STRIKE - OUT STROKE CHALLENGE

Prof. Dr. M A. Aleem, M.D.D.M. (Neuro)

HOD & Professor of Neurology,

Dept. of Neurology,

KAPV Govt Medical College, AGM Govt. Hospital, Trichy – 620018, T.N. India.

Cell 94431 – 59940, 99442-41270.

Every six seconds, regardless of age or gender – someone somewhere will die from stroke.
This, however, is more than a public health statistic. These are people, who at one time, were someone’s sister, brother, wife, husband, daughter, son, partner, mother, father… friend. They did exist and were loved. Behind the numbers are real lives. The World Stroke Organization (WSO) is calling for urgent action to address the silent stroke epidemic by launching the “One in Six” campaign on World Stroke Day, 29 October.
The objective of the campaign is to put the fight against stroke front and center on the global health agenda. The “One in Six” theme was selected by leaders of the WSO to highlight the fact that in today’s world, one in six people worldwide will have a stroke in their lifetime. Everyone is at risk and the situation could worsen with complacency and inaction.
The “One in Six” campaign celebrates the fact that not only can stroke be prevented, but that stroke survivors can fully recover and regain their quality of life with the appropriate long-term care and support. The two-year campaign aims to reduce the burden of stroke by acting on six easy challenges:
1. Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol.
2. Be physically active and exercise regularly.
3. Avoid obesity by keeping to a healthy diet.
4. Limit alcohol consumption.
5. Avoid cigarette smoke. If you smoke, seek help to stop now.
6. Learn to recognize the warning signs of a stroke and how to take action.
Stroke is the second leading cause of death for people above the age of 60, and the fifth leading cause in people aged 15 to 59. Stroke also attacks children, including newborns.  Each year, nearly six million people die from stroke. In fact, stroke is responsible for more deaths every year than those attributed to AIDS, tuberculosis and malaria put together – three diseases which have set the benchmark for successful public health advocacy, capturing the attention of the world’s media and which consequently has provoked world leaders, governments and many sectors of civil society to act.
Stroke is indiscriminate and does not respect borders. Individual countries cannot address the challenges of stroke in isolation. World Stroke Day brings together advocacy groups, patient survivor support networks, volunteer stroke societies, public health authorities, physicians, nurses and others within the allied health professions including civil society at-large, for a collaborative approach to comprehensive stroke education, advocacy, prevention, treatment and long-term care and support for stroke survivors.

The facts behind “1 in 6” campaign

The theme of the 2010 campaign is "1 in 6". The reason behind this is to emphasize how widespread stroke is. Not many people are aware of this fact. One in six people in the world will suffer a stroke in their lifetime;

·        The lifetime risk of stroke is 1 in 5 for women, 1 in 6 for men:

• Every two seconds, someone in the world suffers a stroke
• Every six seconds, someone dies of a stroke
• Every six seconds, someone’s quality of life will forever be changed – they will permanently be physically disabled due to stroke

Facts and Figures 

Question:
Is it true that stroke is responsible for nearly six million deaths every year?

Answer:
Yes, it is. According to the World Health Organization and other leading stroke experts, stroke claims 5.8 million lives each year.
Question:
Is it true that stroke kills more people each year than AIDS, tuberculosis and malaria put together?
Answer: 
Yes, it is. (1) In 2008, AIDS-related deaths totaled 2.0 million (1.7 million – 2.4 million); (2) 1.8 million people died from TB in 2008, including 500,000 people with HIV; (3) there were 247 million cases of malaria in 2006, causing nearly one million deaths, mostly among African children.
According to the World Health Organization and other leading stroke experts, stroke claims 5.8 million lives each year.
Question:
Is it true that stroke also attacks children?
Answer:
Yes, it is.  Stroke also attacks children, including newborns. Visit WSO member organization websites below for more information:
Question:
Is it true that most strokes are not painful?
Answer:
Yes it is.  Most strokes are not painful. Eighty percent of strokes are caused by a blood clot in the brain and usually do not hurt, although some do. Stroke cuts off oxygen to a part of the brain.  Brain cells begin to die but this is usually not painful. Don’t ignore symptoms because they don’t hurt. Only 20% of strokes are caused by bleeding inside the brain, and this type of stroke is usually very painful. 
Question:
Is it true that on a global scale, stroke claims a life every six seconds?
Answer:
Yes, it is. Worldwide, it is estimated that six people die from a stroke every 60 seconds.
Question:
Is it true that every two seconds, someone, somewhere in the world is having a stroke?
Answer: 
Yes it is. There an estimated 30 incidences of stroke per 60 seconds worldwide. Majority are referred to as "silent" strokes. These are the most common type of strokes. The word "silent" is a misnomer. When subjects with "silent" infarcts are examined they have subtle neuropsychological and neurological deficits. An article from the Framingham Study suggests that 1 in 10 individuals, stroke free and living in the community, with a mean age of 62±9 years have a "silent" stroke. If ignored, little strokes could spell big trouble. One subclinical stroke is associated with increased chance of having others and of experiencing a clinical stroke and/or dementia. The combination of subclinical strokes and subclinical Alzheimer lesions may be a background for the association of stroke and dementia given that the lifetime risk of developing either or both is one in three.

