HEALTH With the potential to paralyze and permanently disable, a stroke can trap you in your own body and condemn you to a living death. Awareness and prevention is the only way to win the war against what experts call the deadly ‘brain attack', writes KAMALA THIAGARAJAN

According to WHO statistics, worldwide, 15 million people suffer a stroke every year. Of these, 5 million die and another five million are permanently crippled, disabled or critically dependent on others for their survival. “A stroke occurs when blood flow to the brain is blocked or restricted, causing substantial damage to portions of the brain that are responsible for our normal functioning. The blood flow can be obstructed either by a blood clot in the artery leading to the brain or by the rupture of cerebral blood vessels in the area that lead to bleeding,” says Dr S. Chitrambalam, neurophysician and associate professor, department of neurology, Sri Ramachandra University, Porur, Chennai.

So much is known and discussed about heart attacks and how they threaten our lives. Yet, there is very little public awareness of stroke, despite the fact that this debilitating disease is the third most common cause of death worldwide, exceeded only by heart attack and cancer.

Tell-tale symptoms

We often think that stroke is a disease that strikes like lightening, taking one completely by surprise. However, experts say that there are definite warning signs that we may have ignored.

“Severe numbness that affects just one side of the body, the inability to move part of your face or limbs for a brief period of time, difficulty speaking, blurred or double-vision, episodes of memory loss, severe disorientation and confusion are all symptoms of stroke,” says Dr Chitrambalam.

“When the stroke is less severe, these symptoms may reverse themselves in 24 hours, but periodic attacks will lead to more severe consequences, even permanent and irreversible disability.” These ‘mini-strokes' are called transient ischemic attacks (TIA) and in some cases, may even go unnoticed or ignored by the patient.

Who's at risk?

One common misconception is that stroke is a problem that affects only the elderly. “If you suffer from high blood pressure, smoke excessively, drink alcohol, have a high level of cholesterol, have had a previous history of heart attacks, suffer from uncontrolled and untreated diabetes, you are at risk, whatever your age,” says Dr Chitrambalam. And it's not just men who are vulnerable. “In women who are predisposed, birth control pills can cause a venous stroke. Even children are susceptible and there are rare cases in which a baby is born with a stroke (called perinatal stroke).” So, age really isn't a factor, but your lifestyle can certainly make a difference.

Protecting yourself

Protecting yourself against stroke involves monitoring your lifestyle and health issues and making necessary modifications. For instance, according to research by the World Health Organization, treating hypertension can prevent the risk of stroke by upto 40%. So for every ten people who die of stroke, four of these deaths could have been prevented if only they had monitored their blood pressure and kept it in check with appropriate medication.

“Keeping diabetes under control is another crucial factor,” says Dr K. Murali, an interventional neuro radiologist, Miot Hospitals, Chennai. “One must stop smoking and chewing tobacco. It's also important to get your lipid profile or cholesterol checked periodically. Include physical activity into your daily routine. Avoid junk food which is full of artery clogging trans fat. All these are essential in protecting yourself against stroke,” says Dr Murali. If you have a family history of heart disease, stroke or have experienced these symptoms, Dr Murali advises immediate consultation with a neurologist who may recommend an angiogram of the neck and brain as well as an echocardiogram. “Timely diagnosis is the only way to prevent the devastating effects of stroke,” he says. “If there is only a small blood vessel block, the patient can recover fully with timely treatment and physiotherapy. We can administer clot busters as intravenous drugs in order to unblock and clear the arteries. However, in large vessel blocks, recovery is possible only if drugs are administered within six hours after the stroke has occurred. Beyond this window period, it is dangerous to administer these drugs directly into the clot because it may cause internal bleeding.”

Medical science is constantly evolving and today, there are newer and better therapies.

In a treatment called mechanical clot retrieval, nueronterventionists use catheters and a wire-like tiny clot retrieval device to capture and remove the blood clot, literally pulling it out of the artery so that it no longer blocks the blood flow to the brain. However, the surgery must be administered within 3-4 hours of the attack. Not many hospitals, especially in rural centers, are equipped with an emergency stroke recovery team. Such expertise is only to be found only in bigger towns and cities. “Unfortunately, after 12 hours, little can be done,” says Dr Murali.

However, a team of that included Dr Murali and Dr Chitrambalam did recently save a patient ten hours after he suffered a critical block in the posterior of the brain. The 40-year-old patient, a diabetic who smoked and drank excessively, recovered dramatically after clot retrieval surgery. Most patients would be dependent on ventilators or enter into coma after experiencing such a severe stroke.

“As advanced as technology is, prevention and timely intervention is the only effective cure,” warns Dr Murali. More than ever, it's now important to take care of your body and be alert to its signals.