University of Creative Technology Chittagong

Assignment
on
Stroke

SUBMITTED TO

Mohammad Injamul Hoq

Department of Public Health
Program: Master of Public Health (Autumn 2020)
University of Creative Technology Chittagong

SUBMITTED BY

Rumana Arjuman Huree

ID-20072214
Program: Master of Public Health (Autumn 2020)
Department of Public Health
University of Creative Technology Chittagong
Date of Submission: 21/09/2020

1
 Table of Contents

Particulars Pages
1. Introduction 03
2. Global Facts 03
3. Bangladesh Perspectives 04
4. Symptom of the Disease 05
5. Development of the Disease 06
6. Stage 07
7. Risk Factors 08
8. Diagnosis 10
9. Control & Prevention Strategies 11
10. Management 16
11. Treatment 16
12. Conclusion 18

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1. Introduction
A stroke occurs when the blood supply to part of your brain is interrupted or reduced,
preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in
minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can
reduce brain damage and other complications. The good news is that many fewer Americans
die of stroke now than in the past. Effective treatments can also help prevent disability from
stroke.

2. Global Facts
Evidence-based approaches to organization and planning of stroke care and services require
accurate ongoing data on stroke incidence, prevalence, and outcomes. The best sources of
such data are population-based studies that meet “gold-standard” criteria and are
continuously repeated over time, as stroke epidemiology is changing rapidly. However, such
studies are expensive and require expertise for their proper design and execution. That is
why no such studies have been done in most countries, especially in the developing countries
and over a long period of time. From the public health perspective, there is also a need to
monitor stroke burden on a global scale and compare burden between different countries and
regions over time, including trends and projections relative to other major diseases. To
address these issues and fill the gaps in disease burden estimates across all countries, the
GBD (Global Burden of Disease) Study was set up in 1992 within the Institute for Health
Metrics and Evaluation of the University of Washington. During the period of time from
1990 to present, the GBD Study has developed (and continuously updated) a large database
and advanced methodologies for modeling the burden of a wide range of diseases and their

3
risk factors in 188 countries. This article summarizes GBD 2013 Study findings on stroke
burden recently published in the special open access issue of the journal Neuroepidemiology
and outlines recommended measures to reduce stroke burden. In these publications, stroke
burden is reported in terms of incidence of first-ever stroke (ischemic stroke [IS] and
hemorrhagic stroke [HS] separately, and total stroke), prevalence, mortality, and disability-
adjusted life-years (DALYs) in children (0–19 years of age), young to middle-aged adults
(20–64 years of age), and overall for all ages combined and by sex from 1990 to 2013. All
burden estimates were reported with corresponding 95% uncertainty intervals (UI). In lay
terms, DALYs mean the number of years lost because of disability. The diagnostic criteria
for stroke used in the GBD analyses are based on the World Health Organization (WHO)
definition of stroke. Details on the methodology of the GBD stroke burden estimates,
including diagnostic criteria and data sources, have been published elsewhere.
3. Bangladesh Perspectives
Bangladesh has come a long way in improving its health indicators over the last 40 years.
The achievements in the health sector were made possible due to the priority given to
communicable diseases by both the Government of Bangladesh as well as non-government
organisations. However, non-communicable diseases (NCDs) such as cardiovascular
diseases, diabetes, chronic respiratory diseases, and cancer have begun to greatly impact
public health in developing countries.
NCDs are now considered to be the leading cause of mortality worldwide and are a serious
public health threat to developing countries. According to the World Health Organization
(WHO), almost half of all deaths in Asia can now be attributed to NCDs. Even more
alarming is that over 80 per cent of cardiovascular and diabetes deaths, 90 per cent of deaths
from chronic respiratory diseases and two-thirds of all cancer deaths occur in developing
countries.
Stroke – an aspect of cardiovascular diseases – is one of the leading causes of disability in
many Asian countries, with low-and middle income countries bearing a higher burden of
mortality. It occurs when an artery leading to the brain either becomes blocked or ruptures,
blocking the blood supply and depriving the brain of oxygen. As a result, brain tissues begin
to deteriorate and die, oftentimes causing fatality if prompt medical action is not
administered. While stroke is typically associated with advanced age, the reality is that
anyone at any age (even children) can be afflicted by it as lifestyle is a predominant

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determinant. Smoking, hypertension, diabetes and high cholesterol are the largest risk factors
for having a stroke.

