Stroke Management

Dr Tasaduk Hussain Itoo
Stroke is one of the leading causes of death and disability in India. The estimated prevalence of stroke range from 84 to 262 per 100,000 in rural and 334 to 424 per 100,000 population in urban areas. Based on the recent population- based studies the incidence rate of stroke range from 119 to 145 per 100,000 population. In Jammu and Kashmir, stroke is also very common. As a part of health awareness initiative , I interviewed Dr Ankush Sharma ( DM Neurology PGI Chandigarh) regarding Stroke.
What is a Stroke in simple terms?
A stroke is sudden reduction of blood supply to brain tissue due to blockage of a blood vessel or sudden rupture of a brain blood vessel. In both cases brain tissue is deprived of oxygen and nutrients and hence begins to die.
Is Stroke a medical emergency?
Yes, a stroke is a medical emergency. Prompt treatment is crucial as we lose nearly 2 million neurons every minute after stroke. Early action can minimize this damage and potential complications.
What are the most common signs and symptoms of stroke?
Stroke can present in different ways. Common sign and symptoms are
Sudden onset trouble with speaking and understanding. You may experience confusion. Your speech may be slurred or there can be difficulty in understanding speech.
Sudden onset weakness or numbness of the face, arm or legs. This often happens just on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.
Sudden onset trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
Sudden severe headache which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you’re having a stroke.
Sudden onset walking difficulty. You may stumble or experience sudden dizziness, loss of balance or loss of coordination. Note that these things happen SUDDENLY.
What are the most common causes of stroke?
A stroke may be caused by a blocked artery (ischemic stroke) or the rupture of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn’t cause permanent damage.
What are the most common risk factors for a stroke ?
Many factors can increase your stroke risk. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include:
Lifestyle risk factors
Being overweight or obese
Physical inactivity
Heavy or binge drinking
Use of illicit drugs such as cocaine and methamphetamines
Medical risk factors
High blood pressure
Cigarette smoking or exposure to secondhand smoke
High cholesterol
Obstructive sleep apnea
Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm.
Personal or family history of stroke, heart attack or transient ischemic attack.
What are the common complications of a stroke?
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacked blood flow and which part was affected. Complications may include:
Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities affected by paralysis, such as walking, eating and dressing.
Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly (dysarthria), swallow (dysphagia) or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. Therapy with a speech-language pathologist might help.
Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts.
What are the best possible measures that one can take to prevent a stroke?
Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:
Controlling high blood pressure (hypertension). This is one of the most important things you can do to reduce your stroke risk. If you’ve had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke.
Exercising, managing stress, maintaining a healthy weight and limiting the amount of sodium and alcohol you eat and drink can all help to keep high blood pressure in check. In addition to recommending lifestyle changes, your doctor may prescribe medications to treat high blood pressure.
Lowering the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaque in your arteries. If you can’t control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.
Quitting tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.
Controlling diabetes. You can manage diabetes with diet, exercise, weight control and medication.
Maintaining a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Losing as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.
Eating a diet rich in fruits and vegetables. A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke. Following the Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful.
Exercising regularly. Exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
Avoiding alcohol , if at all. Alcohol can be a risk factor for stroke. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes.
Avoid illegal drugs. Certain street drugs, such as cocaine and methamphetamines, are established risk factors for a TIA or a stroke. Cocaine reduces blood flow and can narrow the arteries.
(The interviewer is a Practicing Physician, motivational speaker, columnist, activist, educator, Journalist)