Stroke: It’s in your Hands
By Priyangwada Perera
The American Physicist Michio Kaku said, “The human brain has 100 billion neurons, each neuron connected to 10 thousand other neurons. Sitting on your shoulders is the most complicated object in the universe.” But what exactly do we know about the brain? The brain is what controls the body and mind. This is the master organ in the body which directly controls or influences the body. In spite of being less than 3 per cent of the body’s mass, the brain receives 20 per cent of total blood flow.
What is stroke?
Despite holding such importance, we have chosen to ignore the brain. Of course, we think of the brain in terms of education and knowledge. That is complete ignorance and misunderstanding. Contrary to popular opinion, you may also say you have always known the importance. Then, are we aware of brain strokes? Stroke and Neurointervention Foundation, India (SNIF) simplifies it. “Stroke is localised damage to brain tissues caused by loss of oxygen supply and nutrients due to blockage in an artery or internal bleeding. Depending on the location and the extent of the damaged area, patients can lose any of the functions of the brain. Some common functions are sensory, motor or reasoning ability.
In many cases stroke can be fatal.” Then the next question would be, how prone we are to a brain stroke. Now that we know Cholesterol is not a condition which affects only the rich-elite, it is time we know more about brain stroke. At the mention of a stroke, if it is our grandfather who comes to our mind, we are not updated. One does not have to be 70 years old and frail to suffer a brain stroke. Of course, some 70 to 80-year-old people also suffer brain stroke. In fact, the average age of a stroke sufferer might be 70. But an alarming rate of people as young as 30 years of age being affected is in the rising. Neuroradiologist Dr. Shakir Husain from the University Hospital, Zurich, Switzerland urged people to be aware of brain strokes.
Silent killer of youngsters
Speaking to us, Dr. Husain said that in fact, brain stroke is the fast emerging silent killer of youngsters. No prejudice, we are not talking about the West. The prestigious Neurosciences Centre at All India Institute of Medical Science, popularly known as AIIMS, says that one fourth of patients suffering from brain strokes are young adults. “The cases show a steady rise, since the strokes in young patients often go undetected. Worldwide, stroke is the third leading cause of death while in India it is the second largest cause of death. Incidence of stroke is said to be on the rise in developing countries.
A few years ago, in the developed world, stroke among young adults was 3.5 – 8 per cent. Whilst in the West, the aging population is more prone to this, in the underdeveloped or developing countries, a relatively younger population is becoming victims,” said Dr. Husain. India, our neighbour, has beaten the developed world with a percentage of 35 per cent. By 2018 India has also become the world’s ‘Diabetes Capital’ and with this, stroke is expected to gain epidemic proportions. How far behind can we be? According to Dr. Husain, brain stroke has now become nothing less than a global epidemic.
Ischemic and Haemorrhagic Strokes
Dr. Husain said that Ischemic Strokes are the most common, accounting for about 80 per cent of all strokes. “It happens when a sudden blockage cuts off the blood supply to the brain. The blockage is usually referred to as a ‘clot’. A blood clot blocks the flow of blood and oxygen to the brain.” He explained. “Around 85 per cent of strokes are Ischemic Strokes. These clots typically form in areas where the arteries have been narrowed or blocked over time by fatty deposits.” These are known as plaques and the process is called atherosclerosis.
This can cause the sudden loss of a function in that part of the brain where the blood circulation was blocked. It can be the left, right, front or some other part of the brain. Brain structure is complex but very elegant. The brain comprises a ‘Cerebral Hemisphere’ which regulates either side of the body’s sensation and movements apart from doing cognitive, higher mental and speech functions. The other part is the ‘Brain Stem’ and ‘Cerebellum’ which is important for ‘life-functions’ such as regulation of consciousness, control of breathing, heartbeat, blood pressure and sleep to name a few. Explaining in the simplest of terms, Dr.Husain said to supply oxygen and other nutrients, the brain has a very evolved network of blood vessels which envelopes the brain over its surface. “There are two sets of arteries which supply blood to the brain; the Carotid System and the Vertebrobasilar System.
Depending on which artery or which of its branches are blocked, the symptoms of stroke may vary from paralysis of one side of the body, loss of sensation in one half of the body, inability to speak or impaired jargon of speech, failure of understanding speech, loss of communication, loss of vision in one eye, syncopal attacks and to even loss of consciousness.” All these symptoms come as a sudden stroke in an otherwise normal person. Dr. Husain said the other 15 per cent is Haemorrhagic Strokes. “These are less common but more dangerous. It happens due to bleeding in or around the brain, when a blood vessel breaks and bleeds into the brain. In mere minutes, brain cells begin to die.
This can be caused due to bleeding aneurysm, an Arteriovenous Malformation (AVM) or an artery wall that breaks open due to dissection. Haemorrhagic Strokes can have a series of side effects.” One distinguishing point often is that they have a sudden severe headache at the outset and often with transient or continuous loss of consciousness. Today, we can quickly identify which type of stroke it is, by doing a CT scan, which is widely available in most parts of the world. Ignorance is the culprit People are more aware of signs of a heart attack and rush to a hospital even if they have a minor chest pain. But for brain strokes the initial symptoms are often missed or misinterpreted as weakness.
However, Transient Ischemic Attack (TIA) symptoms should be taken seriously as they are markers of an impending brain stroke. Most young adults dismiss warning signs such as dizziness, temporary loss of vision, sudden weakness in limbs, and difficulty in speaking or understanding words. You might even find that your right hand cannot be moved, momentarily. It may be a Sentinel Stroke. Most importantly, such symptoms may disappear within a few minutes until 24 hours. Yet, all these are symptoms of TIA, which warns of a possible ‘lethal brain stroke’ in the near future. Often, headaches are ignored. It can be a new headache or a previous kind of headache coming up with vomiting and ‘altered characteristics’. Increase in frequency, severe intensity, and absence of effect of drugs might be very general warnings to arise within days before a stroke.
Act fast, act now – go to neurology
The most important thing is to take immediate action. Time is crucial. However, according to Dr. Shakir Husain, most patients make the crucial mistake of not knowing which specialised opinion they should opt for. “It is all about the brain. In order to not let anyone be misguided, our foremost responsibility is to educate and enlighten people. They should consult a neurologist. They should be prompt. This has the possibility of going wrong due to its ambiguity and diversity of presentations. The patient and family may fail to identify it as a stroke.
Sometimes, even a qualified neurologist may not fully recognise it until a CT scan or an MRI brain scan has proved it. We assume a general physician would ideally refer a patient to neurology. But in the case of an emergency, where the patient is not fully conscious or loved ones are disturbed, it is crucial that the correct decision is made.” A CT scan should determine it. The danger is that a TIA or a mini-stroke can even get better by itself but the danger would stay dormant. In such a case, where it is not a neurologist who treats the patient, be it a doctor of any other specialty, or even a doctor of traditional medicine would be given the credit. This is misleading.
Both preventable and reversible
Today, Stroke is not only preventable but if it happens, it is also reversible: Only if the three most crucial aspects are achieved. Time is crucial. The patient should reach hospital within three hours of the onset of symptoms of stroke. Next, is the availability of a Stroke Care Unit with the facility for clot busting drugs and Endovascular Neurointervention, to open the artery plus good neuro-critical care. But the good news is that prevention is possible.
(Part II will deal with details of the options of treatment as well as prevention of stroke.)