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Stroke = Heart Attack or Brain Attack? :
Many people termed heart attack also as a stroke. But in reality, a stroke is a form of brain attack which occurs when a blood vessel of the brain disrupts / bursts and bleeds. Or there is an interruption in the blood supply due to block inside the vessel of the brain. It prevents blood and oxygen to reach to the brain tissue. Hence, for both of these, there is lack of oxygen supply in the brain that result in the damage of the brain tissue. If not addressed on time, a stroke can definitely result in brain damage that may be permanent one or even may cause death. Cases of stroke are increasing worldwide due to lifestyle or genetic changes. Many who survive a stroke suffer serious disabilities due to failing to receive timely treatment. Around the world, someone suffers a stroke every 3 seconds, amounting to 12.2 million new strokes annually. Globally, one out of four people above 25 is likely to have a stroke.
Some facts :
Stroke is still one of the leading causes of death worldwide, especially in developing countries. The lack of effective education, campaign and resources for stroke awareness is few of the main reasons for the high stroke mortality and disability rate in these countries. Very few stroke patients (<20%) could recognise the initial signs of stroke and less than 25% of them could attend the emergency departments (ED) of an equipped hospital. As per recent statistics, 10% of stroke patients recover fully, 25% recover with minor impairments, and 40% recover with moderate-to-severe impairments. 10% of patients need long-term care, and 15% of strokes result in loss of life.
“Every minute a stroke is untreated; an average patient loses 1.9 million neurons, 13.8 billion synapses, and seven million axonal fibers of brain,” commented by consultant of Neurology, Dr. Krishnan P R of Fortis Hospital, Bangalore. Thus, there remains an urgent need to educate mass people to improve stroke awareness and recognise that it is critically important to attend emergency medical service immediately after the onset of a stroke to prevent mortality and disability.
Concept of World Stroke Day:
“World Stroke Day” is celebrated globally on 29 October. This is observed to raise awareness and to urge for the lifestyle changes that can prevent stroke and reduce chances of a second stroke. On this “World Stroke Day” this post is aimed to generate public awareness and educate them about the risk factors and signs of stroke.
Symptoms of stroke:
If someone is having a stroke, he or she may exhibit some common symptoms. These may be –
• Severe headaches, unusual than common one.
• Numbness in the body especially on face, leg and one side of body.
• Nausea and vomiting
• Paralysis
• Trouble speaking or understanding speech
• Loss of vision; sometimes the vision is black and blur
• Difficulty to maintain the body in balance
• Unstable in walking;
• Dizziness / blackouts – may be repeated
• Loss of consciousness
Risk factors:
Obesity
Lack of mobility / exercise,
Sedentary lifestyle,
Unhealthy diet habits,
Chronic diseases like high blood pressure, atherosclerosis, diabetes, high cholesterol,
Certain medications raise risk of stroke. Blood thinners may cause bleeding in elderly, hormone therapy like oestrogen used in contraceptive pill or for postmenopausal symptom control may also cause hypercoagulable state in blood vessels that may cause stroke if occurs in brain.
Types of strokes:
As established broad concept, there are two major types of stroke. One is ischaemic stroke and another is haemorrhagic stroke. When there is a sudden clot developed either from heart for rhythm changes or valve defect or even somewhere else and the clot travel into the brain. This clot then gets lodged into an artery of brain leading to interrupt or block the blood supply in that area of the brain. This is known as Ischaemic stroke. Ischaemia means lack of blood supply. Another stroke is haemorrhagic stroke which means when there is lot of blood in the brain, it can lead to rupture of blood vessel. This results in accumulation of blood surrounding the brain tissue resulting in compression of brain matters. It is difficult to distinguish between these two types without investigation because both have mostly same symptoms like tingling in hands or legs, partial or gross loss of balance of the body, speech difficulties, drooling of the saliva or deviation of face etc.
Recognition of a stroke:
FAST—face, arm, speech and time, a stroke awareness tool used in English-speaking countries based on the Cincinnati Prehospital Stroke Scale published in 1999 has been in use in many developing countries for stroke awareness education for more than a decade, but, it’s not working well for the language barrier, and the prehospital delay is still devastatingly long causing the failure in improving outcome after a stroke.
