India has witnessed an alarming rise in the occurrence of non-communicable diseases and most of the burden is attributable to cardiovascular diseases. According to a report by the Lancet, the prevalence of heart disease and stroke has increased by over 50 percent in India in the last three decades.
Stroke is a prominent cause of mortality due to neurological diseases in India and was responsible for 7.4 percent of total deaths.
According to the Indian Stroke Association (ISA), 17 million people suffer a stroke each year, out of which 6 million die and five million remain permanently disabled. Due to inadequate preventive and stroke management facilities, approximately eight percent deaths occur due to stroke in middle and low-income countries like India.
A stroke occurs when blood flow to the brain is disrupted — either due to a blocked whistle in the brain (ischemic stroke) or vessel bursting in the brain (hemorrhagic stroke). Once a patient has suffered a stroke, it is also likely that they suffer recurrent strokes.
Thus it is important to understand the risk associated with primary and recurrent strokes to be able to minimize them.
B - Balance
E - Eyes or trouble with vision
F - Face, does the persons face look uneven or drooping to one side?
A- Arm or Leg, does the patient have numbness or weakness in one arm or leg
S - Speech, does the patient have difficulty speaking?
T - Time to reach a stroke-ready hospital
A stroke-ready hospital is one that is equipped with facilities like a CT scanner (available 24x7) and other necessary processes to treat a stroke. Directly approaching a stroke-ready hospital makes it more likely that the patient is eligible for acute stroke therapies, which have a limited time-window.
Risk factors for stroke
Risk factors for getting a stroke can be divided into two parts -- modifiable risk factors (those which we can take preventive measures against, like hypertension or high blood pressure, diabetes, dyslipidemia or high cholesterol, inactivity and obesity) and non-modifiable risk factors (advanced age, male gender and positive family history).
Another condition that can predispose an individual to stroke is something called atrial fibrillation. It is the irregular beating of the heart which can increase the chances of stroke by recurrent clot formation.
Although stroke is supposed to be a disease of the old, India, being the diabetic capital of the world, witnesses strokes occurring in a younger age group. Smoking, oral tobacco, hukka, unhealthy lifestyle and dietary patterns lead to a higher risk of stroke.
Hypertension is the single most treatable risk factor for both ischemic stroke and hypertensive bleed. Diabetes is thw the second most important risk factor for causing an ischemic stroke.
The right treatment depends on the kind of stroke you are having.
A CT scan is required to differentiate between ischemic stroke and bleeding in the brain. Other tests may be required to look at blood vessels and the heart.
People who have an ischemic stroke or stroke due to clogged arteries can be eligible for certain clot-buster medications. In addition to this, in some special cases, the clogged arteries can be reopened within a limited time window.
People who have strokes caused by bleeding need proper management to reduce pressure on the brain, control blood pressure, and in some cases, surgery may be required.
Dedicated units with nurses and doctors trained to treat stroke patients go a long way in preventing disability due to strokes. These units help in the prevention of complications related to a stroke - like bedsores, clots in the leg, and pneumonia. They also help expedite mobility through rehabilitative therapies like physiotherapy and speech therapy. More and more stroke units are required to prevent disabilities related to stroke.
How to prevent strokes?
Strokes can be prevented by regular intake of your prescribed medication which may include blood pressure medication, medicines to lower cholesterol called statins and drugs that prevent blood clots, like aspirin and other blood thinners. Medication which helps to maintain blood sugar levels (closest to normal) is also very helpful in the prevention of stroke.
Lifestyle changes like exercise, smoking cessation and a diet that is rich in fruits, vegetables and low-fat dairy products also go a long way in the prevention of strokes. Cutting down on one's salt intake as per the recommendation of a doctor to five gram per day or one teaspoon a day, helps in stroke prevention. Movement or activity even for durations as short as one-two minutes after every one hour of inactivity is helpful. Weight loss, if you are overweight and limiting the amount of alcohol to safe limits is useful. Quitting tobacco in all forms whether oral tobacco, cigarette and bidi is useful.
Dr Neetu Ramrakhiani is director of neurology at Fortis Escorts Hospital, Jaipur. Stroke is a special area of interest for her and she is currently involved in developing stroke unit at Fortis Escorts Hospital, Jaipur. She has authored an editorial in Neurology India and is principal investigator in a pilot project under Fortis Stroke Registry.