STROKE

Whati
saSt
roke?

Astrokeisamedi calcondi
ti
onthatcausesbraindamagewhi choccur
sduetoadi sr
uptionor
decreaseintheamountofbloodreachingthebrai
n.Thiscausesarapi
dlossofbrainfuncti
on
duet odeathofthebrai
ncell
s.Str
okeissocal l
edbecauseoft hewayi
t"st
ri
kes"peopledown.It
causesasev er
er educt
ioni
nthequalit
yoflif
e.

Al i
ttl
ebi taboutthebrain;Thebr ai
ni sactuallyav eryself
ishorgan, whichrequiresabout20%of
bloodt hat'
spumpedbyt heheart.Itrequir
esconst antsupplyofoxy gen,gl
ucoseandener gy
whi chitrequiresfori
tsactivi
ti
es.Andasweknow, t
hebrainisresponsibleforthingsli
keour
i
nt ell
igence,executi
onoft asks,mov ementofv ari
ouspar tsoft hebody ,br
eathing,speech,
vision,hearingandsomanyot herfunctions.Thebr ai
niswhatkeepsusal ive,makesuswhowe
areanddet ermineshowwef unct i
oni nthesoci et
y .Thebrainisobv i
ouslyav eryimportant
organandt hat'swhyitdoesn'tli
ket obest arvedofi t
ssourceoff ood,whichist heblood.And
that'swhyi nst r
okewher ethebloodsuppl yisinadequate, i
tcomeswi t
hsev ereconsequences.

St
rokeandst
ati
sti
cs

Str
okei
soneofthetop5leadingcausesofdeathandtop3leadi
ngcausesofdisabil
i
ty
worl
dwi
de.Annual
l
y,15mill
ionpeopleworl
dwidesufferastr
oke;1ever
y2seconds.Ofthese,
5
mil
li
ondi
eandanother5mill
ionarelef
tpermanentl
ydisabl
ed,pl
aci
ngaburdenonf amil
yand
communit
y.

RISKFACTORS( Thingsthatcanincr
easethel
ikeli
hoodofhavingastr
oke)Itcanbroadl
ybe
di
v i
dedint
omodi f
iableandnon-modifi
abl
eri
skfactorsdependingont
hethingsyoucanchange
andtheonesyoucannot .I
'm goi
ngtostar
twiththemodifi
ableonesbecausethey'
rethepoi
nt
offocusofpr
evention.

MODI
FIABLERI
SKFACTORS

Hyper
tensi
on/Highbloodpressur
e:Hyper
tensi
oni
soneoft
hemosti
mpor
tantcausesofst
roke.
I
taccountsforabout35–50%ofst r
okeri
sk.
Smoking:Smokingjustonecigaret
teperdayincreasestheriskmorethan30%.Ev enpassi
ve
smoking,
theonewher ey ou'
renottheonesmoki ng,butyou'r
einanenv i
ronmentwherepeopl
e
aresmokingandit'
senteringyournose.Anditdoesn'tst
opatst r
oke,smoking(acti
veor
passi
ve)i
ncreasestheriskofnumer ouscancer
s, hear
tdiseases,
kidneyfai
lur
eetc.

Poor
lycont
rol
l
eddi
abet
es

Obesi
tyorbei
ngov
erwei
ght

Al
cohol

Lackofphy
sicalact
ivi
ty:
Sedent
aryl
i
fest
yleandl
owl
evel
sofphy
sical
act
ivi
tyi
ncr
easest
her
isk
ofhavi
ngastroke.

Hi
ghchol
est
erol

Headt
rauma(
Likei
nar
oadt
raf
fi
cacci
dentorf
all
i
ngdownt
hest
air
s)

Medi
cat
ionsl
i
keor
alcont
racept
ives

Har
ddr
ugsl
i
keCocai
ne,
Amphet
ami
nes,
mol
l
yet
c

NON-
MODI
FIABLERI
SKFACTORS

Age

Gender(
occur
smor
einmal
est
hanf
emal
es)

Race(
Higherpr
edi
sposi
ti
oni
nAf
ri
canAmer
icanst
hanCaucasi
ans)

Si
ckl
ecel
ldi
sease(
whi
chcancauseast
rokeev
eni
nchi
l
drenory
oungadul
ts)

Pr
evi
ousst
roke

Si
gnsandsy
mpt
oms

Thesi
gnsandsy mptomsofastr
okedependonthepartoft
hebr
ainthathasl
osti
tsblood
suppl
yandisaff
ected.Someoft
hesei
nclude:
Paral
ysi
sandweaknessinpart
softhebodyli
ke
arms,l
egs,
faceetc.

