How Stroke can be prevented?
Strokes or cerebro-vascular accidents (CVA) are an important cause of death (third highest), afflicting approximately half a million people in developed countries. However, unlike cancer and heart disease, public knowledge of strokes is minimal.
Most people know the risk factors that lead to heart disease such as high cholesterol and high blood pressure and diabetes. Stroke shares many of these risk factors — in fact, the two diseases coexist quite often and may have to be tackled at the same time. The modifiable risk factors are high blood pressure, cigarette smoking, diabetes mellitus, high blood cholesterol and lipids, physical inactivity, obesity and the presence of heart disease.
The figures present quite a stark picture. Every 45 seconds, someone in the United States has a stroke. Last year there were 7,50,000 full-fledged strokes in the US and half a million transient ischemic attacks (TIAs) or ministrokes. The ministrokes are more of a concern because they may at times be ignored by the patient, but they are the harbingers of a deadly stroke, and timely treatment provides dramatic relief.
Ministrokes are often under-diagnosed. A US National Stroke Association study shows that 2.5 per cent of all adults aged 18 or older (about 4.9 million people) have experienced a confirmed TIA. An additional 1.2 million Americans over the age of 45 have most likely suffered a ministroke without realising it. Again though we do not have reliable data for the Indian population, we must learn from these grim figures. These findings clearly show that if the public knew how to spot the symptoms of stroke, specially ministrokes, and sought prompt medical treatment, thousands of lives could be saved and major disability could be avoided.
The problem is that the symptoms of a ministroke may be subtle and temporary. There are five symptoms, the warning signs of a stroke:
1. Sudden numbness or weakness of the face, arm or leg, especially on one side.
2. Sudden confusion, trouble in speaking or understanding.
3. Sudden trouble seeing in one or both eyes.
4. Sudden trouble walking, dizziness, loss of balance or coordination.
5. Sudden, severe headache with no known cause.
Diagnosis:
1. MRA (MR Angiography) of the brain blood vessels, MRA of neck blood vessels (carotids), MRI of the brain and diffusion weighted study of the brain. The investigation does not involve radiation, x-rays or giving contrast dye injections; hence the scan is very safe.
2. If the so-called sudden stroke is associated with severe headache, the patients require CT angiogram using 128 Slice of the brain, which will detect aneurysms of the brain vessels (weak spots).
The treatment is by a delicate but very simple and effective procedure called a carotid endarterectomy. Simply put, the doctor removes the block in the carotid artery and repairs it. It can be performed under local or general anaesthesia and takes less than half an hour to perform.
During surgery while the artery is clamped to repair it, blood supply to the brain may be maintained by the use of a shunt, which temporarily bypasses the block. For the repair the surgeon may use a piece of vein from the patients own leg or a special biocompatible cloth (Dacron or PTFE - polytetra-flouroethylene). Special magnifying loops and very fine sutures, which are not readily visible to the naked eye, are used for the repair.
The results are excellent as the risk of developing a major stroke is dramatically reduced. Roughly, out of a population of a million people, there are about 50-100 people who would benefit from carotid endarterectomy. A non-surgical procedure called carotid stenting can also be performed when indicated with good results.
In spite of having excellent results with this surgery, it is still emphasised that a stroke is quite easily avoidable . You can greatly help yourself by simple ways of changing your lifestyle:
- Eat a lot of green leafy vegetables, fruits and vegetarian non-oily food with a lot of fibres daily
- Quit smoking
- Reduce alcohol intake to no more than one drink a day (if at all)
- Increase your physical activity, perform regular aerobic exercises
- Control blood pressure by regular medication
- Control diabetes
- Practise yoga
- Have a routine yearly checkup