WORLD STROKE DAY (OCTOBER-29)

WORLD STROKE DAY (OCTOBER-29)

October-29,Today is World Stroke Day

On the eve of World Stroke Day on October 29, doctors caution the public on the factors that cause stroke and how to watch for the warning signs and prevent disaster. Neurologist at K.G. Hospital T.C.R. Ramakrishnan explains that stroke or cerebrovascular accident or brain attack occurs when the vessels supplying blood to the brain are blocked, interrupting the blood flow. This results in the death of the brain cells. And, functions such as speech, memory or movement may be affected depending on the area of the brain involved. Stroke is the second leading cause of death after the age of 60. Studies across the world show that cases of stroke occur every six seconds. It is not that stroke affects only elders. Stroke is the fifth leading cause of death in people aged 15 to 59 years. Stroke is indiscriminate and does not respect age, sex, race or economic status.

Stroke afflicts 15 million people each year. Of them, almost six million die and a further five million are left permanently disabled. In 2009, the World Stroke Organisation fixed October 29 for the start of a global campaign titled “Stroke, what can I do?” The following year, it launched the “1 in 6” campaign to emphasise that one in six people will have a stroke within their life time. This year, the organisation is continuing with the theme of 2010 “One in six”, but has added “Act Now” and “How to Act Now” as additional themes. It has listed some tasks (see graphics) that are critical to avoiding strokes. Diabetologist V. Rajendran of Dr. Rajendran's Diabetes Centre says diabetes mellitus by itself is one of the major and independent risk factors for stroke. Large population studies have shown stroke to be more frequent and have higher mortality in patients with diabetes, with women being more prone to it.

The other associated risk factors increase this risk manifold. High blood pressure and cholesterol and high-risk habits such as use of tobacco and family history of stroke add to the risk that diabetes already poses. Diabetics should constantly monitor blood sugar level and also other metabolic parameters such as cholesterol. Lifestyle and dietary changes should be made if any of these are found to breach normal limits. State president of Indian Medical Association L.P. Thangavel says people are increasingly aware of stroke. Educated people also know that uncontrolled hypertension and diabetes are major risk factors. But, much needs to be done in the rural areas to increase awareness. Hypertension and diabetes screening should be stepped up in rural areas and those found with the symptoms should be educated on the risks from the disease and how to avoid these.

Dr. Thangavel says the symptoms of stroke are easily understandable and primary level physicians can identify these. With imaging systems such as computed tomography available, detection is not a problem. Yet, physicians must approach the patients showing the symptoms (see graphics) with a high degree of suspicion so that accurate diagnosis is not missed. A feeling of pressure or pain in the chest, pain radiating through an arm, difficulty in breathing or breaking out in sudden sweat would have most people rushing to the casualty wing of some hospital, because people today have a fair idea of what a heart attack could be like.

But a stroke is a more silent and devastating assailant and its symptoms continue to be missed, leading to massive loss of life or worse, debilitating disabilities. Failure or delay in recognising stroke signals and the subsequent delays in reaching an appropriate medical facility has been resulting in a huge burden of mortality and disability due to stroke, doctors point out.

In a recent population based study by the Trivandrum Stroke Registry at the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SC/TIMST), along with the WHO, the annual incidence rate of stroke in the State is 135/100,000, with the mortality rate approximately being 25 per cent. About 40-50% of these patients will have moderate to severe disability for life. Approximately 12 per cent of all strokes occur in population less than 40 years of age, according to the Stroke Surveillance India report 2006 by WHO.  The 108 emergency ambulance services under Kerala Emergency Medical Services Project, reached 77 stroke cases to hospitals in the month of September alone.  On World Stroke Day, the emphasis is on spreading more awareness on the silent epidemic of stroke in the community and more importantly, getting the public as well as primary care physicians to learn to recognise the warning signals of stroke.

A stroke or ‘brain attack’ occurs when a blood clot blocks an artery or when a blood vessel in the body ruptures, affecting the flow of blood to the brain and thus damaging the brain cells. The severity of the stroke depends on the extent of brain damage and the location on the brain where the damage has occurred. “Recognising stroke signals and getting the patient to a hospital within the time window of three hours continue to be a major hurdle in stroke management across the world. But with proper training and a well-founded protocol, it is possible to train the general public as well as physicians to recognize stroke signals and act on it without delay,” says P. N. Sylaja, Additional Professor of Neurology and in charge of the Comprehensive Stroke Care program at SCTIMST. Any unusual symptoms which may be quite sudden should be paid attention to, says Dr. Sylaja. A sudden feeling of weakness, blurring or loss of vision, difficulty in speech, a sudden confusion, unsteadiness in gait or loss of balance, a sudden, severe headache could all signal a stroke. People often mistake some of these symptoms to be due to hypoglycaemia or low sodium levels and could totally miss the stroke signals.

There is also the Transient Ischaemic Attack (TIA) or mini stroke, which has all the symptoms of stroke but all of which disappears within 24 hours. TIA is not to be ignored because it is the warning of an imminent major stroke. Studies have shown that up to 20 per cent of those who experience TIA go on to have a major stroke in the next 90 days. . About 15 per cent of stroke victims coming to the hospital would certainly have had a TIA before but they would not have got investigated as the symptoms did not last. “TIA is considered a medical emergency now. Picking up these cases of minor strokes and investigating these patients can drastically bring down stroke incidence. Often, doctors too might miss when the patient describes a TIA event – the patient would describe how he felt a numbness or lost the ability to speak for three minutes and how it all came back to normal soon. It is important that doctors learn to pick up these from the patient during interactions,” Dr. Sylaja says.

Stroke or TIA can occur in any person, regardless of gender and age, even though there are certain common risk factors like advanced age, and co-morbidities, tobacco use, hypertension and diabetes carry substantial additional risk that one needs to pay special attention to. When it comes to stroke, `Time lost is brain lost’ and what is important is that the person is rushed to a medical facility where a neurologist and CT scan facility are available. Treatment is possible and there are chances of recovery, for up to four and a half hours after the event. In our settings patients are brought in often eight to ten hours after the event when there is no scope for treatment. But then even in the U.S, less than 10 percent of stroke victims reach hospital on time The National Health Service (NHS) in UK has been successfully using the acronym -- F.A.S.T – to generate awareness among the public on recognizing stroke and to encourage them to act fast. F.A.S.T refers to Face, Arms, Speech, Time. Face - If you think that a person might be having a stroke, ask the person to smile and see if the smile is drooping. Arms - tell the person to raise both arms and hold it and see if he is able to do it. Speech – check if the speech is slurred. If any of these symptoms are there then Time is crucial and rush the person to the hospital

                                                                               Prof. John Kurakar