Lossofsensat
ionsi
ntheser
egi
ons.

Di
ff
icul
tyi
nspeechpr
oduct
ion

Vi
si
onpr
obl
ems

Headache

Di
ff
icul
tyi
nmov
ementandbal
ance
Whatt
odowheny
oususpectsomeonei
shav
ingast
roke

Timeistissue.There'
sa180-
minutewindowoftime.Thelongerthebraini
swi t
houtbl
ood,
oxygenandgl ucose,t
hemorethebrai
ncell
sthatdi
e.Thegoal i
st or
estorebloodfl
owassoon
aspossibleandt hi
sstar
tswi
thearl
yrecogni
ti
onandthroughtorehabili
tat
ion

UseaFASTst
rokeassessment

FACE:Havethepati
entsmi
leorshowhi
s/hert
eet
h.Checki
fonesi
deoft
hepat
ient
'sf
ace
droopsordoesnotmoveatal
l.

ARMS:Askt
hepat
ientt
ocl
oset
hei
rey
esandl
i
ftt
hei
rar
ms.Checki
fonear
mri
sesmor
ethan
theot
her
.

SPEECH:
Askthepati
enttor
epeataphr
ase.Checki
fthewor
dsar
esl
urr
ed,
abnor
mal
ori
fthey
ar
eunabl
etospeakatall
.

TIME:I
fanyofthesesy
mpt omsareoccur
ri
ng,
cont
actt
heemer
gencyser
vicesi
mmedi
atel
yor
r
ushtothehospi
talf
orpromptcar
e.

Theoutcomedependsonhowquickl
ysomeonerecei
vestr
eat
ment.Pr
omptcar
eal
someans
thatt
heywoul
dbel essl
i
kel
ytoexper
ienceper
manentbrai
ndamageordeat
h.

Rehabil
it
ation:Str
okei
sapotenti
all
yli
fechangi
ngeventthatcanhavelast
ingphysi
caland
emotionaleffect
ssoasuccessf
ulrecover
yfrom ast
rokewillof
teni
nvolvespeci
fi
ctherapi
es
andsuppor tsyst
ems,i
ncl
uding:

Speecht
her
apy

Phy
sical
ther
apy
:Thi
scanhel
paper
sonr
elear
nmov
ementandcoor
dinat
ion.

Occupat
ional
ther
apy
:Thi
scanhel
paper
soni
mpr
ovet
hei
rabi
l
ityt
ocar
ryoutdai
l
yact
ivi
ti
es,

Suppor
tgroups:
Joi
ningasuppor
tgroupcanhel
paper
soncopewi
thment
alheal
thi
ssuest
hat
canoccuraft
erast
roke,
suchasdepressi
on.

Supportf
rom famil
yandf
ri
ends:
Fri
endsandr
elat
ivesshoul
dtr
ytoof
ferpr
act
ical
suppor
tand
comfor
tafterastr
oke.
PREVENTI ON:Becauseofthel ar
gelyconser
vat
ivemanagementwi t
hl i
ttl
eornofundingforhi
gh
-
quali
tyresear
ch,pri
maryprev enti
onisthekeyt
or educi
ngtheburdenoft hedi
seasecountri
es
l
ikeNigeri
awithpoorresources.Sowhatcanwedot oprev
entthelikel
ihoodofastroke
occur
rence?

Well-control
ledBloodpressur
eandbl oodsugarl evel
s:Bloodpressur
ereduct
ionof10mmHg
reducest heriskofstr
okeby~40%.Ahy pert
ensi
vepatientt
hatiscompli
antwit
hhis/
her
doctor'sprescript
ionwit
hawel l
-control
ledbloodpressurehasbeenconclusi
vel
yshownto
preventbot hischemicandhemor rhagicstroke.

Get
ti
ngregularexer
cise:Anactiv
elif
esty
lereducest
her
iskofdi
abetes,
highbl
oodpr
essur
e,
hi
ghchol
esterol
,andot hercondi
ti
onsthati
ncreaset
her
iskofastr
oke

Followingaheart-
healthydiet:
Adi etshoul
dbel owi n“bad”fat
s,suchassaturatedandtr
ans
fats.Peopleshouldalsolimitt
heirsodium/sal
tintake.Eati
ngmor efr
uits,
vegetabl
es,whol
e
grains,heal
thf
ulfats,
andl eanproteinscanhel
pt hem preservecardi
ovascul
arhealt
hwhich
reducest heri
skofast roke.