In Bangladesh, which is ranked 84 in WHO’s mortality rate index (out of 163 countries),
stroke is the third leading cause of death. The majority of cases (82.3 per cent) occur in
individuals over the age of forty; hypertension (63 per cent) was found to be the main risk
factor for stroke, followed by heart disease (24 per cent), and diabetes (21 per cent). A lack
of information and poor control and management of risk factors have contributed to the
growing incidences of stroke.
Access to care for stroke is scarce, and limitations in the capacity of the local health facilities
to manage stroke are well-researched, particularly in primary care facilities. A study
published by icddr,b this year explored care-seeking patterns among individuals who have
survived stroke in 2014 in Matlab, a rural district of Bangladesh. Dr Aliya Naheed, head of
icddr.b’s NCD initiative and co-Principal Investigator of the project, stated that the research
found that the majority of stroke survivors were brought to a health facility and treated by a
qualified doctor. However, only about one-third of patients who died of a stroke in the same
community were brought to a health facility, which may be attributable to poor knowledge
about the severity of stroke and poor access to care in the community. Strengthening
capacities of the primary care health workforce for basic stroke management and efficient
referral to specialized hospitals may improve survival of stroke victims, particularly in rural
areas.
4. Symptom of the Disease
It may be having a stroke, pay particular attention to the time the symptoms began. Some
treatment options are most effective when given soon after a stroke begins.
Signs and symptoms of stroke include:
 Trouble speaking and understanding what others are saying. May experience
confusion, slur words or have difficulty understanding speech.
 Paralysis or numbness of the face, arm or leg. Develop sudden numbness,
weakness or paralysis in face, arm or leg. This often affects just one side of body. Try
to raise both arms over head at the same time. If one arm begins to fall, may be
having a stroke. Also, one side of r mouth may droop when try to smile.
 Problems seeing in one or both eyes. may suddenly have blurred or blackened
vision in one or both eyes, or may see double.

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  Headache. A sudden, severe headache, which may be accompanied by vomiting,
dizziness or altered consciousness, may indicate that having a stroke.
 Trouble walking. may stumble or lose balance. may also have sudden dizziness or a
loss of coordination.
5. Development of the Disease
Although there is an obvious lack of hard evidence on best, proven-effective strategies for
stroke prevention in developing countries, excessive salt intake, tobacco use, and elevated
blood pressure appear to be the 3 most important risk factors for cost-effective stroke
prevention. Communitywide efforts to reduce salt intake (especially through reduction of salt
in manufactured food)21,22 through legislation changes and educational campaigns to
reduce use of table salt, thereby reducing the prevalence of elevated blood pressure, and
tobacco use (through multiple economic and educational policies, including tobacco
accessibility and taxation) 23,24 to reduce the prevalence of cardiovascular disease have
been suggested as 1 of the most cost-effective strategies for stroke prevention at a population
level, especially in developing countries.22,25–27 However, integrated interventions aimed
at multiple stroke risk factors at the population level (especially no pharmacological
interventions) should also be encouraged. Of the pharmacological stroke preventive
interventions, aspirin and inexpensive blood pressure-lowering agents such as blockers and
thiazides have also been suggested as cost-effective in developing countries.2,12,23,26,28
One of the most promising strategies to reduce the prevalence of hypertension and hence
reduce stroke risk in developing countries is to develop strategies to reduce salt consumption
at the population level.2 Unlike major sources of consumed salt in developed countries, in
many developing countries, particularly in rural Asia, the majority of salt consumed is that
from salt added during cooking, including salt consumed from preserved homemade
products. Strategies for stroke prevention should therefore target education and awareness
about the hazards of eating foods so high in salt. There is also evidence that salt substitution
is feasible in developing countries and produces a substantial and sustained systolic blood
pressure reduction and should be actively promoted as a low-cost alternate or adjunct to drug
therapy for people consuming significant quantities of salt.29 It has been shown that
reduction in salt intake by 3 g/day is strongly correlated with a reduction in blood pressure
and an estimated 13% reduction in strokes resulting from reducing salt intake. 30 As diets in
developing countries change more toward the inclusion of processed and fast food, it would
be a difficult task to reduce salt consumption to desired levels. Therefore, food

