Stroke has been described as the commonest neurological emergency. Yet, this silent debilitating disease , caused as a result of the sudden disturbance of the blood supply to a particular area of the brain resulting in death or damage of the brain cells, where only prompt action can help to save life and reduce disability, is still largely unrecognised. Tragically, those most at risk are persons with risk factors for Non Communicable Diseases ( NCDs) such as hypertension, diabetes, heart disease and dementia- risk factors similar to those of stroke.
Recently, stroke was placed at the centre table when experts in the field across the world came together on World Stroke Day to discuss ways in which they could minimise risks and raise more awareness on this most common neurological emergency by urging the public to “Join the MoveMent” and prevent this debilitating disease by leading active healthy lifestyles.
Spearheading the movement, President of the National Stroke Association of Sri Lanka and Consultant Neurologist Dr Harsha Gunasekera in an interview with the Sunday Observer shared his views on why time and prompt detection and treatment was important in preventing complications of stroke and simple rules on preventing this disabling disease.
Excerpts …
Q: Every year, on October 29, stroke experts come together to share their expertise on this debilitating condition affecting millions. Could you explain what is Stroke and how common it is?
A. Stroke is the commonest neurological emergency. Stroke occurs as a result of a sudden disturbance in the blood supply to a particular area of the brain resulting in death or damage of the brain nerve cells (Neurones). Millions of neurons are lost every minute, prompting the need for urgent treatment to save life and reduce disability.
The lifetime risk of stroke has increased from one in six to one in four over the last decade.
Q: What is this year’s theme?
A. The World Stroke Organization (WSO) has declared this year’s theme as, “Join the MoveMent” calling everyone to take preventive measures, especially, highlighting the benefit of an active lifestyle which reduces one’s stroke risk.
Q: Are there different types of stroke? If so what are they?
A. The disturbance of the blood supply in most patients (88%) occur as a result of the blockage of a feeding artery by a thrombus (a static clot) or embolus (a moving clot, usually from the heart). Stroke can also result from haemorrhage following the rupture of a feeding artery.
Q: What is a Transient stroke? Is it the same as a mini stroke?
A. Around a quarter of patients with stroke may experience a Transient Ischaemic Attack (TIA or mini stroke). Here, the symptoms of stroke last only a few minutes and then rapidly resolve. This condition should be given serious consideration and treatment initiated immediately as it may be the only warning one may get before developing a major stroke.
Q: Does stroke share the same risk factors as heart disease and other non communicable diseases?
A. Yes, risk factors for stroke and other NCDs such as heart disease, dementia and cancer are quite similar. Therefore, controlling these risk factors will protect a person from multiple NCDs.
Q: What are the main risks that could trigger a stroke? I understand the World Stroke Organization has highlighted ten?
A. Yes, if you consider the risk weighted by each modifiable risk factor, overall 90% of strokes could be prevented by controlling these ten risk factors. That’s why the WSO has emphasised the controlling of these ten risk factors which can be easily done by changes in lifestyle and medication. Therefore, in a nutshell the ten steps to avoid a stroke are;
1. Know and control your Blood Pressure
2. Do 20-30 minutes of moderate exercise at least 5 times a week
3. Consume a healthy and balanced diet rich in fresh vegetables and fruits and low in processed foods
4. Know your blood cholesterol level and control it
5. Maintain a healthy weight with normal body mass index and waist circumference
6. Stop smoking and avoid smoky environments
7. Reduce alcohol intake
8. Know your blood glucose level and control diabetes
9. Identify and treat irregular heart beat (atrial fibrillation)
10. Manage stress and depression.
Q: What are the early signs of the onset of a stroke? Have you some easy to follow guidelines to offer a layman?
A. Knowing the ‘FAST’ stroke scale is the best way to remember the sudden signs of a stroke. Here is the way to remember it: F - stands for FACE drooping, A - stands for ARM weakness, S - stands for SPEECH difficulty and T - stands for TIME to take immediate action. Therefore, the National Stroke Association together with the Ministry of Health and Suwa Seriya has included 1990 in the stroke awareness leaflets for patients to get to the closest hospital with a CT scanner. Suwa Seriya also encourages the people to download the 1990 app for easier recognition of their location.
Q: What should be done when you get a stroke?
A. Action must be taken immediately – rush to the nearest major hospital – not the general practitioner next door.
The patient should be treated in a hospital equipped with a CT scanner as this helps to identify the type of stroke and initiate treatment promptly. All Provincial and District General Hospitals in the country have CT scanners.
Q: What is the usual treatment procedure?
A. This depends on the type of stroke. Clot busting treatment will be given to eligible patients after assessment. All patients will benefit from urgent treatment at hospital which will prevent further worsening of stroke itself or by its complications. Needy patients will undergo rehabilitation by a stroke team within a stroke unit.
Q: On an average how long does a patient take to recover from a stroke? Is the duration similar to recovering from a heart attack? If the victim is young comparatively will he/she recover faster?
A. This is highly variable and depends on the severity of the stroke and other co-existing disease states. Most patients with mild to moderate severity can be expected to recover within two weeks of onset.
As a rule after a stroke one third of patients recover completely, another third will be left with a permanent disability and a third will die either in the acute stage or later from complications.
Q: Is it true that once a person gets a stroke there is always a danger of another stroke? Is the second and third stroke more dangerous?
A. One in four stroke patients get another stroke. With each recurrent stroke, the disability will increase. Therefore, one needs to carefully continue all medications prescribed and maintain a healthy lifestyle to prevent another stroke (this is called secondary prevention).
Q: What are the new interventions worldwide that are now being tried out for stroke victims? I understand a new intravenous treatment called thrombolysis can reduce disability for stroke if the patient is brought to a stroke unit within 4 ½ hours. Is this available in Sri Lanka?
A. Yes, this (clot buster) treatment has been established in most major hospitals over the last few years. This is an expensive treatment, given free of charge at state hospitals. Unfortunately, despite many awareness programs carried out by the Stroke Association, most patients miss the opportunity for treatment due to late presentation.
In addition, clot retrieval treatment is being developed which can treat strokes in selected patients even up to 6 – 12 hours from onset.
Q: How many stroke units are there in the country? Are they enough? Fully equipped?
A. Most major hospitals now have either stroke units or dedicated beds in neurology units for the care of stroke patients. Stroke units do not require high tech equipment but mostly a defined area to care and rehabilitate the patients through a dedicated multi-disciplinary team which includes doctors, nurses, physiotherapists, speech and language therapists, occupational therapists, psychologists, social workers and nutritionists. In addition, a state-of-the-art National Stroke Hospital is under construction at the Colombo East Base Hospital premises which is scheduled to be completed by 2022.
In the interim, the Ministry of Health has initiated the construction of fully equipped stroke units and the improvement of existing stroke units in ten provincial and district general hospitals.