World Stroke Day: Prevention is better than cure

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World Stroke Day 2021: When actor Sidharth Shukla died at the 40 due to heart attack, it left the entire television industry shocked. This was the time when some of the people from the industry realised the importance of working hard but not at the cost of their own lives. Actor Rahul Roy experienced a brain stroke in 2020 and after listening to the news of Shukla’s demise, he advised actors to not let work get the better of them.

It is not about actors alone. As per the Indian Stroke Association, 17 million people suffer a stroke each year of which six million die and five million remain permanently disabled. And 80 percent of stroke deaths occur in lower- and middle-income countries including India due to inadequate preventive and stroke management facilities. Lack of awareness about the signs and symptoms of the disease plays a major role in making it a leading cause of mortality and disability in India.

Understanding stroke

When the blood supply to a certain part of the brain is interrupted or reduced, a stroke occurs. It prevents brain tissue from receiving vital nutrients and oxygen causing the cells to die. There are two types of stroke – a blocked artery (ischemic stroke) or leaking of a blood vessel (haemorrhagic stroke). In certain cases, there is a temporary disruption in the blood flow to the brain that does not cause lasting symptoms, known as a transient ischemic attack.

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The most common type of stoke is ischemic stroke that happens when the brain’s blood vessels become blocked or narrow, restricting blood flow. The clogged blood vessels are caused by fatty deposits that build up in the vessels or by blood clots that move towards the blood vessel in the brain through the bloodstream. When the blood vessel in the brain ruptures or leaks due to certain healthcare conditions, haemorrhagic stroke occurs. These conditions include uncontrolled high blood pressure, trauma, protein deposits in blood vessel walls, ischemic stroke leading to haemorrhage, overtreatment with blood thinners and bulges at weak spots in the blood vessel walls. Transient ischemic attack occurs when a debris or clot reduces blood flow to part of the nervous system and lasts as little as five minutes.

Being vigilant of signs and symptoms of stroke

Several factors can increase a person’s chance of stroke including being overweight or obese, physically inactivity, heavy drinking, use of drugs, cigarette smoking, high blood pressure, high cholesterol, diabetes, obstructive sleep apnoea, cardiovascular diseases such as abnormal heart rhythm, heart failure and family history of stroke. Other factors like age, race, gender, and hormones also become causes of stroke at times.

Confusion or have difficulty understanding speech, paralysis or numbness of the arm, leg, or face, problems seeing in one or both eyes, headache, and trouble walking are some of the most common signs and symptoms of a stroke. A stroke can sometimes cause temporary or permanent disabilities depending on which part of the brain was affected due to lack of blood flow. If any symptoms of a stroke are noticed, it is advised to think ‘FAST’ and seek medical intervention immediately.

Treating stroke with advanced technologies

When a person is rushed to the hospital with symptoms of a stroke, the emergency team first tries to determine the type of stroke by carrying tests such as CT scan, MRI, carotid ultrasound, cerebral angiogram, and echocardiogram. The treatment is carried depending on the type of stroke the person has suffered from.

At times, some people are diagnosed with atrial fibrillation – an irregular and rapid heart rhythm problem leading to blood clot formation in the left atrial appendage (LAA) of the heart. Such people are at four to five times higher risk of stroke. Some people also have an opening in the heart valve prior to birth called foramen ovale which mostly closes at birth. However, in about 25 to 33 percent cases the opening remains open and is called patent foramen ovale (PFO). PFO does not cause any medical problem for most people but in for some people it may allow a blood clot to pass from one side of the heart to other and then to the brain, resulting in a stroke.

For such patients, minimally invasive procedures are used that entail reduced hospital stays, less infection and give patients a better quality of life. During the procedure, LAA and PFO are closed with a device called occluder with the help of a catheter. This prevents the blood clots from moving towards the brain and obstructing blood vessels.

Prevention is better than cure

Even when we are endowed with cutting-edge healthcare technologies today, prevention has always been better than cure. Knowing the risk factors, following the recommendations by the doctor, and adopting a healthy lifestyle can prevent a stroke. Some healthy lifestyle recommendations like controlling high blood pressure or hypertension, lowering the among of saturated fat and cholesterol in the diet, quitting tobacco use, drinking in moderation, managing diabetes, maintaining a healthy weight, eating a diet rich in fruits and vegetables and exercising regularly can go a long way in living a healthy life.

It is also imperative to spread awareness around the disease and the latest treatment options available. Hospitals and clinics should upgrade their diagnostic facilities of stroke by embracing advanced technologies like insertable cardiac monitor, portable ECG, and mobile applications for surgeons to monitor their patient’s health condition.

(Dr. P K Hazra is Senior Consultant Interventional Cardiologist, AMRI, Kolkata)

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