There are four identifying factors in stroke as stated by the World Stroke Organisation, using the acronym FAST–Face, Arm, Speech and Time. Stroke or brain attack is now the second commonest killer in the world after a heart attack and the first and foremost cause of permanent disability. In India alone, 4,500 people get a stroke every day. Rita informs us about the tell-tale signs, in the weekly column, exclusively in Different Truths.
Stroke or brain attack is now the second commonest killer in the world after a heart attack and the first and foremost cause of permanent disability. It is responsible for more deaths annually than those attributed to AIDS, tuberculosis, and malaria combined. In India alone, 4,500 people get a stroke every day. However, stroke is eminently treatable and preventable but timely medical attention is critical.
While worldwide, those aged 60 years and above are at risk for stroke, in India, the risk of getting a stroke starts earlier at 50 and above. As much as genetic factors playing a role, so do lifestyle and the inability to control risk factors like high blood pressure, diabetes, cholesterol, high alcohol intake and smoking.
Symptoms and Cause
Stroke presents commonly as a sudden onset paralysis of one side of the face, or one hand and face or one full half of the body with or without loss of sensations. Loss of ability to speak and understand spoken words is another common feature. Losing vision on one side of the visual field or one eye is the other feature. Sudden vertigo or dizziness, vomiting, loss of balance in walking, double vision, difficulty in swallowing, etc. are also seen when areas affected are the lower portions of the brain called brainstem. Recognition of these symptoms leads to correct diagnosis of stroke in 80 per cent of the cases.
Strokes result most often from lack of blood flow to parts of the brain, which are supplied by a particular artery feeding the brain of oxygenated and glucose rich blood which help the brain to derive its energy. An active normal brain consumes more energy than any other tissue in the body. So oxygen and energy deprivation kills brain cells quickly. After a cessation of blood flow to the brain, within one second around 32000 nerve cells die and it has been calculated that this may translate also into a loss of 9 hours of human lifespan. Hence, the most important principle in the care of stroke patients is a fast response.
Since one of the largest obstacles to emergency treatment is that many people do not know they are having a stroke, it is critical for everyone to know the primary symptoms. There are four identifying factors in stroke as stated by the World Stroke Organisation, using the acronym FAST–Face, Arm, Speech and Time. F stands for Face, where it is found to be drooping. A stands for Arms, where there is weakness or numbness of arms or legs. S stands for Speech, where difficulty in speech is experienced. T stands for Time, which indicates that medical attention must be sought immediately.
Treatment of stroke should begin within 4.5 hours of the symptoms to be effective. A clot-busting drug called tissue plasminogen activator (tPA) is used in a treatment called thrombolysis to remove the clot in the blood vessel. It dissolves the vessel blocking clot and opens up the arteries, re-establishing blood flow to the starved brain and preventing permanent death and loss of nerve cells. This timely intervention can lead to immediate recovery from paralysis or a minimization of the final severity of stroke.
Continuous advances being made in stroke treatment offer a ray of hope towards better stroke management in the future. An advanced neuro intervention procedure, called Mechanical Thrombectomy, uses a catheter inserted into the groin area. “IVT therapy followed by neuro intervention procedure doubles the chances of stroke reversal. The patient also becomes non-dependent,” says Dr. Joy Varghese, Senior Consultant Neurosurgeon, and Neuro Intervention Specialist.
Stroke prevention strategies need to be reinforced to check the growing number of stroke cases across the world. For primary prevention (prevention of first ever strokes), the effective steps are to a great extent the same as for heart attacks. Most important risk factors are hypertension, diabetes mellitus, high cholesterol, obesity but also includes all forms of heart diseases. Avoidance of tobacco and alcohol and abusive drugs and regular and adequate physical activity and healthy food and sleep habits help prevent stroke.
Once someone develops stroke, it is of paramount importance to prevent further strokes. At Arogya HomeCare (www.arogyahomecare.in), in addition to managing stroke rehabilitation and facilitating early mobilisation of stroke patients through physiotherapy and occupational therapy, we also attach a great deal of importance to educating our elderly care seekers about FAST and recognising the warning signs of stroke.
Photos from the internet.
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