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manufacturing and fast food chains will need to join in the battle to produce food that is
lower in salt content. A shift toward improved diets that reduce stroke risk31 means that
governments in developing countries need to make fresh fruits and vegetables more
accessible and affordable to the general population. It should be noted that a high salt intake
is strongly associated with renal disease, stomach cancer, and osteoporosis as well as
cardiovascular disease and stroke21; therefore, governments have a strong incentive to put
pressure on manufacturing companies to reduce the salt content of foods they produce.
Similarly, smoking cessation campaigns need to be more and effective in developing
countries. Smoking programs and changes in legislation to reduce smoking (eg, smoke
banning in public places, plain packaging, additional tobacco taxation) in developing
countries need to be a priority for policymakers to save millions of lives and reduce
smoking-related morbidity over the next 2 decades.32 Smoking cessation programs in
developing countries need to be culturally appropriate and need to address the regional
cultural diversity within these countries.33 The Project Quit Tobacco International addressed
these issues in tobacco smoking cessation programs in India and Indonesia. The program
highlighted the need to provide populations with specific information on how smoking
caused health problems, which in turn could lead to an increase in the desire to quit smoking.
Combined with education programs that highlight the proven health benefits of smoking
cessation would be an effective means of implementing smoking cessation programs in
developing countries. There is encouraging evidence that effective stroke prevention
programs are achievable in developing countries. For instance, a major stroke prevention/
education program to address the high stroke mortality burden was launched by the Thailand
government in 2006 to 2007 reduce stroke.
6. Stage
 Face drooping. One side of the face droops or is numb. When asked to smile, the
person’s smile looks uneven.
 Arm weakness. One arm will feel weak or numb. When asked to raise both arms, one of
the person’s arms will drift downward.
 Speech difficulty. The person will have trouble speaking. Speech will sound slurred, or
the words will be hard to understand. When asked to repeat a simple sentence like “The
sky is blue,” the person will have trouble repeating it correctly.
 Time to call 911. If the person shows any of the above symptoms, call 911. Even if the
symptoms go away, get an ambulance and get the person to a hospital. Take note of the
time when the symptoms first appeared.

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  Numbness or weakness in the face, arm, or leg, located on one side of the body.
Because our brains control each side of the body from a different hemisphere, a
stroke usually affects one half of the body.
 Confusion or trouble understanding. If you suddenly feel confused and have trouble
understanding things you usually have no problems managing, it could be a sign of
stroke.
 Trouble seeing in one or both eyes. A stroke can affect the area of the brain that
manages vision. A sudden loss of vision is another sign of stroke.
 Sudden dizziness, trouble walking, loss of balance or coordination. The keyword here
is sudden: one moment you’re fine, the next you feel dizzy or have trouble keeping
your balance. This is another sign that your brain is being affected by something.
 Sudden and severe headache with no obvious cause. A stroke can cause a sudden,
very bad headache that doesn’t seem related to your usual headache triggers.

7. Risk Factors
Many factors can increase your stroke risk. Potentially treatable stroke risk factors include:
Lifestyle risk factors
 Being overweight or obese
 Physical inactivity
 Heavy or binge drinking
 Use of illegal drugs such as cocaine and methamphetamine
Medical risk factors
 High blood pressure
 Cigarette smoking or secondhand smoke exposure
 High cholesterol
 Diabetes
 Obstructive sleep apnea
 Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal
heart rhythm, such as atrial fibrillation
 Personal or family history of stroke, heart attack or transient ischemic attack
 COVID-19 infection
Other factors associated with a higher risk of stroke include:
 Age — People age 55 or older have a higher risk of stroke than do younger people.
 Race — African Americans have a higher risk of stroke than do people of other races.

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  Sex — Men have a higher risk of stroke than women. Women are usually older when they
have strokes, and they're more likely to die of strokes than are men.
 Hormones — Use of birth control pills or hormone therapies that include estrogen increases
risk.

