Stroke - Preventable as well as treatable

Beyond World Stroke Day October 29.. Today, disabilities and deaths due to strokes pose a major challenge to both developed and developing countries. Every year six million people die from stroke and the number increases daily, the majority (89 percent) being in low and middle income countries. In fact, stroke is responsible for more deaths every year than the deaths attributed to AIDS, TB and Malaria put together. In addition to being the second leading cause of deaths for people above 60 years, Stroke has now become the fifth leading cause of death of people in age group of 15 to 59... Globally stroke is the leading cause of disability. The World Stroke Organization (WSO) declaring Stroke Day as an annual event in 2006 described it as a public health emergency in 2010 calling for urgent action to address this silent global epidemic. What led to this sharp spike in strokes? Is stroke preventable, treatable, and manageable? What facilities do stroke victims have in Sri Lanka? Following are some answers given by the Consultant Neurologist and President National Stroke Association, Dr. Padma Guneratne when she fielded questions on the topic at a media discussion held at the Health Education Bureau... Q. How common is stroke worldwide? Worldwide stroke accounts for 5.7 million deaths annually, of which 80 percent occur in low and middle income countries. It ranks the second cause of death to heart disease. It is the commonest cause for adult disability sparing no age, sex, ethnicity or country. Q. What is the incidence of stroke in Sri Lanka? Stroke is the leading cause of hospital deaths in Sri Lanka. In Sri Lanka, each year there are about 25,000 people who develop stroke according to the official statistics and this trend is on the increase Q. How is stroke caused? Eighty five percent of patients succumb to stroke when their blood vessels get blocked interrupting blood supply to a certain part of the brain. Others get stroke due to a rupture of blood vessels that leads to bleeding into the brain tissue. The main reason for both these situations is thickening of blood vessels. The thickening is caused by a process called atherosclerosis. Q. How would you recognize a stroke? Sudden development of the symptoms such as numbness or weakness of the face, leg and arm; confusion or trouble speaking or understanding speech; dimness or loss of vision of one eye, loss of balance or unsteadiness can lead to a stroke. When symptoms of stroke improve within 24 hours, it is called mini strokes. It is a severe condition that needs urgent medical attention to mitigate the risk of occurring a major stroke. Of the patients who get Transient Ischaemic Attacks (TIA) or silent mini strokes, four to eight percent may get stroke within one year, and 24 to 29 within five years. Q. What are the risk factors? There are several reasons for having atherosclerosis. Aging and genetic predisposition are important but they are non-modifiable reasons. High blood pressure and smoking are the most important modifiable reasons. Unhealthy diet and lack of exercise leading to development of most other modifiable risk factors such as diabetes mellitus, high cholesterol content, overweight are also important risk factors. Stress in day-to-day life is another. Q. How does one prevent stroke? Know your blood pressure and have it under control. Refrain from smoking, Reduce salty and oily food. Consume plenty of fruits and vegetables. Limit alcohol intake. If you have diabetes and cholesterol, get these two conditions treated and brought under control after consulting a medical professional. If you are under stress for any reason, take time to relax since stress can lead to a rise in your blood pressure. Further, if you experienced any stroke symptoms including sudden weakness of the face or limb, blurring or loss of vision and speech disturbances, seek immediate medical attention. Q. How does one treat or manage a stroke? Strokes are best managed in major hospitals with facilities for CT scanning of the brain. CT scanning clearly differentiates blockage of blood vessel due to a rupture. After the initial emergency management, the patients need long term rehabilitation for secondary prevention. Q. Where can this be done? Long-term rehabilitation is best done in wards meant for stroke patients (Stroke Units.) Stroke care involves availability of services or multidisciplinary teams for organized stroke care and rehabilitation Q. What do you suggest? We should build a healthcare system that responds to the need of the patients in stroke units providing them with individual attention. Q. What happens to patients who are discharged from hospitals? If they need long-term care, who takes care of them? Due to the high turnover of indoor patients in government hospitals, stroke victims are discharged as soon as possible. Although they are discharged from the hospital, they need prolonged rehabilitation services. There are also differently able stroke patients. It is an obligation of a caring physician to refer these differently able stroke patients to a social worker appointed to hospitals. As most of these patients are unable to afford rehabilitation services in the non-governmental sector, medical personnel can make a formal request to the relevant Division al Secretaries (AGA) of the residential area of the patient, to provide them with Community Based Rehabilitation (CBR) services. Several districts are covered by this CBR program and volunteers have been trained to rehabilitate persons with disabilities within the community by the Ministry of Healthcare, Nutrition and Social Services and Social Welfare.