4500 in India! That is incredible to me!
Stroke / brain attack is now the second commonest killer in the world after heart attack and the first and foremost cause of permanent disability. It is responsible for more deaths annually than those attributed to AIDS, tuberculosis and malaria combined and in India alone, 4,500 people get a stroke every day. However, stroke is eminently treatable and preventable but timely medical attention is critical.
Stroke is a catastrophe, presenting commonly as a sudden onset paralysis of one side of face, or one hand and face or one full half of the body with or without loss of sensations. Loss of ability to speak and understand spoken words is another common feature. Losing vision on one side of visual field or one eye is the other feature. Sudden vertigo or dizziness, vomiting, loss of balance in walking, double vision, difficulty in swallowing etc. are also seen when areas affected are the lower portions of brain called brainstem. Recognition of these symptoms leads to correct diagnosis of stroke in 80% of the cases.
Strokes result most often (80%) from poverty of blood flow to parts of brain which are supplied by a particular artery feeding the brain of oxygenated and glucose rich blood which help brain to derive its energy. An active normal brain consumes more energy than any other tissue in the body. So oxygen and energy deprivation kills brain cells quickly. After a cessation of blood flow to brain, within one second around 32000 nerve cells die and it has been calculated that this may translate also into loss of 9 hours of human lifespan. Hence the most important principle in the care of stroke patients is a fast response.
The need for urgency in rushing a patient with stroke to an acute facility arise from the fact that we now have a very effective treatment using a clot busting drug called tissue plasminogen activator (TPA) which given in an appropriate stroke patient within 4.5 hours from the onset of stroke dissolves the vessel blocking clot and opens up the arteries. This reestablishes blood flow to the starved brain and prevent permanent death and loss of nerve cells which can lead to immediate recovery from paralysis or a minimization of the final severity of stroke. In the meanwhile, stroke prevention strategies have to be reinforced. For primary prevention (prevention of first ever strokes), the effective steps are to a great extent the same as for heart attacks. Most important risk factors are hypertension, diabetes mellitus, high cholesterol, obesity but also includes all forms of heart diseases. Avoidance of tobacco and alcohol and abusive drugs and regular and adequate physical activity and healthy food and sleep habits help prevent stroke.
Once someone develops stroke, it is of paramount importance to prevent further strokes. Stroke rehabilitation is a specialized area and stroke units are perhaps the most effective measures in improving stroke recovery. The role of early mobilization of stroke patients and physiotherapy and occupational therapy are well-established.
Since one of the largest obstacle to emergency treatment is that many people do not know they are having a stroke, it is critical for everyone “to be stroke smart and learn the 3Rs of stroke” which are reduced risk, recognize symptoms, respond by rushing into the nearest hospital. The world stroke organization has popularized this campaign using the acronym FAST – Face, Arm, Speech and Time.