Dr. Shyam P Lohani

Stroke is a cerebrovascular disease affecting millions of people annually and leaving a significant proportion of survivors permanently disabled worldwide. A stroke affects the blood vessels that supply oxygen to the brain. The moment the brain does not receive enough oxygen, damage may start to occur. This problem occurs when the blood supply to the brain is decreased or blocked. The rupture or blockage limits blood and oxygen supply to the brain tissues. Lack of oxygen causes brain cells and tissues to get damaged and start dying within minutes.

An estimated 15 million people worldwide suffer a stroke annually. Out of them, 5 million die, and about 5 million others suffer a permanent disability that places a tremendous burden on family and community. Although stroke is uncommon in people below 40 years, the main cause is high blood pressure if it does occur (WHO, 2022).

There are three primary types of strokes -- transient ischemic attack, ischemic stroke, and hemorrhagic stroke. Transient ischemic attack (TIA) is due to a blood clot that typically reverses on its own within a few hours. Ischemic stroke includes a blockage caused either by a clot or plaque in the artery supplying the brain tissue. The symptoms of ischemic stroke can last longer and the complications may become permanent. This type of stroke causes blockages or narrowing in the arteries that supply blood and oxygen to the brain. This may result in ischemia, or a severely reduced blood flow, which damages brain cells.

Hemorrhagic stroke is caused by either a burst or leaking blood vessel that oozes into the brain. Leaked blood creates pressure on brain cells and damages them as well as decreases the blood supply that can reach the brain tissue after the hemorrhage. Blood vessels can burst and spill blood into the brain or near the surface of the brain and also spill blood into the space between the brain and the skull.

The potential causes of each type of stroke are different. However, the risk of a stroke is different among people. Those who are overweight or obese, 55 years of age or older, or have a personal or family history of stroke are more likely to suffer from a stroke. Women are slightly less likely to have a stroke than men of the same age group. Nevertheless, women have strokes at a later age making them less likely to recover and more likely to die as a result of an event.

People with chronic diseases such as high blood pressure, Type 2 diabetes, heart disease, and with high cholesterol are among the most at-risk group for a stroke. Sedentary lifestyles, smokers, people consuming excessive alcohol, and those who use illicit drugs are also more likely to be affected.

The symptoms of a stroke often appear all of a sudden and without warning signs. However, the main symptoms include confusion, including difficulty speaking and understanding speech, a headache, along with altered consciousness or vomiting, numbness or an inability to move parts of the face, arm, or leg, particularly on one side of the body, vision problems in one or both eyes and difficulty walking, including dizziness and a lack of coordination.

Strokes can lead to long-term health consequences. Recognising initial symptoms help patients get prompt diagnosis and treatment. The speed of the diagnosis and treatment becomes vital after a stroke as it leads to temporary or permanent disabilities. The outcome of a stroke depends on how quickly a person receives treatment. Prompt identification and quick medical care help a person less likely to experience permanent brain damage or death. People following a stroke may also experience bladder or bowel control problems, depression, paralysis or weakness on one or both sides of the body, and difficulty in controlling or expressing emotions. However, symptoms associated with a stroke vary among people and may range in severity from mild to severe.

Prevention
The best way to prevent a stroke is to address the underlying risks for a stroke. People are usually advised to lifestyle changes such as eating a healthful diet, maintaining a moderate weight, exercising regularly, not smoking tobacco, avoiding alcohol, or only drinking moderately. It is important to adhere to a nutritious diet that includes plenty of fruits, vegetables, whole grains, nuts, seeds, and legumes.

People are advised to limit the amount of red and processed meat in the diet, as well as avoiding foods containing high amounts of cholesterol and saturated fats. It is also recommended to consume a moderate amount of salt to support healthy blood pressure levels. Other measures a person can take to help reduce the risk of stroke include controlling blood pressure levels, managing diabetes, and getting treatment for heart disease. Regular health checkups, including blood pressure, blood sugar, and cholesterol, are recommended for a person older than 40 years.

Rehabilitation plays an important role as stroke is a life-changing event that can leave a person with long-term physical and emotional consequences. Speech therapy, physical therapy, and occupational therapy can be helpful for improving the quality of life of a stroke patient. Family support is equally vital for making the patient’s life comfortable. It is recommended for stroke survivors to join a support group that helps them cope better with mental health issues, particularly depression.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Center. lohanis@gmail.com)