29th September is World Heart Day
One morning Rahul, a cheerful and healthy-appearing 29 year old, was unable to bounce out of his bed as usual and needed help to arise from the bed. After a few anxious moments he felt alright and went about his regular routine. However, friends and family urged him to go for a medical check-up. After listening to his story, the doctor at a neighbourhood clinic performed routine tests with normal results. As a last check, the doctor asked Rahul to stand up and close his eyes. Rahul stood up normally and closed his eyes – and promptly lost his balance. Rahul was sent for an immediate brain scan which revealed a blood clot (thrombus) in one of the brain blood vessels. Rahul had suffered from a mini-stroke (transient ischemic attack or TSA) that morning.
Available data indicates that, in India, the annual incidence of stroke, ranging from 100-150 per 100,000 people, is higher in urban than in rural areas. In India, one-third (nearly 0.8 million) deaths caused by heart diseases (2.5 million in 2008) are attributed to stroke. Dr. Shamanna S. Iyengar, a cardiologist affiliated with St. John’s Hospital and Manipal Hospital, in Bengaluru, defines “young” in terms of stroke incidence as “the age group 15 to 40 years”. Dr. Iyengar elaborates with “stroke occurs about 15 years earlier in developing areas of the world as compared to the west. In India 10 to 15% of the strokes occur in people less than 40 years of age.”
Stroke is considered a medical emergency. A stroke occurs when a part of the brain does not receive blood supply. Brain cells of the affected region begin to die within a few minutes and often result in long-term dysfunction of the body part controlled by the affected brain area.
There are two main types of stroke. Ischemic stroke is caused by a block (blood clot) in the blood vessel. Blood vessel blocks are caused by clogging of arteries within the brain or internal hardening of the arteries leading to the brain. Often a blood clot from the heart or other body part travels to the brain via an artery (embolism) leading to stroke. Haemorrhagic stroke is caused by bleeding through a tear (rupture) in the blood vessel triggered by high blood pressure, stress, injury trauma, lack of exercise, smoking, excessive alcohol and medications (e.g. warfarin). Bleeding can occur within the brain or between the brain and inside of the skull. Bleeding strokes have a significantly greater death rate than strokes caused by blood clots.
Major risk factors of stroke include aging - an 80 year old has >30 times higher chance of ischemic stroke than a 50 year old. However, the negative impact of stroke on a young person’s family and work productivity is the toughest. Key lifestyle-related conditions that increase stroke occurrence are smoking (doubles the risk), high blood pressure, high blood glucose (diabetes), heart disorders (coronary artery disease, atrial fibrillation), high cholesterol, obesity, low HDL (high density lipoprotein), excessive alcohol and drug abuse.
|Body Part||Signs and Symptoms|
|Face||Drooping of mouth and eyes on one side|
|Arms||Numbness or weakness, unable to lift arm(s)|
|Speech||Slurred speech, difficulty in talking, jumbled words|
Signs and symptoms of stroke include numbness, weakness or paralysis on one side of the body. There is sudden confusion, severe headache with no known cause and trouble in speaking, understanding, seeing, walking, dizziness or loss of balance. Stroke is diagnosed by a clinical (neurological) examination and imaging tests such as CT or MRI scans which determine the type and cause of stroke. An electroencephalography (EEG) test determines the possibility of seizures.
|Modifiable Factors (Factors you can control)||Non- Modifiable Factors (Factors out of your control)|
|Hypertension||Positive family history of stroke|
|Cigarette smoking||Age over 65 years|
|Diabetes||African, South Asian, Caribbean race|
|Alcohol Consumption||Bleeding Disorders|
|High Cholesterol||High cholesterol due to genetic defect|
|Being overweight||Trauma, specially head injury|
|Lack of exercise|
|Improper diet with excess fats|
|Use of oral contraceptive pills|
Stroke treatment depends on the severity of stroke occurrence and presence of other risk factors. Lifestyle modifications are critical in prevention and management of stroke. This involves avoiding smoking, alcohol, high fat or sugar diet and regular physical activity. Medications are used to reduce stroke risk, especially in high blood pressure and atrial fibrillation patients such as antiplatelet drugs (e.g. aspirin) and anticoagulants (e.g. warfarin) to prevent blood clot formation. In severe cases, surgery to unblock the artery (angioplasty) or stop bleeding in the brain (craniotomy) may be necessary to resume normal blood flow. Often physiotherapy is required to retrain the patient to perform daily activities.
So what happened to Rahul? Fortunately, Rahul did not suffer any extensive damage from the mini-stroke. However, he occasionally feels numbness in his left limbs but does not require any medications. Rahul has taken this incidence as a wake-up call to make some lifestyle changes such as avoiding smoking and drinking. He continues his exercise routine and makes a conscious effort to incorporate healthier foods in his diet plus 6-7 hours sleep daily.
Here are some information resources for Stroke:
- Indian Stroke Organization
- Stroke in India
- Heart Disease in Asia
- Stroke in Young in India
- Stroke Program for India
- American Stroke Association