Understanding Strokes

You might often hear people talking about their fathers or elder brothers who suffered strokes and have been bedridden since. Despite having diabetes and blood pressure issues, they used to walk and do daily morning rounds in the park. After a stroke, they not only stopped their morning walks but also needed help just to reach the bathroom. Friends and relatives often mention "stroke" in conversations, describing how the victim developed weakness in their hand or leg, stumbled while walking, and required assistance. These individuals frequently become emotional, tear up easily, lose their temper over small things, or experience memory loss after a stroke.

What is a Stroke?

A stroke is a sudden attack of unconsciousness, paralysis, or both. While unconsciousness might fade, paralysis often remains, affecting the hand or foot. Strokes used to primarily affect the elderly, but now, with the rising number of diabetics, even middle-aged individuals, as young as 50, are at risk.

Warning signs of Stroke

The warning signs of a stroke can be remembered with the mnemonic "BE FAST":

• Balance: Sudden loss of balance or coordination.
• Eyes: Sudden trouble seeing in one or both eyes.
• Face: Facial drooping, usually on one side.
• Arms: Sudden weakness or numbness in one arm.
• Speech: Sudden difficulty speaking or understanding speech.
• Time: Time to call emergency services immediately.

The Deadly Nature of Strokes

Stroke has become a leading cause of death worldwide, especially among diabetics and heart patients. Men are one and a half times more likely to develop strokes than women. For diabetics experiencing a first-time stroke, 40% may not survive. Those who suffer a second stroke face a 35% mortality rate, and with a third stroke, 65% succumb. The impact on human lives, particularly among diabetics, is immense.

Understanding T.I.A. (Transient Ischemic Attacks)

T.I.A., or "mini-stroke," involves temporary loss of consciousness and weakness, lasting less than 24 hours. Without preventive measures, about one-third of T.I.A. patients will suffer a major stroke within five years. It's crucial for T.I.A. patients to take precautions and consult both a neurologist and vascular surgeon to prevent a major stroke. T.I.A. is often caused by narrowing or blockage of the blood vessels in the neck that supply blood to the brain.

Risk Factors for Major Strokes in Diabetics

1. Advancing age or elderly people
2. T.I.A. patients
3. High blood pressure patients
4. Patients with heart disease

Elderly individuals with high blood pressure and a history of heart attacks are highly likely to experience T.I.A. or major strokes. Diabetic patients who are obese or smokers are also at high risk.

The Role of Cholesterol and Atherosclerosis

In 90% of stroke cases, fat and calcium buildup in the neck's blood vessels (atherosclerosis) is the main cause. This process decreases blood supply to the brain and can lead to brain damage. In 10% of cases, external pressure on the blood vessel, birth defects, or heart clots cause strokes.

How Fat and Cholesterol Cause Strokes

Fat and cholesterol deposits in the neck's blood vessels cause swelling and blockages, reducing blood flow to the brain. These swollen areas can bleed internally, blocking the vessel further, or burst, sending debris to the brain and causing strokes. Ulcers can also form, leading to repeated clotting and stroke attacks.

The Importance of the Carotid Artery

The carotid artery, a main vessel in the neck, supplies blood to the brain. Problems in this artery are responsible for two-thirds of stroke cases. Keeping the carotid artery healthy and free of fat deposits can prevent strokes in 85% of patients.

Causes of Reduced Blood Flow in the Carotid Artery

Reduced blood flow can be caused by the artery's excessive length, external pressure from tumors or cancers, and fat deposition due to diabetes. Inflammation diseases like "Takayasu" or injuries from accidents can also block blood flow, leading to strokes.

What Should Diabetics Do?

Diabetics experiencing sudden dizziness or weakness should immediately consult a vascular surgeon to check the health of their carotid arteries. Those who have already had a stroke should work with their neurologist to seek consultation with a vascular surgeon to minimize the risk of future strokes.

Dr. K.K. Pandey, Deppt. Of Vascular & Cardiothoracic Surgery, Indraparasth Apollo Hospital, New Delhi