Stroke: Risks, causes and treatment
The increasing industrialization and rapid development has undoubtedly made life much easier for humans but has come with a heavy price in the form of “Lifestyle diseases”, a result of the unhealthy choices people make in their day to day living. Stroke has emerged as a major lifestyle related health disorder which has now reached pandemic proportions.
Annually, 15 million worldwide suffer a stroke, of these about one-third i.e. ~ 5 million die and another one-third are permanently disabled. As per WHO estimates, a stroke occurs every 5 seconds. Stroke accounts for approximately 10% of all deaths worldwide and is the 6th most common cause disability. In India, 1.44-1.64 million cases of new acute strokes occur every year resulting in 0.63 million deaths.
Stroke or the “Brain Attack” is the result of impairment of blood supply to the brain which may occur in the form of interruption of blood supply by a clot in the blood vessel (Ischemic Stroke) or as a result of rupture of the blood vessel (Hemorrhagic Stroke). Majority (almost 85%) of strokes are of the ischemic variety. Manifestations can be quite variable depending upon the blood vessel involved, part of brain affected and laterality of involvement.
The middle cerebral artery which supplies a large territory of the brain is the most common cerebral occlusion site and manifests as one-sided weakness involving upper and/or lower limbs with or without speech disturbance. Involvement of blood vessels supplying the hind part of the brain results in disturbances of balance and coordination, weakness of all four limbs, double vision, slurred speech, impaired swallowing, decreased level of consciousness, and abnormal respirations.
Depending on the blood vessel affected, Hemorrhagic strokes can also manifest with similar focal symptoms. However, they typically result in more pronounced headaches, nausea and vomiting, and impaired level of consciousness than ischemic strokes. Generally, patients with hemorrhagic strokes are more critically ill than those with ischemic strokes.
Treatment of stroke in earlier times was largely preventive, limited to control of vascular risk factors viz. BP, Diabetes & Cholesterol; and in case of Ischemic Stroke, providing medications that reduce the propensity to clot formation (anti-platelets). The last three decades have seen significant advances in the management, particularly of Ischemic stroke. The availability of clot-busting medication and the devices that can mechanically remove the clot from the involved blood vessel has revolutionized the management of Ischemic stroke.
The degree of damage in Ischemic stroke is dependent on duration for which blood supply remains interrupted and degree of collateral flow of the affected part of the brain. During a stroke 32,000 neurons die per second and the brain ages 3.6 years each hour without treatment. The clot-busting medications and mechanical thrombectomy devices are aimed at early restoration of blood flow to the affected part of brain and can therefore, only be administered in carefully selected patients within a critical ‘window period’, typically 4.5 hours of the onset of stroke, which in certain cases can be extended up to 6 hours.
In spite of the availability of the treatment, even in urban settings a large number of patients remain ignorant and seek medical advice only after the deficit has set in. Once the deficit has set in, treatment is limited to preventing recurrence of the episode and providing rehabilitation in the form of physiotherapy and occupational therapy. Data available from the western literature shows that only 5% of stroke patients receive acute stroke treatment.
For these treatment modalities to be utilized, there is need for greater awareness among the general public. Public health authorities and agencies should organize campaigns and health talks to educate masses so that they seek early treatment for stroke. FAST (F-Facial drooping, A- Arm weakness, S- Speech difficulties, T- Time) campaign launched by group of stroke physicians in UK, to raise awareness regarding the symptoms of stroke is an important initiative in this regard.
In resource poor countries like ours, where the availability of such advance treatment and the cost of therapy makes it out of reach of the greater population, there is need to focus on the preventive aspects. Lifestyle measures such as a healthy diet; rich in fresh fruits, vegetables and low fat dairy products, low in saturated fat and salt, regular physical activity; optimum 20-60 minutes of moderate cardiorespiratory activity 3-5 days/week, limiting alcohol consumption and avoiding smoking, can go a long way in reducing the risk of stroke.
A two-pronged approach, providing the best of available treatment in acute stroke settings and adopting a healthy lifestyle as a preventive strategy aimed at reducing the incidence of stroke can greatly help us in reducing the burden stroke poses to our society.
Dr Prashant Makhija
Dr Prashant Makhija is presently a Consultant Neurologist at Seven Hills Hospital, Mumbai. He has completed his D.M. (Neurology) from G. B. Pant Hospital, Delhi with special exposure in Stroke, Headache, Epilepsy and Nerve/Muscle.
He has also worked as Senior Resident (Internal medicine) at R.M.L. Hospital, Delhi, and as Senior Resident (Neurology) at IHBAS and G.T.B. Hospital, Delhi. He has been a runner up at the TYSA Neurology Quiz. His areas of interest include Migraine, Stroke and Headache.