Question:
Is it true that 80% of all people who have suffered from a stroke now live in low and mid-income countries?

Answer: 
Yes, it is. The burden of stroke now disproportionately affects individuals living in resource-poor countries. From 2000 to 2008, the overall stroke incidence rates in low to middle income countries, exceeded that of high-income countries, by 20%.
Question:
Is it true that the incidence of stroke is growing and that a disproportionate burden is unfolding in resource-constrained countries where awareness of prevention, care and support is lowest?
Answer:
Yes it is. Today, two-thirds of all individuals that have suffered from a stroke live in developing countries where health systems are already challenged to the limit.
Question:
Is it true that stroke is the second leading cause of death for people above the age of 60 years?
Answer:
Yes, it is. According to the World Health Organization (WHO), stroke is the leading cause of death for people above the age of 60 and the fifth leading cause in people aged 15-59. 
Question:
Is it true that most people do not recognize the first symptoms presented by stroke?
Answer:
Correct. Approximately 70% of patients do not correctly recognize their TIA or minor stroke, 30% delay seeking medical attention for >24 hours, regardless of age, sex, social class, or educational level, and approximately 30% of early recurrent strokes occur before seeking attention. Without more effective public education of all demographic groups, the full potential of acute prevention will not be realized.
Question:
Is it true that high blood pressure is the leading risk factor for stroke?
Answer:
Yes, it is. It is very important to find out if you are at risk for high blood pressure, diabetes or high blood cholesterol.
Question:
Is it true that stroke is a leading cause of disability worldwide?

Answer:
Yes, it is. Stroke is a leading cause of disability worldwide. 

Join the “One in Six” campaign.  Tell six other people to take this “strike-out stroke” challenge.

Stroke – Indian Scenario

India is silently witnessing a stroke epidemic Stroke is a Non-communicable disease of increasing socioeconomic importance in ageing populations. According to WHO, stroke was the second commonest cause of worldwide mortality in 1990 and, the third commonest cause of mortality in more developed countries; it was responsible for about 4·4 million deaths worldwide. In the recent estimates made in 1999, the number of deaths due to stroke reached 5·54 million worldwide, with two-thirds of these deaths occurring in less developed countries. Stroke is also a major cause of long-term disability and, has potentially enormous emotional and socioeconomic consequences for patients, their families, and health services. The case-fatality rate due to stroke is reported to vary varies from 11.7% to 32.4%.

In 2005, estimates indicated that 58 million people died, and in them chronic diseases accounted for 35 million deaths (60%). Cardiovascular diseases, predominantly heart disease and stroke, were the cause of death in 17·5 million individuals. After heart disease, Stroke is the second leading single cause of death, with 5·8 million fatal cases per year, 40% of which are in people younger than 70 years. About 15 million new acute stroke events arise every year, and about 55 million people have had a stroke at some time in the past, either with or without residual disability; two-thirds of these individuals live in low income and middle-income countries. Demographic changes, urbanization, and increased exposure to major stroke risk factors will fuel the stroke burden in the future. By 2025, four out of five stroke events will occur in people living in these regions.

The prevalence of stroke in India varies in different regions of the country and, ranges from 40 to 270 per 100 000 population. Approximately 12% of all strokes occur in the population <40 years of age. Major risk factors identified in India are hypertension (blood pressure >95 mm Hg diastolic), hyperglycemia, tobacco use, and low hemoglobin levels (<10 gm %). Stroke accounts for 2 percent of hospital registrations, 1.5 percent of medical registrations and 9 to 30 percent of neurological admissions in major hospitals. The National Commission on Macroeconomics and Health has projected that cases of stroke would increase from 1,081,480 in 2000 to 1,667,372 in 2015. The ICMR study on Burden of Disease (2005) has 1

estimated that there has been an increase in the number of stroke cases in India during the last one and a half decades by 17.5 %. Mortality due to strokes has increased by 7.8% from 1998 to 2004.

Prevention and Control of Cardiovascular diseases, Diabetes and Stroke in Tamil Nadu.

Tamil Nadu has incorporated this component into its recently launched state wide health systems project, which is supported by the World Bank. The need for multi component interventions, affecting several behaviors would be necessary for designing programs related to chronic diseases.

Stroke is a major public health problem. According to World Health Organization (WHO), stroke has caused about 5.54 million deaths worldwide in 1999 with two-thirds of these deaths occurring in less developed countries. Stroke is also the most common neurological condition causing long-term disability and has enormous emotional and socioeconomic consequences in patients, their families and health services. The latest available estimates from Indian Council of Medical Research (ICMR) indicate that in 2004 there were 930,985 cases of stroke in India with 639,455 deaths and 6.4 million disability adjusted life years (DALY) lost.