8. Diagnosis
Strokes are usually diagnosed by doing physical tests and studying images of the brain
produced during a scan.
When you first arrive at hospital with a suspected stroke, the doctor will want to find out as
much as they can about your symptoms.
A number of tests can be done to confirm the diagnosis and determine the cause of the
stroke.
This may include: 
 A blood test to find out your cholesterol and blood sugar level
 checking your pulse for an irregular heartbeat
 taking a blood pressure measurement
BRAIN SCANS
Even if the physical symptoms of a stroke are obvious, brain scans should also be done to
determine:
 if the stroke has been caused by a blocked artery (ischaemic stroke) or burst blood vessel
(haemorrhagic stroke)
 which part of the brain has been affected
 how severe the stroke is
Everyone with suspected stroke should have a brain scan within 1 hour of arriving at
hospital.
An early brain scan is especially important for people who:
 might benefit from medicine to clear blood clots (thrombolysis), such as alteplase or early
anticoagulant treatment
 are already taking anticoagulant treatments
 have a lower level of consciousness
This is why a stroke is a medical emergency and you should call 999 when a stroke is
suspected – there's no time to wait for a GP appointment.

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The 2 main types of scan used to assess the brain in people who have had a suspected stroke
are:
 a CT scan
 an MRI scan
CT scans
A CT scan is like an X-ray, but uses multiple images to build up a more detailed 3-
dimensional picture of your brain to help your doctor identify any problem areas.
During the scan, you may be given an injection of a special dye into one of the veins in your
arm to help improve the clarity of the CT image and look at the blood vessels that supply the
brain.
If it's suspected you're experiencing a stroke, a CT scan is usually able to show whether you
have had an ischaemic stroke or a haemorrhagic stroke.
It's generally quicker than an MRI scan and can mean you're able to receive appropriate
treatment sooner.
MRI scans
An MRI scan uses a strong magnetic field and radio waves to produce a detailed picture of
the inside of your body.
It's usually used in people with complex symptoms, where the extent or location of the
damage is unknown. 
It's also used in people who have recovered from a transient ischaemic attack (TIA). 
This type of scan shows brain tissue in greater detail, allowing smaller, or more unusually
located, areas affected by a stroke to be identified.
As with a CT scan, special dye can be used to improve MRI scan images.
SWALLOW TESTS
A swallow test is essential for anybody who has had a stroke, as the ability to swallow is
often affected soon after having a stroke.
When a person cannot swallow properly, there's a risk that food and drink may get into the
windpipe and lungs, which can lead to chest infections such as pneumonia. This is called
aspiration.
The test is simple. The person is given a few teaspoons of water to drink. If they can swallow
this without choking and coughing, they'll be asked to swallow half a glass of water.
If they have any difficulty swallowing, they'll be referred to a speech and language therapist
for a more detailed assessment.

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They usually will not be allowed to eat or drink normally until they have seen the therapist.
Fluids or nutrients may need to be given directly into a vein in the arm (intravenously) or
through a tube inserted into their stomach via their nose.
HEART AND BLOOD VESSEL TESTS
Further tests on the heart and blood vessels might be done later to confirm what caused
your stroke.
Some of the tests that may be performed are described below.
Carotid ultrasound
A carotid ultrasound scan can help to show if there's narrowing or blockages in the neck
arteries leading to your brain.
An ultrasound scan involves using a small probe (transducer) to send high-frequency sound
waves into your body.
When these sound waves bounce back, they can be used to create an image of the inside of
your body.
When carotid ultrasonography is needed, it should happen within 48 hours.
Echocardiography
An echocardiogram makes images of your heart to check for any problems that could be
related to your stroke.
This usually involves moving an ultrasound probe across your chest (transthoracic
echocardiogram).
An alternative type of echocardiogram called transoesophageal echocardiography
(TOE) may sometimes be used.
An ultrasound probe is passed down your gullet (oesophagus), usually under sedation.
As this allows the probe to be placed directly behind the heart, it produces a clear image of
blood clots and other abnormalities that may not be seen with a transthoracic
echocardiogram.
9. Control & Prevention Strategies
Stroke is the second leading cause of death and disability in the world. 1,2 During the past
several decades, the burden of stroke in the world has shifted from developed to developing
countries.3 Now, 75% of all stroke deaths and 81% of the total disability-adjusted life years
lost because of stroke occur in developing countries. 3 This shift in the burden from the
developed to developing countries is thought to be driven by the aging of population,
population growth, and changing patterns of diseases because of changes in risk factors and

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differences in socioeconomic status and health care.4,5 Stroke, therefore, has emerged as a
major public health priority in developing countries.

