The FAST way to recognise a Stroke

As we know, normal brain functions are essential for our day-to-day activities. Any sudden interruption in normal brain function is referred to as a stroke or brain attack.

It has to be mentioned that the human brain is more complex than a supercomputer. It is a mystery that has not been solved completely despite tremendous technological advancement. 

A stroke is a condition that occurs when there is a sudden blockage or rupture of brain blood vessels. The sudden blockage could be caused due to pre-existing atherosclerotic disease in neck or brain blood vessels and/or embolism from a cardiac source. Rupture of the brain blood vessels is caused by high blood pressure, uncontrolled diabetes, aneurysm, or arterio-venous malformation.

Stroke Burden

World Statistics:

 Stroke is the 3rd leading cause of mortality worldwide after ischemic heart disease and cancer. And it has been estimated that one in six people worldwide will have a stroke in their lifetime. Every 6 seconds, a stroke kills someone in the world. And approximately 17 million people experience a stroke each year, where 6 million do not survive. About thirty-three million people have had a stroke, and most of them have had residual disabilities. 

Statistics in India:

 In India, the cumulative incidence of stroke is 10-15 million patients per year, that is, 1.27-2.2 per 1000 persons. Every day nearly 4500 strokes happen all over India. Someone suffers from a stroke every 40 seconds. And each year approximately 4 lakh people die, which means every 4 minutes, one person dies due to stroke. 

Stroke is indeed a devastating disease, a major cause of mortality, morbidity and disability globally.

The Two Types of Stroke: Ischemic and Haemorrhagic

Ischemic stroke is the most common type and accounts for approximately 80% of all cases. It occurs due to a sudden blockage of brain blood vessels either due to deposition of a high level of harmful cholesterol (LDL) in the inner layer of the blood vessels (called thrombotic stroke) or due to a blood clot in the heart which causes an obstruction in the blood flow of brain blood vessels (called cardioembolic stroke).

Haemorrhagic stroke is the second most common type, accounting for approximately 20% of cases. It occurs due to rupture of brain blood vessels caused by high blood pressure, high sugar, rupture of an aneurysm, AV malformation, or congenital disabilities in the vessel wall. 

TIA (Transient Ischemic Attack) is also called temporary paralysis, in which the patient recovers within minutes or a few hours without any treatment. However, this condition must be taken seriously as a warning sign of brain stroke.

Risk Factors

People suffering from high blood pressure, uncontrolled diabetes, obesity, excessive stress, high LDL cholesterol, high homocysteine, and high triglycerides are susceptible to stroke. Excessive smoking, alcohol intake, and tobacco chewing are also risk factors. Congenital heart and valvular heart diseases can also become the cause of stroke, especially in paediatric patients.

Treatment

Treatment of stroke depends on the type of stroke, time of onset, and affected brain area. 

In the case of ischemic stroke, due to sudden blockage of brain blood vessels, treatment is done by administering either intravenous clot busters/thrombolysis or neuro-interventional procedure like mechanical thrombectomy, angioplasty or stenting. These procedures are performed by an endovascular technique in the Cath Lab without opening the skull. An example is a cardiac angioplasty Cath Lab procedures. 

Intravenous thrombolysis needs to be done within 4.5 hours from the onset of stroke and endovascular mechanical thrombectomy within 24 hrs. Nearly 2 million neurons lose their functions within one minute of an ischemic stroke. Hence early recognition of stroke symptoms can help in the timely initiation of treatment.

Treatment for haemorrhagic stroke involves emergency clot removal in order to reduce the brain’s swelling, or removal of the bone marrow and reattaching of it after the patient is cured.

Prevention of Stroke

Risk factors such as age, family history, and congenital disorders cannot be controlled. However, even a slight moderation in our everyday lifestyle can greatly prevent the occurrence of stroke. 

A healthy balanced diet and at least 30 minutes of physical exercise can help prevent stroke. Controlling blood pressure, sugar and cholesterol levels in addition to quitting smoking, alcohol, and tobacco also help prevent stroke. It is also recommended that people maintain their body weight according to their BMI and get regular health check-ups.

The Warning Signs of a Stroke

1. Deviation of mouth to one side.
2. Numbness or weakness on one side of the body.
3. Imbalance, dizziness and confusion.
4. Difficulty in speaking or comprehending.
5. Speech disturbances.
6. Loss of vision in one or both eyes.
7. Severe headache, nausea, vomiting and vertigo.

Summary:

• Controlling all risk factors, receiving guided advice from professionals, and leading a regulated lifestyle can go a long way in preventing strokes. 

• It’s imperative to stay away from stress. 

• A healthy brain resides in a healthy body.

Dr Suresh Gupta
Chairman, Department of Neurosciences
Eternal Hospital, Jaipur