By Doris Obinna
Of all deaths recorded in the United States in 2009, stroke accounted for 128, 842. This is about 38.9 deaths per 100, 000 population. It was almost twice as high among non-Hispanic blacks (73.6 per 100, 000), and higher among non-Hispanic blacks than their white counterparts (25.0 versus 10.2).
Beyond the United States, stroke is the fifth killer disease. It occurs when blood supply to the brain is reduced or interrupted. In the event of this, the brain stops getting enough oxygen or nutrients, leading to the “death” of brain cells.
Globally, about 16 million new cases of stroke and 62 million stroke survivors were estimated in 2005, with deaths from stroke accounting for 9.7 per cent of all deaths. Stroke cases are expected to increase to over 23 million and 7.8 million deaths by 2030, in the absence of significant global public health response.
According to an expert, Dr. Gabriel Omonaiye, strokes or cerebrovascular accident (CVA), are a mixed group of disorders involving, sudden, focal interruption of blood flow in the brain causing deficiency in neurological functions.
He said: “It is a medical emergency and a leading cause of deaths in the Western world (the third most common). In the US, it is the fifth cause of death, causing one death every five minutes.
More than 100,000 cases are recorded yearly on Nigeria.
“Stroke, also known as brain attack, is a real medical emergency, that needs immediate intervention by highly trained group professionals using the best medical knowledge, skills, drugs, interventions, equipment and technology for the afflicted to have the best possible outcomes. But unfortunately here, there is a conspiracy of unfavourable factors and beliefs, which work to cause the patient to hold the short end of the stick. Such issues as poverty, health illiteracy, superstitious beliefs, and dearth of diagnostic machines and absence of the latest cutting edge technology adversely hinder the prognosis of patients with stroke.”
There are three main kinds of stroke: ischemic, hemorrhagic, and TIA.
Symptoms of stroke
Stroke occurs suddenly, but there are symptoms that confirm what the problem is. Stroke victims have the following symptoms, among others:
• Trouble with speaking and understanding.
• Headache.
• Numbness or inability to move parts of the face, arm, or leg – particularly on one side of the body.
• Trouble seeing, in one or both eyes.
• Trouble walking, including dizziness and lack of co-ordination.
• Bladder or bowel control problems
• Depression
• Pain in the hands and feet that gets worse with movement and temperature changes
• Trouble controlling or expressing emotions.
Omonaiye said: “There may be other symptoms such as abdominal pain, nausea, vomiting, and loss of appetite. Some people have an aura. It has, however, been discovered that in young women with migraine aura, there is a slightly increased occurrence of thrombotic stroke. The observation is, however, not causal.”
Prevention
Omonaiye said there is need for early diagnosis and adequate control of hypertension. He listed other measures, such as: control of diabetes, low fat diet, reduction of high cholesterol, weight reduction and regular exercise as necessary.
“There is need to stop smoking, abuse of cocaine and other harmful substances. Alcohol intake should be reduced also s well as treatment of atrial fibrillation,” he said.
Diagnoses
There are different ways of diagnosing stroke. They include:
Physical examination: Here the doctor asks about the patient’s symptoms and medical history. They may check blood pressure, listen to the carotid arteries in the neck, and examine the blood vessels at the back of the eyes, all to check for indications of clotting.
Blood tests: The patients blood will be tested to know how quickly the blood clots, the levels of particular substances (including clotting factors) in the blood, and whether or not the patient has an infection.
CT scan: This is a series of X-rays that can show hemorrhages, strokes, tumors, and other conditions within the brain.
MRI scan: Radio waves and magnets create an image of the brain to detect damaged brain tissue.
Carotid ultrasound: – This is done to check the blood flow in the carotid arteries and to see if there is any plaque present.
Cerebral angiogram: This is done by injecting dyes into the brain’s blood vessels to make them visible under X-ray, with the view to giving a detailed view of the brain and neck blood vessels.
Echocardiogram: Here is a detailed image of the heart created to check for any sources of clots that could have traveled to the brain to cause a stroke.
Treatments for stroke
There are different forms of treatment ischemic and hemorrhagic strokes. However, whatever method used, the important thing is to diagnosed stroke quickly to reduce the damage done to the brain, but also because treatment suitable for one kind of stroke can be harmful to someone who has had a different kind.
Ischemic stroke, caused by blocked or narrowed arteries, is treated by focusing on restoring an adequate flow of blood to the brain. It could be by use of drugs to break down clots and prevent others from forming. Aspirin can be given, just as injection of a tissue plasminogen activator (TPA), which is effective at dissolving clots. However, TPA needs to be injected within 4.5 hours of stroke symptoms starting. It could be done by administering directly into an artery in the brain or using a catheter to physically remove the clot.
The type of stroke could also be treated using endarterectomy, which involves a surgery to open the carotid artery and remove any plaque blocking it. Also, another surgery procedure called angioplasty could be done. This is done by the inflation of a small balloon in a narrowed artery, via catheter and then inserting a stent (a mesh tube) into the opening to prevent the artery from narrowing again.
On the other hand, hemorrhagic stroke, caused by bleeding into the brain, could be done focusing on controlling the bleeding and reducing the pressure on the brain. This could be done using drugs to reduce the pressure in the brain, control overall blood pressure, prevent seizures and prevent sudden constrictions of blood vessels.
Surgery could also be used to repair any problems with blood vessels that have led or could lead to hemorrhagic strokes. “Surgeons can place small clamps at the base of aneurysms or fill them with detachable coils to stop blood flow and prevent rupture,” says an expert.
Recovery and rehabilitation
According to an expert, lifestyle changes can help you recover from a stroke and may help prevent another one. Examples of these changes include quitting smoking, following a healthy diet, maintaining a healthy weight, and being physically active.
Experts stated that rehabilitation actually starts in the hospital, following a stroke. Depending on the severity of the stroke, rehabilitation options can include: A rehabilitation unit in the hospital with inpatient therapy, a sub-acute care unit, a rehabilitation hospital with individualised inpatient therapy and home therapy.
“A long-term care facility that provides therapy and skilled nursing care. However, the long-term goal of rehabilitation is to improve function so that the stroke survivor can become as independent as possible. This must be accomplished in a way that preserves dignity and motivates the survivor to relearn basic skills that the stroke may have impaired – skills like bathing, eating, dressing and walking,” said an expert.