Since its publication in Lancet Neurology online on World Stroke Day in 2016, stroke 1-2-0 as an education programme based on FAST is getting popular as it is much suitable for rapid recognition of a developing stroke and help to quick response in some countries. It uses 1-2-0, the well-known medical emergency phone number. 1-2-0 is also used as an easy mnemonic tool of stroke sign where 1 represents ‘First, look for an uneven face’, 2 represents ‘Second, examine for arm weakness’ and 0 represents ‘Zero (absence of) clear speech. The quick recognition lead to action by dialling 1-2-0 for the immediate activation of Emergency Medical Service. One of the most important strengths of Stroke 1-2-0 compared with FAST is that it eliminates the language barrier by using only the coded numbers that is used for emergency medical services.
Importance of Immediate Management:
Responding to a developing stroke is critical as more brain tissue is irreversibly damaged if emergency management is not received by a patient in time. A goal of 60 minutes or less from door-to-treatment is ideal. A duration of 4.5 hours is often referred to as the “Golden Hour” for stroke. During this period, a focused diagnostic workup has to be completed to rule out other conditions that may mimic a stroke. Medical professionals termed this as “Golden Hour” as such since it can make a huge difference if can be treated within this time frame. Patients who receive the clot-breaking drug (tPA class drug) within the golden hour are more likely to avoid long-term brain damage and have increased chances of full recovery and good survival.
The patient of a suspected stroke should be immediately taken to a nearby hospital which is equipped to handle such patients – a ‘stroke’ ready hospital. “Upon reaching the emergency, a CT Scan of the brain is requested immediately after initial assessment at the hospital. Proper diagnosis within the first few hours after the onset of the stroke symptoms should be done. The most definite treatment for stroke due to clogged vessel is endo-vascular thromboembolectomy, which means removing the blood clot under the image- guidance (CT/ MRI) which will enable assessment of the proper flow of the blood to the brain after the procedure as well. The patient is directly taken to the Neuro-vascular Cath-lab to open up the blocked vessel of the brain.
Other treatments:
Managing causes and other existing co morbid conditions need to be managed as appropriate with the guidance from a multidisciplinary team action. Aspirin and other anti-platelet drugs, anticoagulants, statins and blood pressure medicines are used to reduce the risk of clots and prevent stroke due to high blood pressure or cholesterol. Carotid endarterectomy surgery is sometime performed if the build-up of fatty plaque is excessive in carotid artery. Anti-hypertensive medicines are used in haemorrhagic strokes to lower blood pressure. A craniotomy is a surgical procedure usually performed when indicated to remove blood in the brain if any blood vessel bursts.
Prevention is always better:
As termed this is aimed to recognition and modifying the lifestyle. Lifestyle changes for reducing risk of stroke includes minimizing alcohol consumption, controlling the body weight, managing stress, giving importance to mental health, and eating a well-balanced diet. The chronic diseases should be kept under control by diet, exercise or other measures and taking specific regular medicines. The dietary modification can be the easiest and quickest change one can make in the lifestyle. Beside drinking sufficient fluids for a day, adding fruits and vegetables, whole grains, fibres, protein and other essential nutrients to the diet could help manage almost any chronic disease and prevent clogging of arteries. Seasonal fruits and vegetables can help lower the risk of a stroke as these are naturally low in fat and calories, but rich in fibre. These contain essential nutrients like potassium, fibres, folate, vitamin A and vitamin C. Potassium rich foods like bananas, tomatoes, melon and soybeans can help keep the blood pressure under normal range which is considered as one of the leading risk factors of stroke. Food high in magnesium such as spinach also helps minimise the risk of stroke. One should have at least two servings of fruits and include seasonal vegetables on a daily basis to cut the risk of a stroke and maintain a healthy weight. Doing regular physical exercise is important to keep the all the body parts more active and to prevent stasis of blood inside the blood vessels.
Key messages:
Stroke can happen to anyone at any age. Nearly 80% of all strokes are preventable. Stroke is the fifth leading cause of death in the U.S. and a leading cause of severe disability. When somebody has a stroke, every second that goes by is crucial and essential as millions of neurons of brain begin to die, time could not be more precious than anything to save life. The precious time campaign aims to raise awareness of stroke signs and the benefits of timely access to emergency medical care in the “Golden Hour” time frame. This is also a concern for dissemination of quality service in different parts of the countries in developing nations. A well planned care service may need to be developed. Another challenge is to set up equipped hospitals with trained sufficient stuffs to manage strokes in different hospitals specially in developing countries where resource and funds are limited. Hence policies need to reform in the developing countries to call for a comprehensive care delivery to recognise and manage stroke cases.