Stroke: A dangerous condition

LAST week was a sorrowful one for me as I lost one of my finest friends, Kazia Agustine, a pharmacy technician, who succumbed to complications of stroke. The woman brought Tynwald South to a standstill and it showed how much popular she was. The “best girl” at my 2007 wedding, Kazia should surely rest in peace!

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a medical emergency and prompt treatment is crucial. Early action can reduce brain damage and other complications. Worldwide, cerebrovascular accidents (stroke) are the second leading cause of deaths and third leading cause of disability. Symptoms

Symptoms of stroke can vary from one person to another. Pay attention to the time the symptoms begin. Some treatment options are most effective when given soon after a stroke begins. The following may be present symptoms:

Trouble speaking and understanding what others are say

ing: One may experience confusion, slurred speech or difficult in understanding speech.

Paralysis or numbness of the face, arm or leg: One may develop sudden numbness, weakness or paralysis in your face, arm or leg usually affecting one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Problems seeing in one or

both eyes: You may suddenly have blurred or blackened vision in one or both eyes or you may see double.

Headache: A sudden, severe headache which may be accompanied by vomiting, dizziness or altered consciousness may indicate that you are having a stroke.

Trouble walking: You may stumble or lose your balance. Causes

There are two main causes of stroke, a blocked artery (ischemic) or rupture of a blood vessel (haemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as transient ischaemic attack (TIA) that does not cause lasting symptoms. Haemorrhagic stroke

This type of stroke occurs when a blood vessel in your brain leaks or ruptures. Brain haemorrhages can result from many conditions which include the following:

 Uncontrolled hypertension.

 Overuse of anticoagulants.

 Trauma such as vehicle accidents.

 Presence of aneurysms which can burst.

 Protein deposits in blood vessel walls that lead to weakness in the vessel wall (Cerebral amyloid angiopathy).

 Ischaemic stroke leading to haemorrhage. Risk factors for strokes

So many factors have been associated with strokes and sometimes precautionary action should be taken. The following are some of the factors:  Obesity or overweight  Physical inactivity  Heavy or binge drinking  High blood pressure  High cholesterol  Cigarette smoking  Diabetes

 Family history of stroke, heart attack or TIA.

Other factors associated with a higher risk of stroke include age (above 55 years), sex where men have a higher risk than women.

African Americans have a higher risk of stroke than do people of other races. Prevention

It is prudent that you know your risk factors, hence preventive measures. In general, healthy lifestyle is key to prevention:

 Controlling hypertension: Make sure you are careful on blood pressure control. Many people default in taking their hypertension medication citing numerous beliefs.

 Keep cholesterol levels under check: Eating less cholesterol and fat. If dietary control of cholesterol is not possible, you may make use of cholesterollowering drugs like Atorvastatin, Simvastatin, Lovastatin, Pravastatin, Rosuvastatin etc.  Quitting tobacco smoking.  Managing diabetes: Keep sugar under control by diet, exercise, weight loss and medication

 Eat lots of fruits and vegetables: Fruits and vegetables reduce your risk of stroke. Olive oil, fruits, nuts, vegetables and whole grains may be useful

 Avoiding illegal drugs: Certain street drugs like cocaine and methamphetamine are established risk factors for TIA or stroke. Preventive medications

If you had an ischaemic attack, your doctor can recommend medications to reduce risk

of having another stroke. These include:

 Anti-platelet drugs: Antiplatelet drugs make these cells less sticky and less likely to clot. Examples include aspirin and clopidogrel.

 Anti-coagulants: These drugs reduce blood clotting. Heparin is fast acting and may be used short-term. Slower acting medication like warfarin can also be used. Diagnosis

Diagnosis depends on physical examination findings on top of other investigations. The following are some of the common tests done:

 Blood tests: Full Blood Count will look for platelet levels. Low platelets can result in severe bleeding. Sugar check should be done.

 Computed Tomography (CT) Scan: A CT scan can show bleeding in the brain, an ischemic stroke, a tumour or other conditions.

 Magnetic Resonance Imaging (MRI): Damaged brain tissue can be detected.

 Carotid Ultrasound: The images of the inside of the carotid arteries can be produced.

 Echocardiogram: Sources of clots can be found in your heart that could have moved from the heart to the brain.

Let us all be wary about stroke and its risk factors. Our habits can determine our future!

 Dr Johannes Marisa is a medical practitioner and a public health practitioner who can be accessed on: doc