In India the incidence of stroke is likely to rise in the coming years due to:

1. increase in population
2. increase in life expectancy
3. rapid urbanization from migration of villagers to the cities
4. changing lifestyles involving sedentary habits, smoking, excess alcohol use, etc.
5. rising stress level in life

According to the estimates by the National Commission on Macroeconomics and Health, India, there will be 1.67 million stroke cases in India in 2015

Stroke – FAQs

What is a stroke?

A stroke occurs when a blood vessel (artery) that supplies blood to the brain bursts or is blocked by a blood clot. Within minutes, the nerve cells in that area of the brain are damaged, and they may die within a few hours. As a result, the part of the body controlled by the damaged section of the brain cannot function properly.

If you have symptoms of a stroke, you need emergency care, just as though you are having a heart attack. If medical treatment begins soon after symptoms are noticed, fewer brain cells may be permanently damaged.

What causes a stroke?

• An ischemic stroke is caused by a reduction in blood flow to the brain. This can be caused by a blockage or narrowing in an artery that supplies blood to the brain or when the blood flow is reduced because of a heart or other condition.
• A hemorrhagic stroke develops when an artery in the brain leaks or bursts and causes bleeding inside the brain tissue or near the surface of the brain.

Before having a stroke, you may have one or more transient ischemic attacks (TIAs), which are warning signals that a stroke may soon occur. TIAs are often called mini-strokes because their symptoms are similar to those of a stroke. However, unlike stroke symptoms, TIA symptoms usually disappear within 10 to 20 minutes, although they may last up to 24 hours.

What are the symptoms?

Symptoms of a stroke begin suddenly and may include:

• Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body.
• Vision problems in one or both eyes, such as double vision or loss of vision.
• Confusion, trouble speaking or understanding.
• Trouble walking, dizziness, loss of balance or coordination.
• Severe headache.

How is a stroke diagnosed?

Time is critical in diagnosing and treating a stroke. The first step will be a physical exam and tests of your brain function, followed by a type of X-ray called a CT scan of the brain to establish the type of stroke-ischemic or hemorrhagic. This distinction is critical because the medicine given for an ischemic stroke (tissue plasminogen activator, or t-PA) could be life-threatening if given to someone with a hemorrhagic stroke (bleeding in the brain). A prompt diagnosis is also crucial because t-PA should be given within 3 hours of when your symptoms began.

How is it treated?

Ischemic stroke: Doctors will first stabilize your condition and try to restore or improve blood flow to the brain. If less than 3 hours have passed since your symptoms began, tissue plasminogen activator (t-PA), a clot-dissolving medicine, may be given. Research shows that the medicine can improve recovery from a stroke, especially if given within 90 minutes of your first symptoms.1

Hemorrhagic stroke: Treatment for a hemorrhagic stroke is difficult. It includes monitoring and controlling bleeding and pressure in the brain and other efforts to stabilize vital signs, especially blood pressure.

After your initial emergency treatment, health professionals will focus on preventing complications such as pneumonia and future strokes. Your health professional will also involve you in a stroke rehabilitation program as soon as possible.

Can I prevent a stroke?

You can help prevent a stroke by eliminating risk factors.

You may lower your risk of stroke if you can control certain diseases or conditions. These include:

• High blood pressure (hypertension). High blood pressure is the second most important stroke risk factor after age.
• Diabetes. Having diabetes doubles your risk for stroke because of the circulation problems associated with the disease.2
• High cholesterol. High cholesterol can lead to hardening of your arteries (atherosclerosis). Hardening of the arteries can cause coronary artery disease and heart attack, which can damage the heart muscle and increase your risk of stroke.
• Other heart conditions, such as atrial fibrillation, endocarditis, heart valve conditions, or cardiomyopathy.

You also can make lifestyle changes that may help you lower your risk of stroke. These include:

• Quitting smoking. Daily cigarette smoking can increase the risk of stroke 2½ times.
• Becoming more active. Physical activity reduces the risk of stroke.
• Eating a nutritious diet. Having more fruits, vegetables, fish, and whole grains (for example, brown rice) in your diet may help lower your risk of stroke and other diseases.

Some risk factors, however, can't be changed. Risk factors that you cannot change include:

• Age. The risk for stroke increases with age. Most strokes occur in people older than 65.2
• Race. African Americans, Native Americans, and Alaskan Natives have a higher risk than people of other races.
• Gender. Stroke is more common in men than women. However, at older ages, more women than men have strokes. At all ages, more women than men die of stroke.
• Family history. The risk for stroke is greater if a parent, brother, or sister has had a stroke or transient ischemic attack (TIA).

Prior history of stroke or TIA. About 14% of people who have a stroke have another stroke within 1 year.

Prof. Dr. M A. Aleem, M.D.D.M. (Neuro)

HOD & Professor of Neurology

Dept. of Neurology