Challenges to Providing Healthcare for Stroke

Although the burden of stroke has increased in developing countries, the health care services
have not caught up. The challenges to provide health care services for stroke in developing
countries include lack of awareness about stroke and its risk factors, lack of economic
resources and publicly funded well functioning healthcare systems for primary and
secondary prevention, lack of ambulance services and facilities for acute stroke management,
unaffordable cost of tPA (tissue-type plasminogen activator), lack of rehabilitation facilities,
preference for alternative and complementary medicines over modern medicines, and poor
secondary prevention. These challenges often lead to worse outcomes after stroke, and
studies in some regions of Gambia and India have reported 30-day case fatality as high as
40%.7,8 Also, a large percentage of people in developing countries live in rural areas where
health care is not accessible. Authors of several studies have shown high mortality and
prevalence of stroke in rural regions of developing countries.9–11 The poor population in
developing countries are often affected by stroke, and stroke perpetuates poverty in these
people. Attempts are being made in developing countries to improve stroke services, but
these are in very early stages.12 Therefore, urgent attention is needed to reduce the burden of
stroke in developing countries.

Need for an Emphasis on Prevention

Stroke is preventable. Although attempts should be made to improve acute stroke care
services in developing countries, data from the developed countries suggests that a strong
emphasis on prevention would be needed to reduce the burden of stroke. From a public
health point of view, preventive measures to reduce the risk of stroke would provide
additional cross-cutting benefits. For example, reducing blood pressure or cholesterol using
pharmacological and lifestyle interventions would also reduce mortality because of other
chronic diseases, such as coronary artery disease, chronic kidney disease, and reduce the risk
of dementia.

Risk Factors for Stroke in Developing Countries

Are the risk factors for stroke different in developing countries than in developed countries?
INTERSTROKE (A Study of the Importance of Conventional and Emerging Risk Factors of
Stroke in Different Regions and Ethnic Groups of the World), the largest international case-

12
control study on stroke which included participants from developing countries in Africa,
Asia, America, and the Middle East provided important insights in this regard. 13 The study
identified 10 modifiable risk factors for stroke and calculated their population-attributable
risk which is the percentage of stroke cases that would not occur if the risk factor is
eliminated (Table). The risk factors identified were hypertension, lack of physical activity,
abnormal lipids, unhealthy diet, abdominal obesity, psychological factors, current smoking,
cardiac causes, alcohol consumption, and diabetes mellitus. Together, these 10 risk factors
accounted for close to 90% risk of stroke. Although there were geographic variations in the
extent of the risk (odds ratios) because of each risk factor, the overall direction of association
of risk factors with the risk of stroke was similar except for diet in south Asian countries. A
recent large case-control study from Africa also confirmed the association of risk factors
identified in the INTERSTROKE study with the risk of stroke. 24 Therefore, by and large, the
risk factors for stroke seem to be similar in the developing and developed countries. Few
additional stroke risk factors were identified by the Global Burden of Disease study. These
include low glomerular filtration rate, ambient and household air pollution, and lead
exposure.

Table. Stroke Risk Factors Identified in the INTERSTROKE Study, 13 and the
Preventive Strategies Targeting These Risk Factors in Developing Countries
Population-
Preventive Strategies for Stroke Being Used or
Risk Factor Attributable Risk
Trialed in Developing Countries
of Stroke (%)

Mass screening and treatment of hypertension,

community-based hypertension control using
High blood pressure 47.9 community health workers, polypill, community-
based lifestyle change program, mass health
promotion strategies

Physical inactivity 35.8 Mass health promotion strategies.

