Understanding Stroke: Recognising Signs and Taking Preventive Measures

What is a stroke?

A stroke, also known as a brain attack, occurs when the blood supply to a section of the brain is restricted or when a blood vessel in the brain ruptures, which leads to temporary or permanent damage to specific areas of the brain. 

The Burden of Stroke in the World and India

• Stroke is a major cause of disability and death globally, ranking second as a cause of death and third in terms of death and disability combined. 

• The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) reported a significant increase in new stroke cases, total stroke cases, stroke-related deaths, and disability indicators from 1990 to 2019. 

• The incidence rates and prevalence rates among individuals under 70 years old also increased. Stroke-related mortality and disability rates were higher in low-income groups compared to high-income groups.

•  In India, the occurrence of stroke ranged from 105 to 152 cases per 100,000 people annually, surpassing rates seen in high-income countries

Types of strokes

• Stroke, as mentioned earlier, can be classified  into: 

  • Ischemic stroke occurs when the blood supply to the brain gets blocked 

  • Hemorrhagic stroke occurs when damage to the brain happens due to the rupture of the blood vessel of the brain. 

• There is another entity called transient ischemic attack which is not stroke by definition, in which there is a decrease in flow to the brain for some period leading to transient symptoms, usually less than 24 hours. Those with transient ischemic events are at increased risk of stroke in future and hence to be identified and managed earlier. 

• Among the different types of stroke, ischemic stroke is the most common type, followed by intracerebral haemorrhage and subarachnoid haemorrhage.

Risk factors of stroke

• The significant risk factors for stroke include high blood pressure, diabetes, heart and blood vessel diseases, high blood cholesterol levels, smoking, abnormal brain vessels like brain aneurysms or arteriovenous malformations, infections, age, sex, race and ethnicity, family history and genetics. 

• Other risk factors include anxiety, depression, high-stress levels, living or working in areas with air pollution, certain medical conditions, medications that increase bleeding risk, unhealthy lifestyle habits, and overweight or obesity. 

• These risk factors associated with stroke can be divided into two groups based on their controllability: 

  • modifiable factors (such as hypertension, smoking, diabetes, and obesity)

  • non-modifiable factors (including age, gender, and family history)

• Risk factors management remains the key, as stroke is a preventable disease and by mere risk factors mitigation, the risk can be brought down. 

Recognising early signs of stroke

• Identify the early warning symptoms of the stroke; if identified early, damage to the brain can be minimised by immediate intervention. 

• One should know the symptoms of stroke, and the acronym 'FASTER' can come in handy in recognising the symptoms early. 'FASTER' stands for 

  • F: Face - Look for drooping or numbness on one side of the face. Ask the person to smile; 

  • A: Arms - Check for weakness or numbness in one arm; 

  • S: Stability - Watch for difficulty maintaining balance, walking, or loss of coordination;

  • T: Talking - Look for changes in speech, such as slurring or difficulty understanding;

  • E: Eyes - Note any sudden visual changes, like loss of vision or double vision; 

  • R: React - Call an ambulance immediately if you observe these symptoms, even if they seem to improve.

How are strokes treated?

• In the case of ischemic strokes, 

  • If a patient presents as early as within 4.5 hours to the hospital, they can undergo treatment with intravenous medications to open up the blood vessel 

  • Even selected eligible patients presenting later, within 24 hours, can be offered mechanical removal of clots. In the same way, for patients with bleeding in the brain, optimal management of blood pressure is required early for better outcomes. 

• In patients with intracranial haemorrhage, urgent institution of therapies like blood pressure management and interventions for vascular malformations. 

How can further attacks of strokes be prevented?

• Most of the time, patients do not reach the hospital on time; in such cases, prevention of another attack is important. 

• Patients with ischemic stroke may be on oral drugs, which include blood thinners for life. 

• The cornerstone to averting future attacks lies in embracing medication adherence, mitigating risk factors, and making transformative lifestyle adjustments. 

What are the ways disabilities can be managed in patients with stroke, and what is the role of rehabilitation?

• Following an attack, individuals may endure a spectrum of disabilities ranging from mild to severe, which can endure and even escalate over time, which can persist and progress. Disability can be improved through aggressive rehabilitation. 

• Stroke rehabilitation is a comprehensive program aimed at helping individuals recover skills lost after a stroke. It addresses various aspects such as movement, speech, strength, and daily living skills affected by the stroke. 

• Participating in a focused rehabilitation program has shown better outcomes compared to not undergoing rehabilitation. 

• The program includes tailored approaches like physical exercises, technology-assisted activities, cognitive and emotional therapies, and alternative treatments. 

• Starting rehabilitation early after a stroke is crucial for optimal recovery. 

• The duration of rehabilitation varies based on stroke severity, and it can be done in different settings, such as inpatient units, outpatient facilities, or at home. 

• A collaborative team of specialists provides care, and factors like physical, emotional, and social aspects influence the rehabilitation outcome. 

• Recovery is highest in the first few months, but improvement can continue for up to 12 to 18 months, requiring dedication and perseverance for the best results.

Key points

• A stroke occurs when the blood supply to the brain is restricted or a blood vessel ruptures, leading to brain damage and potential disability or death.

• Stroke is a significant global health issue, ranking as the second-leading cause of death and the third-leading cause of death and disability combined.

• Ischemic stroke, hemorrhagic stroke, and transient ischemic attack are the different types of stroke, with ischemic stroke being the most common.

• Significant risk factors for stroke include heart and blood vessel diseases, high blood pressure, diabetes, smoking, and obesity. Some factors can be controlled, while other risk factors are non-modifiable.

• Early diagnosis is crucial for minimising brain damage. Prompt medical intervention can be effective, including intravenous medications and mechanical clot removal. 

• Rehabilitation plays a vital role in improving disabilities, with early participation and dedicated efforts leading to optimal recovery.