World Stroke Day 2019 October 29th : "Cut Stroke In Half" focus on stroke risk and prevention PROF DR.M.A.ALEEM M.D., D.M.,(NEURO) NEUROLOGIST TRICHY TAMILNADU INDIA

World Stroke Day 2019 October 29th : "Cut Stroke In Half " focus on stroke risk and prevention

PROF DR.M.A.ALEEM M.D., D.M.,(NEURO)

EMERITUS PROFESSOR OF NEUROLOGY

THE TAMILNUDU DR.M.G.R. MEDICAL UNIVERSITY

PAST PRESIDENT TAMILNADU PONDICHERY ASSOCIATION OF NEUROLOGISTS

FORMER OF VICE PRINCIPAL HOD& PROFESSOR OF NEUROLOGY KAPV GOVERNMENT MEDICAL COLLEGE& MGM GOVERNMENT HOSPITAL

CONSULTANT NEUROLOGIST AND EPILEPTOLOGIST (TRAINED AT INSTITUTION OF NEUROLOGY QUEEN`S SQUARE . LONDON.UK.) ABC HOSPITAL, ANNAMALAI NAGAR , TRICHY -620018

SECRETARY NEUROLOGIST ASSOCIATION TIRUCHIRAPPALLI

DIRECTOR ABC HOSPITAL TRICHY

drmaaleem@hotmail.com

The analysis of the Global Burden of Disease, which shows that globally the lifetime risk of stroke has risen and now stands at 1 in 4. Combined with the Interstroke findings that showed around 90% of strokes are linked to a small number of easily addressed risk factors, the potential impact of public understanding of stroke risk and prevention awareness is clear.

This year my message When it comes to stroke, think prevention – Don’t be the one.’is relevant and essential to everyone about stroke

Stroke is not prevented by hoping it will never happen to you. This campaign encourages everyone to be proactive by understanding their stroke risk and taking the steps to prevent stroke and its devastating consequences.

While our efforts on World Stroke Day are largely directed towards raising public awareness of the steps we can all take to reduce our risk, the 2019 campaign is a key component of our strategic commitment to 'Cut Stroke in Half'.

Stroke in India

Developing countries like India are facing a double burden of communicable and non-communicable diseases. Stroke is one of the leading causes of death and disability in our country. The estimated adjusted prevalence rate of stroke range, 84-262/100,000 in rural and 334-424/100,000 in urban areas. The incidence rate is 119-145/100,000 based on the recent population based studies. There is also a wide variation in case fatality rates with the highest being 42% .

Why stroke matters

A stroke can happen to anyone, at anytime and anywhere. Today stroke is the leading cause of disability worldwide and the second leading cause of death, but almost all strokes could be prevented.

This year 14.5 million people will have a stroke, 5.5 million people will die as a result.

80 million people have survived stroke worldwide.

Many stroke survivors face significant challenges that include physical disability, communication difficulties, changes in how they think and feel, loss of work, income

and social networks.

Learn about stroke

Stroke happens when the blood supply to part of the brain is cut off. Without blood, brain cells can be damaged or die.

Nearly 14 million people will have a stroke this year and around 5.5 million people will die as a result. Stroke can have different short- and long-term effects depending on which part of the brain is affected and how quickly it is treated.

Survivors can experience wide ranging disabilities including difficulties with mobility and speech, as well as how they think and feel. Fast access to treatment saves lives and improves stroke recovery.

Types of stroke

There are two main types of stroke, ischemic and haemorrhagic.

Ischemic strokes

These strokes occur as a result of an obstruction in a blood vessel supplying blood to the brain. An obstruction of blood flow in the blood vessel can cause a blood clot to form, this is called a cerebral thrombosis. The main cause of cerebral thromboses are fatty deposits in blood vessels and arteries (atherosclerosis).

Blood vessels can also be blocked by a blood clot that has formed in another part of the body, usually the heart or large arteries of the upper chest and neck. Sometimes a portion of a blood clot breaks loose, enters the bloodstream and travels through the brain's blood vessels until it reaches vessels too small to let it pass. This is called a cerebral embolism. The main cause of this kind of clot is an irregular heartbeat, known as atrial fibrillation (AF).

