Stroke, commonly referred to as a brain attack, is a debilitating neurological condition impacting over 20 million individuals globally and responsible for nearly 5 million fatalities annually. Annually, on October 29, World Stroke Day is recognized around the globe to foster public awareness regarding the latest advancements in stroke management, as well as to educate individuals on identifying early warning signs of a stroke. Crucially, this initiative highlights the significance of seeking optimal treatment and understanding preventive measures against stroke risk factors. Furthermore, it aims to impress upon stroke survivors the vital role of effective rehabilitation in aiding them to achieve a near-normal quality of life. A stroke occurs when blood flow is obstructed in the brain’s blood vessels, leading to ischemic strokes, which represent approximately 80% of cases, or when damage occurs to these vessels, resulting in hemorrhagic strokes.
The incidence of stroke is on the rise, particularly in developing regions, fueled by increasing rates of diabetes, hypertension, brain infections, and road traffic accidents. This alarming trend has positioned stroke as the third leading cause of death worldwide. The severity of stroke symptoms can vary exceptionally; depending on the affected brain region, individuals may experience mild manifestations such as numbness, while others may fall into a coma or face life-threatening conditions. In the past two decades, advancements in stroke management and patient rehabilitation have markedly improved; presently, a significant number of strokes can be effectively treated and mitigated. Timely medical intervention within the crucial Golden Hour after symptom onset is essential for patient benefit.
The Golden Hour
A stroke often arises suddenly and can frequently be a silent condition. Prompt recognition of stroke symptoms by both patients and their families is crucial for accessing effective medical treatment, especially within a specified timeframe that significantly aids survival and reduces long-term disabilities. Acute strokes treated within four and a half hours with clot-busting injections to open blocked blood vessels—along with interventions to remove clots if addressed within 12 to 18 hours—can greatly affect outcomes for those grappling with this serious ailment. However, awareness of early stroke symptoms and available treatment options remains limited among the general populace. The term ‘The Golden Hour’ encapsulates this critical four and a half hour window in stroke care, where early treatment significantly enhances recovery prospects. Delays beyond this timeframe increase the likelihood of irreversible brain damage. It is important to note that thrombolytic injections are contraindicated for strokes due to brain hemorrhaging, which require alternative treatment approaches.
Common Symptoms of Stroke: Symptoms depend on the area of the brain that is affected
The common symptoms of brain stroke include:
- Speech difficulties
- Sudden and acute headache
- Confusion
- Vision loss
- Inability to balance
- Change in state of consciousness
- Weakness of one side of the body
The World Stroke Organization (WSO) has popularized a simple slogan to help the general public recognize stroke symptoms quickly, known as FAST:
- F – Face: Check for drooping on one side of the face.
- A – Arm: Observe if one arm drifts downward when both arms are extended.
- S – Speech: Listen for slurred speech; immediate action is necessary.
- T – Time: Act swiftly by calling for emergency medical help.
What to do if you or someone you know has a stroke?
Immediate action is critical; call the nearest hospital with stroke treatment capabilities without delay. It is vital to remain calm, as anxiety can exacerbate the situation. Take the initiative to visit the hospital promptly, even if symptoms appear insignificant, as they may deteriorate rapidly. If you suspect a stroke is occurring, refrain from driving; instead, call an ambulance or arrange for someone else to transport you. Medical professionals will conduct blood tests alongside CT or MRI scans to determine the type of stroke and select the appropriate course of treatment. If patients arrive within the four and a half hour window, they may be eligible for the “Clot-Busting injection,” potentially combined with clot removal procedures if they arrive shortly after this initial timeframe. In cases showing brain bleeding, surgical options may be recommended. Additional interventions, such as stenting, intra-arterial thrombolysis, or mechanical thrombectomy, can be employed and may still be effective within 24 hours following the attack.
Risk Factors for Stroke
Certain health conditions elevate the likelihood of experiencing a stroke. Individuals with chronic hypertension, heart disease, diabetes, obesity, high cholesterol, tobacco usage, and excessive alcohol consumption are particularly at risk. Fortunately, many of these conditions are manageable and preventable. There are also non-modifiable risk factors, including genetic predisposition, age, and gender, with stroke occurrence slightly more prevalent in females due to hormonal influences. Generally, the risk of stroke escalates with age, especially for those over 55–60 years, though lifestyle changes have shifted the trend, leading to approximately 25% of all strokes occurring in individuals younger than 40 years.
Among various factors, high blood pressure is the most significant contributor to stroke risk; even minor reductions in blood pressure can lead to a substantial decrease in stroke incidents. Effectively managing these risk factors may prevent strokes in about 75-80% of individuals, underscoring the necessity for healthcare professionals, NGOs, governmental entities, and the media to initiate programs aimed at increasing awareness of stroke risk factors and best practices for their management. Given the current burden of strokes, enhancing hospital capabilities by establishing specialized stroke care units and dedicated rehabilitation facilities is imperative.
Always remember: time lost equates to brain lost. Seeking immediate medical advice increases the likelihood of significant recovery.
STROKE IS NOW TREATABLE AND PREVENTABLE
(Author: Dr. Sreekanta Swamy, Lead Senior Consultant – Neurology, Aster RV Hospital, Bengaluru)