National Institute for Stroke and Applied Neurosciences,
AUT University, Auckland, New Zealand
Stroke
is one of the biggest causes of disability and death in the world. In Nigeria,
it is estimated that strokes are responsible for between 5 to 17% of all
medical deaths per year. In addition to this, strokes have enormous economic,
psychological and social burden for patients, families and caregivers. However,
despite the huge impact of stroke, very few people outside the health sector
are aware of what a stroke is, how to identify a stroke, what the risk factors
of stroke are and how they can reduce their chances of having a stroke. This article
will aim to answer some of those questions, and give people the information
needed to prevent them from suffering a stroke.
What
is a stroke?
A
stroke is a medical emergency where blood circulation in the brain is
disrupted, due to either a blockage in the blood vessel (ischaemic stroke) or
if the blood vessel ruptures or bursts (haemorrhagic stroke). This results in a
part of the brain not receiving adequate blood supply, which leads to the death
of brain cells in the affected part. The severity of symptoms is related to
where in the brain the disruption occurs, as this affects how much of the brain
(and which area of the brain) is affected.
Sometimes,
the blockages can be temporary. If symptoms last for less than 24 hours, the
event is called a Transient Ischaemic Attack (also known as TIA or mini-stroke).
These may be warnings for more severe strokes in the future and one should
always seek medical attention – even if the symptoms go away quickly.
However,
the impact of stroke can be greatly minimised if people act quickly and seek
medical attention as soon as possible.
How
can you tell if someone is having a stroke?
The F.A.S.T. is an easy way to detect some
sudden signs and symptoms of a stroke and prompt immediate actions:
Face drooping: Does one side
of the face droop? Ask the person to smile. Is the face symmetrical?
Arm weakness: Is one arm weak
or numb? Ask the person to raise both arms. Does one arm drift downward?
Speech difficulty: Is speech
slurred, are they unable to speak or understand? Ask the person to repeat a simple
sentence.
Time to call: Time to call an
ambulance if the person shows any sign of these symptoms, even if the symptoms
go away very quickly
Although
two thirds of strokes occur without any warning signs, approximately one third
of strokes do have warning signs, including transient ischaemic attack (TIA or
mini stroke). An ambulance should be called immediately if any of the
following symptoms occur (especially symptoms with sudden onset):
·
loss of strength (or sudden
clumsiness – such as being unable to stand up, or dropping items) in some part
of the body, espeically on one side, including the face, arm or leg;
·
numbness (sensory loss) or
other unusual sensations in some part of the body, especially if one-sided;
·
complete or partial loss of
vision on one side;
·
inability to speak properly
or to understand language;
·
loss of balance,
unsteadiness or an unexplained fall;
·
any other kind of transient
spells (vertigo, dizziness, swallowing difficulties, acute confusion, or memory
disturbances);
·
headache that is unusually
severe, abrupt, or of unusual character (including unexplained change in the
pattern of headaches);
·
sudden alterations of
consciousness or convulsions/seizures etc.
These
warning signs may occur alone or in any combination. They may last a few
seconds or up to 24 hours and then disappear (TIA), or as a single episode
during a day or repeated. During the first 24 hours it is impossible to know
for sure if symptoms are due to stroke or due to TIA. However, symptoms can
indicate a hidden problem with blood flow in the brain, which, if ignored,
could result in a severe stroke.
What
are the risk factors of stroke?
While
stroke is a serious health issue, current research suggests that upto 80% of
strokes are preventable.
The
main risk factors for stroke are:
- High blood pressure (hypertension):
The lower your blood pressure, the lower your risk of stroke. The usually recommended
target for blood pressure reduction is blood pressure below 140/90 mm Hg (or
below 130/80 mm Hg in diabetics).
- Heart disease: People with heart
disease, atrial fibrillation and left ventricular hypertrophy are at
significantly higher risk of stroke. Regular medical advice on controlling
these conditions are essential in reducing stroke risk.
- Diet and lifestyle: A healthy
lifestyle and well balanced diet can significantly reduce your chances of
having a stroke. What you eat and how often you exercise should be
balanced to maintain a healthy body weight.
- Smoking and alcohol: Smoking
tobacco makes you 4 times more likely to have a stroke. Smoking constricts
and hardens the arteries throughout the body, thus reducing the blood
flow, and makes the blood more likely to clot. Even second hand smoking
(being in the same room as someone smoking) can increase your risk of
stroke significantly.
There
are some risk factors for stroke that we cannot control. Your age, sex,
ethnicity and genetics can influence your risk of stroke, but the effects of
these factors is greatly reduced if you the controllable risk factors are well
managed.
How
high is your risk?
Unfortunately,
even if someone is trying to manage the risk factors, it is very hard to
determine what their actual risk of stroke is. Until recently, the only way to
determine if you were at risk of stroke was if your doctor told you. However,
the National Institute for Stroke and Applied Neurosciences has recently
developed an app that can calculate your risk of stroke. The Stroke Riskometer™
is available for both Android and iPhone platforms, and assesses both absolute
risk (i.e. how likely you are to have a stroke in the next 5 or 10 years) as
well as relative risk (i.e. how likely you are to have a stroke compared to
someone your age and sex with no risk factors). Relative risk is particularly
important in trying to determine whether you need to make any changes to your
lifestyle, as the absolute risk (particularly for young people) can often be
quite low. In addition to your risk factor, the app also lets you see what your
risks are, and in the Pro version, gives you guidance on what you can do to
minimise these risks. More information is available at www.strokeriskometer.com
Having
a stroke is a serious incident with potentially devastating consequences. However,
you can greatly lower your risk of having a stroke by being aware of what your
risk factors are, and taking the correct steps to maintain a healthy lifestyle.
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