Haemorrhagic strokes

Haemorrhagic strokes happen when a weakened blood vessel ruptures and bleeds into the brain. The blood builds up and creates pressure on the surrounding brain tissue. These bleeds can be caused by an aneurysm or an arteriovenous malformation (AVM).

Aneurysm

An aneurysm is a ballooning of a weakened region of a blood vessel. If left untreated, the aneurysm continues to weaken until it ruptures and bleeds into the brain.

Arteriovenous Malformation (AVM)

An AVM is a cluster of abnormally formed blood vessels. Any one of these vessels can rupture, also causing bleeding into the brain.

Transient Ischemic Attack (TIA or mini-stroke)

A TIA is caused by a temporary disruption in the blood supply to an area of the brain. It can cause symptoms similar to a stroke, but unlike a stroke these symptoms pass quickly and usually fully resolve within 24 hours.

In the early stages of a TIA it is impossible to tell whether or not it is a stroke, so it is important to call emergency services. People who have TIA are also at risk of further TIAs or a full stroke, so it is important that they see a doctor who can look at the causes of the TIA and provide treatment for the underlying cause.

The risk factors for TIA are similar to those for stroke and similar to stroke, TIAs also contribute to an increased longer-term risk of dementia.

Recognising when someone is having a stroke and getting immediate emergency medical care makes a big difference to survival and recovery. Act FAST!

Signs of stroke FAST

Stroke happens when the blood supply to part of the brain is cut off. Without blood, brain cells can be damaged or die.

Stroke is a complex medical issue. But there are ways to significantly reduce its impact. Recognizing the signs of stroke early, treating it as a medical emergency, with admission to a specialized stroke unit, and access to the best professional care can substantially improve outcomes.

The main symptoms of stroke can be remembered and checked with the word FAST.

Face – is the face drooping to one one side

Arms – is there a weakness in one arm

Speech – is speech slurred or garbled

Time – if these symptoms are present it is time to call emergency services

Stroke treatment

Stroke is a complex medical issue. But there are ways to significantly reduce its impact. Recognizing the signs of stroke early, treating it as a medical emergency with admission to a specialized stroke unit, and access to the best professional care can substantially improve outcomes.

Stroke prevention

1 in 4 of us will have a stroke in our lifetime, but almost all strokes can be prevented. If you want to avoid a stroke the first step is to understand your individual risk factors.

Up to 90% of strokes could be prevented by addressing a small number of risk factors, including hypertension, diet, smoking and exercise. Preventive action on stroke would also contribute to a massive scale reduction in stroke and would conribute to global goals to reduce cardiovascular disease, cancer, diabetes and other significant causes of death and suffering worldwide.

Cut Stroke in Half

The World Stroke Organization is leading the development and implementation of an integrated prevention strategy that has potential to cut stroke in half by 2030. With a focus on low and middle income countries where stroke is not only more prevalent but has the most devastating impact the strategy includes:

Access to low-dose combination therapy for patients at medium risk of stroke

Development of stroke specialist Community Healthworkers

Access to innovative mobile technologies that support access to prevention infomormation

Key treatment issues

Low public awareness of symptoms, inadequate and uneven access to specialist stroke treatment and lack of coordinated action around the world are key issues in stroke.

Awareness

Saving lives and improving outcomes from stroke starts long before a patient has contact with a health professional. It starts with public awareness of stroke symptoms. Awareness of FAST improves timely access to specilaist medical treatment which minimises damage to the brain, increases the treatment options available, reducing the risk of death and disability. Sustained public awareness campaigns supported by governments and delivered in partnership with local stroke organizations go hand in hand with efforts to access to acute treatment.

Access to healthcare

Financial barriers to prevention and detection of stroke risk factors through universal health coverage and access to essential medicines is critical to stroke prevention and will reduce the individual and community costs of stroke. Acess to specialist acute stroke care through the development of stroke units and professional education is needed to broaden access to quality stroke care.

Rehabilitation and life after stroke

Rehabilitation starts in the hospital as soon as possible following a stroke. It can improve function and help the survivor regain as much independence as possible over time. Many stroke survivors will need on-going treatment to address the physical impact of stroke and to maintain their mental health and well-being. Universal health coverage should include access to rehabilitation and long-term care needs of stroke suruvivors.