Brain stroke is the second-largest cause of death in the world, but is preventable

A 52-year-old high-flying businessman was in a boardroom meeting when he suddenly fell unconscious. He had suffered a massive stroke, which left the right side of his body paralysed. After being on the ventilator for about 15 days in the ICU, he was shifted to a ward. Two weeks later, he was discharged on a wheelchair. While he had made some recovery, he couldn't walk without support, and had lost a lot of his memory and language skills. Neurologists had little hope that he could ever go back to work.

Gyanesh had been diagnosed with hypertension and diabetes eight years ago. Everybody in his household was concerned about the illnesses, except him.

He seldom visited doctors, because they gave him "big prescriptions and even bigger and bitter advice". What he hated most was their diktat to quit his age-old habit of smoking.

His business was growing, which only meant that he spent long hours at the office. He had no time to waste on futile things such as morning walks and exercises. He worked even on weekends, hardly took a break. To maintain social contacts, which were necessary for his business, he frequently attended late night parties and drank and dined with the who's who of the society.

He never took his medicines on time, which was the reason for constant fights with his wife.

......... 

Brain stroke is the second-largest cause for death and the leading cause for serious disability and healthcare expenditure. One in every six persons may suffer a stroke in their lifetime.

The triad of poorly controlled hypertension, diabetes and smoking constitutes the most important risk factor for stroke in our country. Photo: Reuters

In Asian countries, including India, the disease is spreading in epidemic proportions, and the young population is getting affected more and more.

Surprisingly, 80 per cent of all strokes can be prevented.

The risk factors

The non-modifiable risk factors for stroke are age (risk increases with age), gender (men are more prone) and a family history of strokes.

Medical risk factors:

1. Hypertension: Needs to be identified early and controlled with lifestyle changes, a low-salt diet and medication.
2. Diabetes: Needs to be identified and controlled with diet, exercise, and medications.
3. TIAs (Transient Ischemic Attack): Mini strokes are subtle symptoms that can disappear within 24 hrs. They are sentinel warning signs and patients who get intervention at this stage can be spared a major stroke.
4. Atrial Fibrillation: Symptomatic /asymptotic irregular beating of heart that can produce a clot, which is then pushed to the brain.
5. Significant heart disease causing low ejection power of the heart.
6. Valvular heart disease (like rheumatic heart disease)
7. Critical Carotid stenosis: Narrowing of the blood vessels that supply the brain, can be detected by a simple Doppler Test.
8. Obstructive sleep apnea: Excessive snoring, frequent spells of nocturnal awakenings due to airway obstruction, which leads to chronic sleep deprivation.
9. Fibromuscular Dysplasia
10. A previous stroke increases the risk of another stroke by 10 times.

Modifiable lifestyle risk factors one can control are:

1. Obesity
2. Smoking  
3. Excess alcohol intake
4. Sedentary lifestyle and lack of exercise
5. Chronic stress
6. Poor sleep pattern
7. Unhealthy dietary habits

The triad of poorly controlled hypertension, diabetes and smoking constitutes the most important risk factor in our country. Interestingly, heart attacks and brain strokes share common risk factors.

To prevent:

1. Walk for at least 30 minutes (around 10, 000 steps every day)/do moderate exercises.
2. Control hypertension and diabetes
3. Watch your weight.
4. Have a balanced diet of fresh fruits, vegetables, white meat and fish rich in omega-3 fatty acids. Keep fat intake low.
5. Practise yoga or meditation to relieve stress and get your heart and the brain pipes (carotids) evaluated for a block

The most important steps in stroke management are early identification and early intervention.

How to recognise a stroke

The much propagated slogan world over, Time is Brain, implies that neurons are destroyed rapidly as a stroke progresses, and lays emphasis on early treatment.

The commonly used pneumonic for this is FAST -check for Facial asymmetry, drooping Arms, Speech difficulty, if these are affirmative, don't lose Time. Rush to the nearest stroke management-equipped center.

Acute stroke management

If referred to a centre equipped to treat strokes within the "golden period", which is 4.5 hours, many ischemic stroke patients can be saved.

The treatment of strokes has taken a paradigm shift in the Past two decades, with major advancements in drugs and interventional techniques. "Clot buster" drugs can be administered through the intravenous route, intra-arterial route and clots can be sucked out mechanically by catheters, depending on the case.

With highly advanced centres coming up with comprehensive after-stroke rehabilitation strategies, the care of stroke patients has taken a giant leap, improving the final outcome for patients manifold.

If we are "stroke smart", we can prevent it to a great extent. In the unfortunate eventuality of an attack, prudent and timely decisions can save us from a catastrophe.

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