Moderation is key when it comes to alcohol. Excessive drinking can increase your risk.
Control Diabetes: Regular monitoring and adherence to a diabetes management plan is crucial.
Proper treatment of underlying medical conditions which increase the risk of stroke like Atrial Fibrillation, dyslipidemia and depression.
Treat Stroke:
Treatment options for stroke have been transformed in recent years, saving more lives and reducing disability for those who have access.
6 key facts about stroke treatment
1. Early recognition makes a big difference.
Knowing the signs of stroke and getting treatment quickly saves lives and improves recovery.
2. Around 1 in 10 more people make an excellent recovery when cared for in a specialized stroke unit. All patients with stroke (ischaemic or haemorrhagic) should be admitted to a specialized stroke unit, which involves a designated ward with a specialized team.
3. Clot-busting drugs (tPA or thrombolysis) increase the chance of a good outcome by 30%.
Clot-busting drugs break up blood clots. This treatment can be administered up to 4.5 hours of symptom onset in many patients with ischaemic stroke. The earlier it is given, the greater the effect.
4. Clot retrieval treatment increases the chance of a good outcome by more than 50%.
Clot retrieval treatment (mechanical thrombectomy) involves removing a blood clot and can improve survival rates and reduce disability for many people with ischaemic stroke caused by large artery blockage.
5. Rehabilitation is a critical step in the treatment process.
Rehabilitation starts in the hospital as soon as possible following a stroke. It can improve function and help the survivor regain as much independence as possible over time.
6. One in four survivors will have another stroke.
Treatments that prevent another stroke include drugs to lower blood pressure and cholesterol, antiplatelet therapies, anticoagulation for atrial fibrillation, surgery or stenting for selected patients with severe carotid artery narrowing. Lifestyle changes can also greatly reduce the risk of another stroke.
Life after stroke:
Around the world, about 80 million people have experienced a stroke. Stroke can affect how you think, talk, move and feel. Many survivors will live the rest of their lives with some form of disability or impairment which cause practical, emotional and financial challenges. With specialist rehabilitation and support, stroke survivors can however recover or find their ‘new normal’ and enjoy life.
Prof.(Dr) Bashir Ahmad Sanaie HOD Dept. of Neurology, Superspeciality Hospital, Shireen Bagh Dr. Tanveer Hassan Baba Consultant Dept. of Neurology, Superspeciality Hospital, Shireen Bagh