Strokes can happen to anyone anywhere and on the occasion of World Stroke Day, neuro experts from AIIMS explained the “BE FAST” rules to prevent sudden deaths caused by strokes.
To learn more, read the following excerpts from Medically Speaking’s conversation with the expert panel, which included: Dr SS Kale, HOD, Neurosurgery, AIIMS; Dr Padma, HOD, Neurosciences, AIIMS; Dr Sanjay Wadhwa, HOD PMR Department, AIIMS.
In simple layman’s term please help us understand why are we even talking about stroke, what exactly is a stroke and why is it important , so pertinent in a country like us and how do we increase awareness around stroke ?
Dr Padma: Stroke, as we call it, a brain attack, is so staggering in terms of the burden of illness in society, especially in the developing world, where India is a prototype. As I speak now, we have a stroke happening every 20 seconds, and a stroke debt every 2 minutes. In a year, I mean last year, we had 18 lakh stroke patients in India, out of which 25% were younger than 40 years old. A brain attack or a stroke is an acute paralysis or acute weakness on one side of the body, that is, when there is a shortage of blood supply to the brain. If there is a clot or if there is a breakage of the blood vessel and bleeding and there is a lack of blood supply to the brain, there is an attack. An attack justifies the emergent action which is required. It is all within minutes, and so that’s why the theme for this world stroke day is “Time Saves Lives” and every minute counts.
Why is awareness around stroke so important and how can these crucial golden minutes really help in saving someone’s life sir?
Dr SS Kale: The problem is with the blood supply of the brain. If it stops suddenly, the neurons start dying, and unfortunately, neurons are one of those few cells that do not re-generate. If you might have noticed that the skin re-generates itself, other tissues heal themselves, wounds get healed on their own, there might be a scar, but unfortunately, if the neurons in the brain die, they will never come back again. That is why it is crucial to save as many neurons as you can. So, that is why it is important to act within minutes or at the most within the hour.
What are the symptoms of stroke and how should someone perhaps who is around someone should know that a person is getting a stroke and what do they do to save that person?
Dr Sanjay Wadhwa: One of the easiest ways to remember what the warning signs or deterrent signs of stroke are is by using the word “FAST,” because a stroke is an emergency and indicates that one must act fast. So, in the word FAST, F stands for FACE, A stands for ARM, S stands for Speech, and T stands for Time. Because time is of great essence, when the face gets affected by a stroke, the arm may become weak, the speech may get slurred or lost, and it all happens very suddenly in general. Some people have also added BE FAST to these alphabets. Here, B stands for balance and E for eyes, because some people have imbalances or loss of balance, and some people may have a diminution of vision. So, the symptoms and indications of stroke can be summed up very simply: BE FAST. This also encourages and emphasises that if there is a suspicion of stroke, act immediately because if there is a delay, thousands or millions of brain cells may die permanently.
What should one do when they see someone having a stroke? Slurring in speech, numbness in the arm is certain, prominent telltale signs of a stroke. How can a person expedite the reaction time?
Dr Padma: It could be a sudden loss of consciousness to which every body reacts, or it could be a very subtle deviation of the mouth or some weakness on one side, or people say it’s possible that glucose is less in the body, and sometimes a stroke even presents it that way. There are several ways to react to it: one, if you are aware that there is any sudden change in the function of the body, that’s the hallmark of it, because the brain is a super computer that commands every single action. At that moment, I rushed to the nearest stroke-ready hospital. We need to have a map of these stroke ready hospitals. All the doctors and medical people are now aware that the moment there is a stroke, they immediately need to treat the patient and shift him or her to a stroke-ready hospital where a diagnosis can be made, because for a diagnosis, you need at least a CT-SCAN machine. Secondly, try to determine if there is a clot in the artery. You need to unclog it, either by intravenous technique or sometimes by mechanically taking it out with a bigger center. There are primary stroke-ready centres and even more advanced stroke centers. We do have those, but the thing is that you need to recognise and rush to a stroke-ready hospital. That’s how you manage a stroke.
What types of stroke and what really causes a stroke , hypotension is the one reason we know , tell us other reasons that could cause a stroke ?
