Brain Stroke: All you need to know

Stroke is a catastrophic problem arising because of interruption of blood supply to a portion of the brain. The most common cause is a clot formation in one of the blood vessels supplying the brain. These blood vessels arise from the heart and are a part of the vessels which supply blood and nutrients to different parts of the body. The result is damage to a portion of the brain depending upon the artery involved.

 Stroke leads to loss of many bodily abilities. These abilities could include speech, movement and memory.  How a stroke patient is affected depends on where the stroke occurs in the brain and how much of the brain is damaged. For example, someone who has a small stroke may experience only minor problems such as weakness of an arm or leg.  People who have larger strokes may be paralyzed on one side or lose their ability to speak.  Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.

 Stroke is a common cause of death after heart attacks and cancers in the general population. According to the World Health Organization, 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled. The cumulative incidence of stroke ranged from 105 to 152/100,000 persons per year, and the crude prevalence of stroke ranged from 44.29 to 559/100,000 persons in different parts of the country during the past decade (ICMR data). These values were higher than those of high-income countries. Every year 1.44-1.64 million cases of new strokes occur. In a study from Kashmir valley conducted by Dr Parvez shah and colleague from Srinagar found that there was a predilection of strokes in males and especially in rural population.  High blood pressure and smoking were the commonest causes in this population. Intra cerebral bleeding presented in more than half the cases making them the highest risk strokes with a very high mortality. A recent study of 2019 by Hakim Mohd Shafi and Aijaz Ahmad Hakeem from the valley, again pointed out that hemorrhagic strokes were seen in 79% of their patient population of 100 consecutive patients.

There have been significant developments in the very early management of an acute stroke by administering clot buster medicines after a CT Brain to rule out bleeding as the cause has shown very good results and near complete recovery but unfortunately very few patients reach hospitals in this time window. The result is that most major strokes lead to permanent disability and become a burden on the family with little hope of significant recovery. It is therefore imperative that the answer is prevention of a stroke. The good news is that according to epidemiological data more than 80% strokes can be prevented.

These measures are simple but need a periodic medical check and treatment of the risk factors.

Diagnosis of high blood pressure and its treatment:

High BP is a very important risk factor but often goes un-noticed and for this reason is also called a “silent killer”. The first symptom of high B P unfortunately can be a stroke. All adults must know their BP and if it is more than 140/90 mms Hg they should see their doctor. Higher it is the greater is the risk of a stroke. Effective medical treatment is very important to minimize the chance of getting a stroke. It should be emphasized that non drug treatment with better life style is always a necessary accompaniment to drugs. The ideal BP should be around 130/80 mms Hg.

Atrial Fibrillation (AF) and risk of Stroke:

AF is an abnormality of heart beat which increases the risk of stroke by at least 5 times. As age advances the risk also increases exponentially. The hallmark of this arrhythmia is rapid and irregular heart beat and pulse.

 The upper chambers of the heart (atria) beat chaotically and red blood clot can form because of stagnation of blood. A portion of these clots can get dislodged and enter the blood circulation of brain and produce a stroke suddenly. ECG diagnoses this arrhythmia and most patients with AF need anti-coagulants. It is noteworthy that aspirin in this situation is in effective and is not an anti-coagulant. It is an anti-platelet drug which only prevents only white clot formation whereas we need to prevent red clot (thrombus) formation. Warfarin and newer drugs like dabigatran, rivaraxoban and apixaban are the agents. These agents need to be given under medical supervision.

Cigarette Smoking and Tobacco Abuse:

It is a very important risk factor in the causation of stroke especially in persons who already have risk factors like hypertension and a family history of stroke. It has been shown that quitting smoking reduces the stroke risk substantially. In several patients with stroke smoking is the only identifiable risk factor.

Diabetes:

This disease like hypertension is often silent and is an important risk factor for stroke and heart attacks. This coupled with obesity and high BP which is a frequent association leads to a very high incidence of stroke. India is also called the diabetic capital of the world with around 70 million patients with this disease.

Early detection and good treatment always helps. New drugs for treating diabetes help in reducing strokes. These agents belong to the groups of GLP1 analogues and SGLT2 inhibitors. No doubt life style management, weight reduction and treating other risk factors like high BP and high cholesterol levels assume immense importance.

High Cholesterol levels:

This again is a very important risk factor. The sub fraction LDL cholesterol (bad cholesterol) has a very important linear relationship with vascular events like heart attacks and strokes.  Higher its level more is the chance of an event. Getting levels measured in every adult especially those with a family history and risk factors like hypertension and diabetes is very important. Patients with high levels need administration of drugs like statins in appropriate doses (atorvastatin and rosuastatin) to bring these levels down. This alone can reduce the chances of a stroke by up to 30% in high risk individuals. The levels of LDL cholesterol in such subjects should be kept less than 70mgs/ dl.

Losing Weight and Exercise:

Overweight individuals (body mass index > 27 Kgs /M2 need to lose weight which helps in reducing the risk of stroke. Regular exercise is one of the most important modes of losing weight. Weight loss is clearly associated with reduction of vascular events including strokes. A brisk walk or a jog for half an hour or more per day can help lose weight and decrease the chance of ever suffering from a stroke.

Eating a Healthy Diet:

A diet rich in fresh fruits and vegetables with 4 to 5 servings a day goes a long way in reducing risk factors like hypertension, diabetes, over weight and finally reducing the vascular events like heart attacks and strokes. In addition reducing salt intake and carbohydrates complements this benefit. Cooking media rich in monounsaturated fats like mustard oil or olive oil also help in reducing vascular events. Regarding eggs, one a day is good because of its overall nutritional value in spite of having 373 mgs of cholesterol.

Stroke is a devastating event and makes the life of the individual and his family miserable. Once it occurs nothing much can be done to eliminate this misery. At best some palliation is possible. It is best to adopt measures to prevent it. It is possible to prevent it and simple measures need to be adopted. Public campaigns to educate our population are of utmost importance.