Dyslipidemia
(apolipoprotein Apo 26.8 Polypill, mass health promotion strategies
B/ApoA1 ratio)

Diet risk score 23.2 Mass health promotion strategies

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Table. Stroke Risk Factors Identified in the INTERSTROKE Study, 13 and the
Preventive Strategies Targeting These Risk Factors in Developing Countries
Population-
Preventive Strategies for Stroke Being Used or
Risk Factor Attributable Risk
Trialed in Developing Countries
of Stroke (%)

(unhealthy
cardiovascular diet)

Abdominal obesity 18.6 National program targeting obesity

Psychosocial factors 17.4 …

Mass health promotion strategies, antitobacco

Current smoking 12.4
measures by the state

Polypill, national program to control cardiac

Cardiac causes 9.1
diseases

Alcohol consumption 5.8 Mass health promotion strategies

Diabetes mellitus 3.9 National program to control diabetes mellitus

Interstroke indicates A Study of the Importance of Conventional and Emerging Risk Factors
of Stroke in Different Regions and Ethnic Groups of the World.

In developing countries, the other stroke risk factors that operate include infections (eg,
tuberculosis, syphilis, HIV infection, malaria, schistosomiasis, gnathostomiasis, rheumatic
heart disease, infective endocarditis, mycotic aneurysms), sickle cell disease, Takayasu
disease, snake bites, and scorpion sting. Many of these risk factors are being controlled
because of gradually improving awareness, health care services, screening for those with
rheumatic heart disease, and sickle cell disease in the school health programs, as well as
mass infectious disease eradication programs, and likely to contribute to a smaller number of
stroke cases at the population level. However, more progress needs to be made in Africa
where these risk factors are still prevalent. For example, in the INTERSTROKE study, the
10 risk factors discussed above contributed to 82% of the total risk of stroke as compared to
≥90% in the other continents.13
Strategies for Stroke Prevention
Two major strategies have been proposed for reducing the risk of cardiovascular diseases
(CVDs). The first one is the high-risk strategy, and the other one is the mass strategy.27

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High-Risk Strategy
The high-risk strategy identifies those at a higher risk of developing a disease. For stroke
prevention, those with modifiable risk factors (Table) can be targeted for primary prevention
of stroke under the high-risk strategy. In addition, a new approach of prevention based on
projected overall CVD risk has been proposed. This approach posits that an individual may
not have a specific disease or a health condition, for example, hypertension or diabetes
mellitus, but may have a higher overall cardiovascular risk because of presence of multiple
risk factors, such as prehypertension and dysglycemia which do not meet treatment
thresholds as per the current standards of care. The support for this argument comes from the
observation that cardiovascular risk increases linearly above the systolic blood pressure of
115 mm Hg.
Lifestyle Change
Most of the clinical guidelines on prevention of CVDs focus on individual patient
recommendation and emphasize lifestyle change as the first line prevention strategy.
Evidence from cohort and interventional studies supports the role of reduced salt intake,
increased fruit and vegetable consumption, physical activity, weight loss, tobacco cessation,
limited alcohol intake, and management of psychosocial stress in reducing cardiovascular
risk.32 Therefore, such measures need to be emphasized to prevent stroke in developing
countries as well. A recent cluster randomized controlled trial from Nepal showed that
lifestyle change program implemented through community health workers successfully
reduced blood pressure demonstrating the feasibility of this approach. However, one of the
major limitations of individual-based lifestyle and behavioral change approach is that it is
difficult to sustain34 and scale. The emergence of global epidemic of obesity highlights the
limitations of individual-based preventive strategies.
Pharmacological Interventions
Hypertension is the leading risk factor for stroke and its control remains one of the most
effective interventions to reduce the risk of stroke. Screening for hypertension at population
level and making treatment available and affordable has resulted in reduced stroke incidence,
prevalence, and mortality in Japan and Taiwan. Shortage of doctors in developing countries
can create a barrier to screening and treatment of hypertension, but the emerging evidence
from randomized controlled trials from Argentina, China, and India suggests that
community-level interventions involving community health workers can lead to improved
hypertension control.