Dr SS Kale: One is when the blood supply is suddenly cut off, or if not entirely to the brain, but one part of the brain, say the part of the brain which controls your right side, will suddenly stop working. They will die, and then the right side of the person’s body will stop working. I say the right hand, leg, or right side of the face, and sometimes all three together. So, that is one kind of stroke. The second type of stroke is the hemorrhagic stroke. When there is a lot of sudden bleeding in the brain, or one of the vessels bursts, it could be an artery or sometimes a vein, which causes a clot of blood to sit in some area of the brain, and this clot of blood causes pressure on the neurons, which again causes damage wherever it is sitting. So basically, there are these two types of strokes, and in the second one, the blood should remain in the blood vessels, but if it escapes, it can cause a hemorrhagic stroke. Now let’s come to the risk factors. Which people can get a stroke? Am I likely to get a stroke? If I am an elderly person, then the chances of a stroke are higher. If I am hypertensive, my chances would be higher. If I am a diabetic, my chances would be higher. If I have hyperlipidemia, I am likely to have a stroke. So these are the kinds of risk factors that we talk about. We generally divide these risk factors into two types. One is modifiable, where we can bring a change by intervention. For example, if I am obese, I can do exercise, I can change my diet, I can lose weight, I can become fit, etc. But there are certain factors which are non-modifiable, such as age. If I am already 75, I cannot change my age.
Can lifestyle changes reduce the chances of stroke or can they actually prevent stroke all together sir?
Dr Sanjay Wadhwa: Lifestyle has a major role to play in the causation of non-communicable diseases and stroke is one of the leading examples. People who have very bad habits of eating they are likely to put on weight so by way of obesity they’re likely to have diabetes which is a risk factor for stroke. If you intervein in modifying the lifestyle then you can reduce the risks of stroke to a significant extent and some other diseases that I mentioned just now.
Can those people also who perhaps are at a disadvantage because of these uncontrollable factors, can they also make it some modification ,at least reduce the stroke?
Dr Padma: A lot of these what we call conventional risk factors, such as hypertension, also, of course, diabetes and your propensity to put on weight. It is obviously not always in your hands that you are eating a lot; sometimes you have this genetically and it just becomes a pear-shaped body. Even if you’re genetically predisposed, you don’t have to have this. You can prevent your heart attack and brain attack, so being aware of this and not being complacent about it matters.
85% people have unfortunately experienced in stroke but many of them lead a normal life even after that. Please elaborate a little bit on the rehabilitation part.
Dr SS Kale: There are ways and means available which can help mitigate the loss which you’ve suffered because of a stroke. First thing is to follow doctor’s advice and make all the necessary changes in your diet or schedule so that risk factors again come into play. People are now trying to device implants which can allow a person to see again. We have seen people with completely paralysed patients where the exoskeletons start working.
We are speaking of the three R’s of stroke, how to spot a stroke fast also three R’s of stroke recognition, rehabilitation and recovery. Elaborate a little bit on the rehabilitation and recovery part.
Dr Sanjay Wadhwa: There are ways and means available which can help mitigate the loss which you’ve suffered because of a stroke. You can modify risk factors and try to prevent it as much as possible, but some unfortunate people do suffer from it. It is important to remember that, unfortunately, some of the people who suffer strokes die. But a large majority of people survive and many of these survive with a residual disability. Rehabilitation is a journey that normally begins in an institutional setting.
Stroke rehabilitation can begin as early as 24-48 hours after onset of acute stroke, so we have to initiate early steps so that extent of disability is reduced as much as possible. Education, equipment and modification of the immediate environment are some of the components of a comprehensive rehabilitation plan. Professor Padma Srivastav was a key contributor to the development of all of these guidelines, which are very comprehensive and have been endorsed by the ministry of health and family welfare.
Unfortunately we are seeing a large number of population being affected by strokes which is a younger population something perhaps which is not very common at least a decade ago it increased by 100% correct. What would be your message?
Dr Padma: Number one prevents strokes. You just have to One super computer, which is equal to your life, prevents anything from happening to it. Traffic accidents are also brain attacks. Number two-if there is a stroke happening, be aware of how to recognise it and reach out as an emergency. It is an emergency, so you should not waste any time, as again, we say, time saves lives. Every minute counts. That’s the team of the World Strike Day. Number three: if there is an unfortunate incident, don’t lose hope. The earlier you rehabilitate, the better the recovery. Never lose hope. Every stroke recovers to a small or large extent. It’s in your hands.