Immediate Action Can Prevent Strokes
By Priyangwada Perera
At one time, getting a stroke was something fatal. It was almost believed that there is no point in going for treatment. With the advances in medicine and therapy, there is so much more hope now. However, one needs to take ‘immediate action’ when symptoms develop.
National Stroke Day was on 28 February. The National Stroke Association of Sri Lanka declared National Stroke Day in 2001 and they are celebrating their 20th anniversary this year. Their prime motive is to promote stroke awareness among Sri Lankans. The National Stroke Association of Sri Lanka wants to convey the message that stroke is treatable as long as it is diagnosed early. President National Stroke Association of Sri Lanka, Consultant Neurologist Dr. Harsha Gunasekara spoke to us.
According to community studies in Sri Lanka, around 10 people per 1,000 fall victim of stroke. Strokes are caused by a sudden interruption of blood supply to the brain. There are two forms. One is caused by a sudden blockage of a feeding vessel of the brain. This is the commonest where 85 per cent of the cases reported are of this nature. Next is the rupture of a feeding vessel resulting in a brain bleed. Symptoms can vary depending on the area of the brain affected. These range from paralysis to loss of vision, numbness of body on one side, loss of balance, loss of speech and so on.
The easiest way to recognise such symptoms causing a stroke is to use the stroke scale called FAST. The letter F stands for facial drooping, A for arm weakness, S for disturbed or slurred speech and T is for time to recognise quickly and to dispatch the patient immediately to the hospital is crucial. "However, what we want to tell the public is to use the Suwa Seriya free ambulance service available countrywide. The best is to call 1990 because they know to which hospital such a patient should be taken to. We want to request the public to download the 1990 Suwa Seriya App on their mobile and call the ambulance with the app for easier identification of the location to save time. The ambulance service has a medical team, a paramedical team and they know exactly where to dispatch the patient." This is reiterated because prompt action and correct decision-making is most crucial in such a case.
Where prevention is possible, the focus should rest there. Explaining further, Dr. Gunasekara said stroke occurs as a result of multiple risk factors. There is no single cause. "There are four types of unhealthy lifestyle practices associated with stroke. Smoking, heavy alcohol use, unhealthy and poor diet which includes the consumption of fast food and processed food with a higher percentage of salt, sugar and fat. The fourth is lack of physical exercise, together which leads to obesity."
The best and the easiest way to stay away from developing a stroke is to quit smoking, control your consumption of alcohol, adapt a healthy lifestyle with a balanced diet (at least five portions of vegetables and fruit, low in salt, sugar and trans fats) and exercise 30 minutes per day, five days a week. These simple steps will prevent stroke in majority of people.
The four major medical risk factors for stroke are high blood pressure, diabetes, abnormal blood lipid levels and atrial fibrillation (which is irregular heart beat predisposing to blood clotting). These need medical attention and treatment with medication. 90 per cent of strokes can be controlled by adapting healthy lifestyles and controlling the risk factors mentioned above.
One in four of us are at the risk of developing a stroke at some stage in life. Hence, it is important that we focus on this preventive lifestyle. It is up to the individual to adapt the four lifestyle changes and obtain medical advice when necessary.
If a stroke happens, the first thing is to recognise it and immediately to get to a hospital that has CT scan facility. The usual practice of rushing to your family doctor will not help in this situation. Every minute counts as the treatment with clot busters have to be initiated immediately.
Dr. Gunasekara also had a word of wisdom for stroke victims. During this post-pandemic situation, they should take their medication regularly and adhere to their healthy lifestyle. If stroke symptoms occur, come to the emergency unit. All patients are screened for COVID-19 so, there won’t be unnecessary exposure. “We see patients coming to the hospital late; missing the opportunity for urgent treatment. Statistics show that one in four survivors suffer another stroke. A second stroke can be disastrous and it should be prevented.”
There is another form of stroke which occurs in about 10-15 per cent of patients called a hemorrhagic stroke. It is due to rupture of a feeding artery or an aneurysm. Rupture of a feeding artery will cause a brain bleed and diagnosis can be confirmed by a CT scan. Rupture of an aneurysm (termed subarachnoid haemorrhage) causes a sudden explosive headache. It can be so severe that you feel as if you are hit on the head and can cause collapse. The patient should immediately be taken to emergency care. A CT scan can diagnose it. Even though all hospitals may not have the required facilities to treat it, patient can be transferred to the proper hospital. There is emergency medication given to prevent complications. Specific treatment is by surgery (clipping of the aneurysm) or interventional radiology (coiling).
Overall, one third of stroke survivors are left with some form of disability. Due to possible side effects, all stroke survivors must undergo rehabilitation with a multidisciplinary team to minimise the complications. Physiotherapy, speech therapy, occupational therapy and psychological/social support and counselling are integral parts of multidisciplinary approach to stroke rehabilitation.