Experts warn of high stroke incidence in Kashmir

Srinagar, Oct 28: Leading neurologists and cardiologists in Kashmir have issued a call to prioritize stroke prevention and management, citing worrying trends in the incidence and nature of strokes in the region. On the eve of World Stroke Day, experts highlighted the pressing need for public awareness and improved healthcare strategies to tackle what has been declared a global health emergency.

Dr Bashir Ahmed Sanaie, Head of the Department of Neurology at GMC Srinagar, noted that stroke is the second most common cause of death and the third leading cause of disability worldwide. "Although research on stroke incidence in Kashmir is limited, available studies suggest that stroke rates here may be higher than in other parts of the country," he said, urging that addressing this crisis should be a priority.

Experts advocate for a multi-faceted approach, focusing on prevention, rapid symptom identification, and immediate expert intervention to curb the rising incidence of stroke in Kashmir and save lives. Dr Sanaie said his department was actively involved in educating patients and the general population about the risk factors of stroke and had advanced in management and quality of life after stroke.

Adding depth to the discussion, former GMC Srinagar Neurology Head Dr Parvez Ahmed Shah presented findings from his extensive research on strokes in Kashmir. "Globally, ischemic strokes, caused by vessel blockages, are most common. However, in Kashmir, hemorrhagic strokes, which result from blood vessel ruptures, are more prevalent," Dr Shah said, attributing this to high hypertension rates, smoking, dyslipidemia, diabetes, and inconsistent adherence to hypertension medications. He emphasized the need to reduce salt intake, noting that many in Kashmir consume 8 to 10 gm per day, largely due to the traditional consumption of salted tea (Noon Chai). “For those with hypertension, salt intake should be limited to less than 2 grams daily,” he advised, also cautioning against over-the-counter cold medications, which can increase blood pressure.

Dr Khalid Mohiuddin, Head of Cardiology at GMC Srinagar, highlighted the increasing stroke risk among Kashmir’s ageing population and noted that strokes are more common in winter. “Atrial fibrillation is a major contributor to ischemic strokes in Kashmir. Anticoagulants are crucial for managing AF, but in cases where bleeding risk prevents their use, a left atrial appendage device can be placed in the heart,” he advised, stressing the need for timely AF treatment.

Discussing stroke management, Dr Mohiuddin outlined that thrombolysis, a clot-busting treatment, should be performed promptly to dissolve ischemic clots. If unsuccessful, thrombectomy—a procedure accessing the clot through a neck vessel—can be pursued. He praised the expertise available in Kashmir’s tertiary care centres, where radiologists, cardiologists, and neurologists collaborate to improve stroke outcomes, though similar resources are lacking in peripheral areas.

"Time is everything in stroke," Dr Mohiuddin said, highlighting that recognizing stroke symptoms, such as sudden weakness, dizziness, slurred speech, facial drooping, and loss of consciousness, and seeking immediate medical assistance is crucial for recovery.

“My warning: Don’t waste time seeking treatment at a hospital where a team of cardiologists, radiologists and neurologists is unavailable. We also need to have advanced imaging available to treat a clot immediately,” he said.

Dr Imran Hafeez, a specialist in cardiovascular diseases working as an Additional Professor at SKIMS Soura, explained that certain strokes, especially embolic strokes, often originate from heart issues like atrial fibrillation (AF), an abnormal heart rhythm that can lead to clot formation. “In patients with AF, the irregular heartbeat can send a blood clot to the brain, causing a stroke. Patients should be evaluated for non-valvular AF using a Holter monitor,” he recommended. He emphasized managing lifestyle factors and insulin resistance to reduce stroke risk: Prevention of strokes is possible, and it has to start now for every individual. Dr Hafeez also participated in the Run for Stroke event organised by the Department of Neurology, GMC Srinagar today.