A report by the Indian Stroke Association indicates that approximately 18 lakh stroke cases are reported every year in India. Stroke is presently the third leading cause of mortality and the sixth leading cause of disability adjusted life years in India. Every year, the October 29 is observed as World Stroke Day to build public awareness about the condition and to find ways to reduce the burden of stroke. This year’s World Stroke Day theme #precioustime revolves around the importance of timely medical care and why every second matters when a patient has a stroke.
What is stroke?
Stroke is a temporary interruption of blood supply or temporary seepage of blood into the brain, which causes a sudden neurological deficit, said Dr Amit Kulkarni, Senior Consultant Neurologist and Stroke Specialist, SS SPARSH Hospital. “It can lead to sudden weakness, numbness, giddiness, imbalance, vision problems, sudden confusion and speech difficulties. The critical thing to note here is the word ‘sudden’ because stroke symptoms are sudden and unexpected,” Dr Kulkarni said.
As mentioned above, there are mainly two kinds of strokes – Ischemic stroke where the blood supply to the brain is interrupted, and the other is hemorrhagic stroke which occurs when there is a seepage of blood in the brain caused due to a ruptured blood vessel.
Risk factors for stroke
Dr Kulkarni noted that though there is a common understanding that stroke occurs only among the elderly, it is true that stroke is seen among the younger population, too. “Hence, indicating that there is no age bar for stroke. The age group of 60 or older is the commonest age group who are affected by stroke. About 10-15 per cent of strokes occur in people younger than 45 years which includes children as well,” he said.
Common risk factors include the following
*Hypertension
*Diabetes
*Atherosclerosis: A condition in which there are cholesterol deposits in the blood vessels that compromises blood flow- carotid stenosis and intracranial stenosis (blockage of brain arteries)
*Smoking, sedentary lifestyles, and high alcohol consumption
*Atrial fibrillation (irregular heart rhythm)
*LV dysfunction (poor capacity of the heart to pump blood)
*Obesity and obstructive sleep apnea
*Genetics and some environmental factors
“Similar to how cholesterol deposits in the coronaries of the heart can lead to heart attack, deposits in the arteries of the neck or brain can also cause a stroke by a mechanism of plaque rupture causing further blockage of the arteries. Indians and Asians have a higher proportion of stroke patients with intracranial atherosclerosis- blockage of brain arteries (ICAD) as compared to the Western population,” said Dr Kulkarni.
It is important to pay attention to signs and symptoms of stroke (Source: Getty Images/Thinkstock)
BE-FAST in recognising stroke symptoms
When it comes to spotting a stroke, BE FAST acronym should be followed. Here are some signs to watch out for
B – Balance: Sudden loss of balance or difficulty walking in a straight line
E- Eyes: Sudden squinting of the eyes or loss of vision in the eyes.
F- Facial: Facial drooping on one side or deviation of angle of mouth to one side
A-Arm weakness: When they are unable to lift or hold something with the arm
S- Speech: Sudden loss of speech. The person is not able to speak even one or two words. There can be loss of language function or speech is slurred or both
T – Timely action: When you see these symptoms, call the ambulance immediately and shift the patient to the nearest stroke-ready hospital.
“In hemorrhagic stroke (leakage of blood within brain substance or subarachnoid space), symptoms such as sudden severe headache, loss of consciousness or seizures may also be seen in patients. The usual cause in such cases is high blood pressure or abnormality in the arterial wall or abnormal communication between an artery and vein,” Dr Kulkarni mentioned.
Treatment for ischemic stroke
Timely treatment can significantly improve the patient’s chances of recovery. Once the patient is shifted to a stroke-ready hospital, a clot buster is administered to break the clot that is causing the interruption of blood flow. “It can be given up to 4.5 hours from the onset of symptoms. The earlier the clot buster is administered, the better the results,” said the expert.
If any of the major arteries are blocked-LVOs (Large vessel occlusions) (MCA, ICA, Basilar artery) which is detected by CT Angiogram or MR Angiogram, then it is less likely that IV clot buster alone will open the artery. “In such cases, DSA (Digital subtraction angiogram) is done and a guiding catheter followed by a stent retriever is passed via groin puncture, which engages the clot and the clot is extracted. This procedure can help substantially reduce disability and mortality in large vessel strokes. This can be done upto 6-7 hours in LVOs and in small percentage of patients, upto 24 hours also based on CT/MR perfusion studies,” Dr Kulkarni noted.
Stroke rehabilitation – Regaining strength after stroke
If the doctors can break the clot on time and establish blood circulation, the impact is minimised, said Dr Kulkarni. “If the patient does not have access to immediate treatment, it may lead to complete loss of speech and weakness on the right side of the body or a neglect of one side of the body, leading to more permanent disability and higher mortality,” Dr Kulkarni said.
The process and the timelines for rehabilitation depend on the severity of the stroke. Stroke impacts a person both physically and emotionally. For someone who has been active throughout their lives and when they suddenly find themselves confined to a wheelchair, they may experience anxiety and in some cases depression too apart from physical inability. Rehabilitation is essential to help the patient recover lost skills, capabilities and overall confidence.
The rehabilitation plan revolves around specific bodily functions that are impacted by stroke. It can include the following
– Physical therapy- muscle strengthening and improving muscle coordination and regaining range of motion.
– Walking balance and gait training
– Speech, language and swallowing therapy
– Occupational therapy
– Psychosocial counselling and support
The timeline of the rehab can begin as early as 48 hours after stroke onset (as soon as stroke symptoms stabilise, not necessarily until symptoms start improving). It continues for a few weeks depending again on the severity and location of the stroke, the expert said.
SPOT Stroke, STOP Stroke
“The phrase ‘time is brain’ indicates that a patient loses 1.9 million neurons each minute as the stroke progresses. Therefore, time is of the essence in stroke treatment. Whenever the symptoms show, you must rush to a stroke-ready hospital. Hence, the acronym, spot stroke, stop stroke, explained Dr Kulkarni.
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Here's all you need to know about strokes (Source: Getty Images/Thinkstock) 
It is important to pay attention to signs and symptoms of stroke (Source: Getty Images/Thinkstock)
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