Managingbodywei
ght
:Ifaper
sonisov
erwei
ghtorhasobesi
ty,
reachi
ngaheal
thybodywei
ght
canbr
ingdownthei
rri
skforst
roke.

Getti
ngenoughsleepandmanagingstr
ess:Get
ti
ng6-
7hour
sofsleepandtaki
ngstepst
o
reducest
ress,
suchasr el
axat
iont
echni
ques,mayhel
ptopr
eventst
rokeandimpr
oveoveral
l
healt
handwell-
being

Qui
tt
ingSmoki
ngandal
cohol
dri
nki
ng

N. B"Part
ialSt
r oke"ormi nistroke.Medi cally,t
hisi
sknownasaTRANSI ENTI SCHEMI C
ATTACK( TI
A).Thi soccursduet oat empor aryblockageofbl oodfl
owt othebrai
n.Sy mptoms
ofaTI Aarethesameast hoseofast r
oke, buttheyusuall
yl astl
essthan5mi nutesbutnot
mor ethan24hour s.Andt heydonotcauseper manentdamageandt heyresol
veont heirown.
Andweknowt hatonet hingaboutNi geri
ansi sthatoncet here'
snoissueagain,t
heyf eel
everyt
hingisalright.Butthedanger ousthingaboutaTI Ai sthatifi
thashappenedbef ore,iti
s
mor eli
kelyt
ohappenagai n,andt histi
me, wi t
hmor epermanentdamageandconsequences.
About33%ofal lpeoplewhohav eaTI Awi llexperi
enceamor eseverest
rokewithin1y ear.Soit
i
sadv isedtotreatt hem asmedi cal emergenci esevenifthesy mptomsaret emporar
ybecause
theyserveaswar ningsignsforf uturestrokes.

Quest
ion:
Cant
hepat
ientf
unct
ionnor
mal
l
yaf
teral
lthemedi
cal
andnonmedi
cal
treat
ment
s?

Answer:That
'swhyt i
mi ngisimportantwhenaper sonhasastroke.Dependingont heext
entof
brai
ndamage, somef uncti
onscanber est
oredbutitwon'
tnecessari
lybe100%, becausethe
cell
softhebraindonotr egenerat
eliketheonesinotheror
gansliketheLiv
er .Butwit
h
tr
eatmentandr ehabi
l
itati
on,thepatient
'squal
it
yoflif
ecanbeimpr oved
Quest
ion:
Thi
sIguessi
sthesecondar
yst
agereact
ions,ther
eshouldbesymptomsbefor
eone
get
stothi
sst
age?Howdooneknowwhenbl oodfl
owi sgett
ingi
nter
rupt
ional
ready?

Answer:That'
swhyIhadt otalkaboutTr ansi
entischemi catt
ack.Ithappenssuddenlywith
symptomsbuti tusuall
yreversesoni t
sownwi thoutpermanentbrai ndamage.Butwheni t
happens,i
t'
sthebody '
swayofsay ingthatitmighthappenagai n.Basicall
y,t
hemor bi
d
mechanismsthatunder l
ieahear tatt
ackar ealsoinvolv
edi nasimilarfashi
oninast r
oke.Soa
heartat
tackcanbot hdir
ectl
yandi ndirectl
yincreasetheriskofast r
oke.Andt hat
'swhy
prev
entioni
sreallythebest.

Questi
on:What
'st
heagerangeforpossi
bleTI
AandPer
manentSt
roke?Imeani
sitpossi
blef
or
ateenagert
ohaveast
ri
ke/Str
oke

Answer
:Ther
ear
eri
skf
act
ors

Ageisoneoft hem andactually

, t
her i
skofhav i
ngast rokeincreaseswi thage.Andthoughi t
occursmoreintheelderl
y,it'
snotr est
rictedtool dpeople.Youngpeopl ecouldal sogetast r
oke.
Youngpeoplearenowdev elopi
nghy pertension.Therear ealsothingslikesi
cklecelldi
sease,
useofcocaineorestrogen-contai
ningor alcontracepti
ves.Thesei ncreasetheriskofstroke
eveninyoungadults.Geneticstoocouldpl ayapar t.Therear epeoplethatarejustbiol
ogical
ly
predi
sposed.