STROKE

Name and magnitude of the problem:
Stroke (cerebrovascular accident). This is a very common ailment affecting millions each year. It leaves more than half the affected disabled requiring years of rehabilitation efforts.

How one contracts the illness:
A stroke occurs when there is a disruption of the cerebral blood flow to the brain. It results in either temporary or permanent neurologic deficits. There are two major categories of stroke. Ischemic stroke (cerebral infarction) accounts for 80% of all strokes and results from embolic obstruction or thrombosis of a vessel supplying a part of the brain. Hemorrhagic stroke, the other 20% of strokes, results from bleeding either into the subarachnoid space or the parenchyma of the brain.

Signs and symptoms:
Patient manifestations vary according to location affected. It may range from sudden onset of loss of power of one whole side of the body to a short lived mild weakness of one limb which lasts only about 5minutes. Some other manifestations include paresthesias; loss of vision in part of the visual field; hemisensory deficits; swallowing difficulties; aphasia (inability to produce or understand speech), severe headache, sudden loss of consciousness etc …

How it is diagnosed:
Diagnosis can be made with some degree of certainty after taking history and in some cases neurological examination. It can be established by neuroimaging.

How it is treated:
If patient presents within 3 hours to a center experienced in thrombolysis of stroke patients clot lysis using thrombolytics is the treatment of choice in selected patients. In ischemic strokes aspirin or other anti-platelet drugs are instituted early on. Most cases do not require any treatment other than supportive care, including physiotherapy, use of proper feeding techniques, prevention of deep vein thrombosis etc…

Important considerations:
Since one of the main risk factors of strokes is hypertension, it should be aggressively treated as soon as detected. Creating awareness regarding need and benefits of adequate control of hypertension will go a long way in decreasing the incidence of this disease of high morbidity and mortality.

What can you do?
Once stroke is suspected medical attention should be sought immediately since the 1st 24hours are most critical period. Due attention should be also given to proper feeding techniques as lot of the time deterioration of patient is not due to stroke per se, but due to aspiration of food into the respiratory airways. Physiotherapy on a continued basis is imperative for the proper recovery of the patient which may take from 3-6 months- or as long as 2yrs in some cases.