Brain Stroke | Act Now, Prevent and Save Lives

Stroke is sudden impairment or loss of consciousness, sensation and voluntary motion that is caused by blockade or rupture of a blood vessel supplying the brain and is accompanied by permanent damage of brain tissue. It arises because of interruption of blood supply to a portion of the brain.

The most common cause is a clot formation in one of the blood vessels supplying the brain. The degree of disability depends on where the stroke occurs in the brain and how much of the brain is damaged?

For example, someone who has a small stroke may experience only minor problems such as weakness of an arm or leg. People who have larger strokes may be paralyzed on one side or lose their ability to speak. Some people recover completely from strokes, but more than two thirds of survivors will have some type of disability. Although stroke is more often seen in older people but younger persons also get it.

Stroke is a huge problem with one person in India succumbing to stroke every 4 minutes. Every year around 1,85,000 strokes are reported. To handle this enormous burden the number of certified neurologists in India are only 2,500, amounting to 1 neurologist for 5 lakh population. According to WHO a minimum of one neurologist should be available for 1 lakh patients. In this situation health education for masses and paramedical workers assumes great importance. Strokes are common in Jammu Kashmir and Ladakh.

Although effective therapies are available for treatment, they need the patient to arrive at a center with CT brain facility to rule out an internal bleed at the earliest before giving clot dissolving medication. The time window is up to 4.5 hours but first 90 minutes have the best results. To achieve this a very early recognition of stroke by the family members or those with him is exceedingly important. Therefore, all the importance should be given to the earliest recognition to salvage the patient. Besides this we need to educate public at large regarding the preventive measures.

Early Recognition of Stroke:

To make it understandable an acronym FAST should be remembered. F= facial asymmetry, drooping of one side when asked to show teeth or smile. A= Arm, assess arm weakness by asking it to be lifted. S= speech difficulty and slurring T= Time elapsed. Remember time is very important and every minute counts before patient reaches a treatment facility. Similar acronyms can be made in local languages like MUHBBT in Urdu/Hindi (Muh=face, B= bazoo, B= baat, T=time) etc. Patients with any one of these features need to be rushed to a health care center for timely treatment.

Measures for preventing a Stroke:

According to epidemiological data more than 80% strokes can be prevented. These measures are simple but need a periodic medical check and treatment of the below enumerated risk factors given in order of importance.

1. High Blood Pressure: the most important risk factor for both ischemic due to clotting) or hemorrhagic stroke (rupture of a vessel in brain is hypertension (HT). Early detection of HT and effective treatment to keep the BP less than 130/80 but more than 120/80 mms Hg. This can be achieved by good life style and supervised medical treatment.

2. Physical Activity: Regular exercise amounting to at least 8,000 steps per day or 30 to 45 minutes of brisk walk in all weathers throughout the year for at least 5 days per week.

3. Keeping Bad Cholesterol Low: A heart healthy diet, restriction in eating red meat and treating high levels with safe drugs like atorvastatin or rosuvastatin under guidance. Aim is to keep the LDL cholesterol below 70 mgs/dl especially in those where other risk factors are present.

4. Healthy Diet: rich in fruits, fresh vegetables, nuts and low in carbohydrates and sugars like bakery products. Keeping large servings of rice or Roti’s as the staple food with fat rich curries leads to unhealthy traits leading to increase in vascular events like heart and brain attacks.

5. Keeping body weight, Body Mass Index (BMI) and Waist Hip Ratio, WHR) in check: Overweight is defined as BMI> 25 Kgs/ M2. WHR: Less than 0.85 in women and less than 0.90 in men. All this can be achieved with exercise and dietary restrictions.

6. Psycho Social Stress: It is a very important part of modern life style. Devoting one hour a day on relaxing techniques which can vary from person to person. Spiritual meditation, exercise, yoga, sporting activities, watching a soothing movie or listening to music all can achieve it.

7. Smoking: Avoiding tobacco in all forms especially smoking of any form (Cigarette, hukkah, bidi etc.) It has been shown that quitting smoking reduces the stroke risk substantially. In several patients with stroke smoking is the only identifiable risk factor.

8. Causes related to Heart (Atrial Fibrillation): A kind of chaotic and very irregular heart beat called atrial fibrillation is a cause especially in elderly. These patients often have history of high BP. It leads to clot formation in the upper chamber of heart (left atrium). This clot when dislodged frequently gets into the small brain vessels and produces a blockage leading to a sudden onset stroke. Most of these patients depending on a scoring system need blood thinners (anti coagulants) like dabigatran, apixaban or rivaroxaban under supervision long term, It is to be noted anti platelets like aspirin, clopidogrel or ticagrelor do not work to prevent stroke in these patients. These only lead to increase in serious bleeding.

9. Diabetes Mellitus: This disease like hypertension is often silent and is an important risk factor for stroke and heart attacks. It is often associated with obesity and high BP , also called the “deadly duo” leads to a very high incidence of stroke. An early recognition and good medical treatment are important.

Bath Room and Early Morning Strokes:

It has been observed in several studies that strokes and heart attacks occur more frequently in the mornings between 7 and 9 am. These have been correlated to the act of defecation which often leads to a strain leading to an upsurge of BP leading to a haemorrhage and also platelets are more reactive in the morning leading to clot formations.

Another factor recently commented upon is that bathing habit of first putting hot water on head and scalp leads to increase in blood supply to brain leading to haemorrhage especially in persons with risk factors. It is therefore recommended to pour water on feet and legs and then go upwards.

Take Home Message:

Stroke is a devastating event and makes the life of the individual and his family miserable. Once it occurs prompt attention is needed and getting proper medical attention is extremely important. Once fully evolved treatment is only palliative. It is best to adopt measures to prevent it, which is possible by treating the risk factors like high BP, regular exercise, keeping cholesterol low, consuming healthy diet, keeping body weight in check, managing stress, cessation of smoking, using anticoagulants in patients with atrial fibrillation and recognizing and managing diabetes well.

Public campaigns to educate our population are of utmost importance. We need to mobilize stroke stakeholders around us and drive awareness and action on stroke prevention. The theme of world Stroke Day this year is “Together we can be #Greater than the stroke”.

Prof U Kaul is a Founder Director Gauri Kaul Foundation.

Recipient of Padma Shiri and Dr B C Roy Award.