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Population-Based Strategy
The second preventive strategy is the one where mass (population-based) approaches are
used to target entire population to reduce cardiovascular risk. It is argued that even a small
but population-wide reduction in the level of risk factor results in large overall beneficial
effects.27 It needs health systems approach with a mass mobilization, policy, and legislative
changes. Despite limited hard evidence to support such approaches, given the limitation of
individual-based lifestyle change strategy, there is increasing interest in population-based
strategies for cardiovascular risk reduction. A successful example of mass health promotion
strategy in a developing country is from Mauritius, where an intervention involving use of
mass media, legislative measures, as well as health education in community, school, and
workplace was used to promote healthy nutrition, increase exercise, smoking cessation, and
reduction in alcohol intake.
Current Efforts Towards Prevention of Stroke
Several developing countries are taking steps to reduce the risk of stroke. The Chinese
Center for Disease Control and Prevention has drafted a China National Plan for Non-
Communicable Diseases Prevention and Treatment to increase awareness about
noncommunicable diseases, improve control of hypertension and diabetes mellitus, reduce
smoking and salt consumption, and improve disease surveillance. 49 Similarly, a large-scale
programme called the National Program for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases, and Stroke was launched by the Government of India in 2010 for
early diagnosis and treatment of these diseases, promoting lifestyle modification and
capacity building at various levels, including training of manpower.
10. Management
 A physical exam. Your doctor will do a number of tests you're familiar with, such as
listening to your heart and checking your blood pressure. You'll also have a neurological
exam to see how a potential stroke is affecting your nervous system.
 Blood tests. You may have several blood tests, including tests to check how fast your
blood clots, whether your blood sugar is too high or low, and whether you have an infection.
 Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a
detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke,
a tumor or other conditions. Doctors may inject a dye into your bloodstream to view your
blood vessels in your neck and brain in greater detail (computerized tomography
angiography).

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11. Treatment
Treatment depends on the type of stroke: ischemic or hemorrhagic.
Ischemic stroke.
For this type of stroke, treatment focuses on restoring blood flow to the brain.
 Clot-dissolving medicine called tissue plasminogen activator (TPA). This
medicine can improve recovery from a stroke, especially if it's given as soon
as possible after the stroke happens. Doctors try to give this medicine within 3
hours after symptoms start. Some people may be helped if they are able to get
this medicine within 4½ hours of their first symptoms.
 You may also get aspirin or another antiplatelet medicine.
 In some cases, a procedure may be done to restore blood flow. The doctor
uses a thin, flexible tube (catheter) and a tiny cage to remove the blood clot
that caused the stroke. This procedure is called a thrombectomy.
Hemorrhagic stroke.
For this type of stroke, treatment focuses on controlling bleeding, reducing pressure
in the brain, and stabilizing vital signs, especially blood pressure.
 To stop the bleeding, you may get medicine or a transfusion of parts of blood,
such as plasma. These are given through an IV.
 Closely watched for signs of increased pressure on the brain. These signs
include restlessness, confusion, trouble following commands, and headache.
Other measures will be taken to keep you from straining from excessive
coughing, vomiting, or lifting, or straining to pass stool or change position.
 If the bleeding is from a ruptured brain aneurysm, surgery to repair the
aneurysm may be done.
 In some cases, medicines may be given to control blood pressure, brain
swelling, blood sugar levels, fever, and seizures.
 If a large amount of bleeding has occurred and symptoms are quickly getting
worse, you may need surgery. The surgery can remove the blood that has built
up inside the brain and lower pressure inside the head.
After either kind of stroke and after your condition is stable, treatment shifts to preventing
future strokes and other problems and to your recovery.
 Need to take a number of medicines to control conditions that put you at risk for
stroke. These conditions include high blood pressure and atrial fibrillation. Some

17
 people need to have surgery to remove plaque buildup from the blood vessels that
supply the brain (carotid arteries).
 A stroke rehabilitation (rehab) program can help you regain skills lost. Or it can help
make the most of your remaining abilities.

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12. Conclusion
Stroke cases in Bangladesh have significantly increased in number over the past decades;
adverse outcomes from these cases are also rising due to the low number of neurologists and
specialized hospitals in the country. Because stroke poses long-term economic impacts on
individuals, families, and the country, we urge the Bangladeshi government to put more
emphasis on healthcare development by building more stroke rehabilitation units and tertiary
hospitals to prevent stroke occurrence and recurrence.
References
1. Mohammad, Q. (2014). Management of stroke - Bangladesh perspective. Bangladesh
Medical Journal, 42(1), 34-37. https://doi.org/10.3329/bmj.v42i1.18979
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