Every year, five million people around the world lose their lives to strokes, as per the data collected by the World Health Organisation. Strokes, a disease with a fatality rate of over 33%, happen suddenly and cannot be predicted, but can be prevented. A stroke occurs when the blood supply to the brain is interrupted or stopped, leading to the rapid deaths of neurons. Common signs of a stroke include loss of balance, facial asymmetry, and slurred speech, among others. While we cannot predict or assume if a person might get a stroke, experts say that it can be prevented through lifestyle changes. As the World Stroke Organisation observes World Stroke Day on October 29, TNM speaks to experts on the risk factors, treatment, and prevention of strokes.
What is a stroke?
The American Stroke Association defines stroke as a disease that affects arteries leading to and within the brain. It says that a stroke occurs when an artery that carries oxygen and nutrients to the brain is either blocked or ruptured, preventing blood flow and causing the death of brain cells. Strokes are classified into ischemic (caused by a clot in arteries) and hemorrhagic (caused by a burst or ruptured artery). Stroke patients may experience partial or complete loss of vision and/or speech, paralysis, and confusion. If properly treated within the first few hours, the symptoms can be reversed to a great extent. According to the World Health Organisation (WHO), around 15 million persons are affected by stroke every year, of whom around five million die.
How to prevent a stroke?
Dr Preetha Purushothaman, a Chennai-based neurologist from Prashanth Hospitals, says that one cannot see the symptoms of a stroke unless an attack happens. However, she adds, signs of a stroke are quite evident. “The most common symptoms include slurred speech, drooping or deviation of the mouth to one side, and losing the ability to maintain balance,” she says.
Dr Abhinav Raina, a Neurology consultant at Manipal Hospital in Whitefield says that the mnemonic BE-FAST should be kept in mind in a suspected event of stroke attack. "B stands for Balance, we should look out for sudden loss of balance in a person. E stands for Eyes, that is, sudden loss of vision. F is for facial asymmetry while A is for Arm, a sudden weakness in the arms. S is for Slurred speech and T is for Time, indicating that we should call for medical help as soon as possible and take the patient to a stroke-ready hospital," he explains. He adds that water should not be given to those exhibiting stroke symptoms until a hospital confirms that it is not a stroke. "Water might lead to choking. In case a person is diabetic, check their glucose level, as hypoglycemia also exhibits similar symptoms to that of a stroke," he says.
Concurring that strokes are characterised by a sudden onset of symptoms, Dr Sivaranjan, who is a neurologist at Kauvery Hospital in Chennai, says, “A person can identify a stroke when something happens to the body acutely [unpleasant or unwelcome], especially in terms of speech, walking, and/or general mobility.”
What is a stroke-ready hospital?
Dr Abhinav lists the criteria that make a hospital a stroke-ready one:
It should have an Emergency department that is ready to handle stroke cases, with a 24/7 CT and MRI facility, along with all specialists.
By definition, all tertiary hospitals will be stroke ready. Do not waste time by going to nursing homes, clinics, etc.
From the minute a patient enters a hospital, the tests should be rapidly conducted and the reports should be given within a very short span of time. The door-to-report time should be 20-30 minutes.
Can strokes be avoided?
While there is no way to completely eliminate the possibility of strokes, experts believe that lifestyle changes can reduce the risk of a stroke. Preetha said that smokers experience the highest risk of stroke and cutting down on cigarettes and alcohol can help minimise the risk. “Obesity and a sedentary lifestyle are big contributors to strokes. A healthy diet and regular exercising can go a long way to help avoid strokes. Cutting down on alcohol consumption also helps. I would suggest people get regular check ups and keep track of their cholesterol, sugar, and blood pressure levels,” Preetha says. The doctor notes that while there is no 100% prevention of strokes, following a healthy lifestyle can cut down the risk to 50%.
Abhinav says that the risk factors of a stroke are similar to that of a heart attack. "Uncontrolled diabetes, high blood pressure, alcohol consumption, obesity, sedentary lifestyle — these are all preventable risk factors. Strokes can be prevented if these are taken care of," he adds.
Time is of the essence
According to Preetha, as soon as a person exhibits stroke symptoms, they should be rushed to a hospital. "The golden period is for four hours 30 mins after the symptoms have set in.It is best to rush to the hospital and get a CT scan so that doctors can start treatment. There is nothing really to be done at home,” she says.
However, there have been several medical advancements that have positively impacted stroke treatment protocols. “It is usually advised to treat strokes within the golden hour to mitigate risks. But with advancements in technology, even if the treatment exceeds 4.5 hours, the risks can be reduced. Doctors can now inject a dye during angiography to see the blood vessels and know the exact block. Then we send a microcatheter inside, use a stent retriever to place it over the clot, and remove it. This procedure is called mechanical thrombectomy. This is the treatment when there is a clot visualised in the angiography," she says. Preetha also says that patients will have to be hospitalised for a minimum of five days or more, depending on the type of stroke.
"Whether a stroke can be completely cured or not depends on the type of stroke a person suffers. If it is a small stroke, the patient can be cured fully. If it is a very large stroke, the patient will become unconscious and even enter a coma stage. If that is the case, complete recovery is not possible. If it is a larger stroke that requires extensive treatment, the period of hospitalisation will be longer," she says.