Females are MORE affected by Stroke

This year’s theme for the World Stroke Day ( marked every 29th October to focus attention on Stroke )  was ‘ I am a woman’. It is to make the people aware that the females are more affected by stroke

More than half of the new strokes occur in women and one out of every five women with stroke die.The reasons for this could be many, e.g. females have increased risk of stroke during pregnancy and peurpurium(delivery), and they on an average live longer than males.

Stroke or paralysis( in layman’s term) is a brain disorder which results due to decreased or cut off of blood flow or rupture of blood carrying tubes in the brain. It is a global epidemic problem. Stroke is the most important neurological problem which results in disability of the affected individual and greatly affects the whole family because of the economic burden it results in.

It occurs mostly suddenly. Many people fail to recognize this problem as stroke which results in delay in treatment. In most cases stroke is preventable if proper care is taken care of the risk factors. It is called “brain attack” similar to heart attack to make the people realize the importance of seeking medical advice as early as possible which can significantly reduce the long term disability.

29th of October every year is observed as World Stroke Day with different themes to educate the public about the symptoms, advances in investigations and treatment modalities.

Stroke is turning into a major public health problem in third world countries because of increased incidence of Diabetes and Hypertension in addition to changes in life style in these parts of world

It is the third leading cause of death all over the world.. It affects nearly 20 million people all over the world per year. About 5 million die of stroke in a year all over the world. Nearly 80 % of all strokes deaths occur in developing and underdeveloped countries.

Brain attack or stroke is of two major types 1. Ischemic stroke (stroke due to blockage of decrease or blockage of blood flow) 2. Hemorrhagic stroke (stroke due to rupture of blood tubes). About 80% of all strokes are due to ischemia and only 20% are due to hemorrhagic

Stroke occurs mostly after the age of 55-60 years; however it can occur at any age due to different causes. About 15-20% occurs below the age of 40 years. The stroke frequency increases steadily after the age of 60 yrs and maximum incidence are in the age group of 80 yrs

There are multiple risk factors for developing stroke. Some can be modifiable some cannot be.

The most common modifiable risk factors are 1. High blood pressure for long time 2. Diabetes mellitus . 3. Smoking 4. Excessive alcohol consumption 5. Increased cholesterol (Lipids) and obesity 6. Heart diseases

High blood pressure is the most commonly observed risk factors in majority of the stroke patients.. Even small reduction of BP can make a significant reduction in the number of stroke patients.

The risk factors which cannot be modified are 1. Hereditary 2. Black race 3. Age and 4. Gender (more in females because of few special reasons i.e. pregnancy, peurpurium (post delivery period)

The symptoms of stroke depend on the area of brain involved. It can vary from simple numbness to deep coma and death. The most common symptoms are 1. Difficulty to speak 2. Weakness of a part of the body 3. Loss of vision 4. Loss of balance 5. Acute confusion 6. Altered state of consciousness 7. Acute severe headache.

For common man to identify the stroke a simple pictorial instruction is published which is called ‘ACT-F.A.S.T’

People can identify most strokes if they identify a person with the above symptoms

Unfortunately the percentage of people who can identify the early symptom of stroke is significantly low in third world countries including India. This is true even in urban areas.

Doctors usually do either a CT scan brain or MRI scan brain to all patients who presents with symptoms of stroke along with few blood investigations.

Most people think stroke cannot be treated by modern medical or surgical methods and don’t bother even to take the patient to hospital unless he is unconscious or any other major events occur. Majority resort to native medicines and other spiritual methods to treat stroke.

For the past one to two decades there has been a tremendous advancement in the field of stroke in terms of investigation, and treatment.

From 1995 onwards with the land mark study of NIND (national institute of neurological diseases-USA) about the usage of ‘CLOT BUSTER’ drug r-tpa ,thousands of stroke affected people have improved significantly and have had minimum or no long term disability. With the usage of this drug ‘rtpa’ more and more neurologist all over the world have made millions of stroke affected person’s life comfortable.

The only difficulty to treat with the above drug is the time factor. The affected individual should reach the hospitals where this facility available within 4.5 hours after the first symptoms is noted, it is also called ‘Golden Hour’ for the treatment of stroke. A lot of initiative should start from NGOs, government bodies and private sectors to educate the public about the availability of this drug and the importance of taking the stroke affected persons to hospitals as early as possible.

There are many other options are available for those who cannot reach in this time. These are intra arterial thrombolysis, usage of MERCY devises, stenting procedures etc. which are available in some major hospitals in India. Apart from medical management many surgical options are also available in the management of stroke due to different causes.

The drugs like Ecospirine, and clopidogrel which are called “blood thinners ” and anticoagulants are the most popularly used ones

Many people think that stroke improvement stops after few months after the initial treatment. It is well known now that stroke improvement is a continuous process with proper rehabilitation and medications. There is need for many more well equipped rehabilitation centers for stroke along with specialized medical personnels.

Many initiatives have been started by the government to educate the public about the stroke and the treatment available. Unfortunately these facilities are available in major hospitals and metros and India being predominantly rural population majority of the affected cannot get the benefit of these advancements in stroke treatment.

These awareness initiatives should also reach to the rural areas so that the stroke affected individuals can be shifted to the centers where these facilities are available. Stroke is a leading cause of death in rural India.

Please remember time lost is Brain lost, the earlier the stroke affected person seeks medical advise the better chances to improve significantly.

Dr.Sreekanta Swamy

M.D, D.M
Senior Consultant in Neurology
Apollo Hospital, Bangalore- India