HD is a 72-year-old man with poor management of his hypertension and diabetes. He was talking with his children when they suddenly noticed him falling off his chair and not able to speak. He had suffered a stroke.
Stroke can actually be referred to as the brain correlate of a heart attack. It basically involves a sudden disturbance in the functioning of the central nervous system, especially the brain, due to poor blood flow to it.
Types of stroke: There are principally 2 types.
• Ischaemic type: This is the common type. It generally involves sudden blockage in the blood vessels of the brain.
• Haemorrhagic type: This involves a sudden burst in the blood vessels of the brain leading to bleeding into or around it.
How does stroke manifest in the individual? The evidences of stroke include
• Facial droop (or abnormal facial appearance)
• Arm or leg weakness and
• Difficulty with speech
Anyone that has any of above in a sudden manner should be assumed to have a stroke. Knowledge of this encourages prompt search for medical attention. Stroke can impair the functional capabilities of an individual. Some persons die from it.
Risk factors for stroke (what would increase the likelihood of an individual to have stroke?)
• Commonest risk factor that an individual can control is hypertension. Hypertension hastens thickening of blood vessels and blocks blood flow to the brain. Also, in the haemorrhagic type, a very high blood pressure can lead to a burst of weak vessels.
• Poorly controlled diabetes mellitus…also leads to damage to blood vessels of the brain.
• Smoking…hastens the accelerated damage to blood vessels in the brain.
• Heart rhythm abnormalities. These allow blood clots to form in the heart that can be transported to the brain and cause blockage of blood vessels.
• Abnormal levels of blood fat.
• Obesity / lack of exercise. These can increase the risk of having hypertension and diabetes.
• Conditions like chronic kidney disease, heart failure and blood clotting abnormalities can increase the likelihood of having stroke.
• In young persons, inherited abnormalities in blood vessel structure can increase the likelihood of having stroke.
• Recreational drugs like cocaine can increase the likelihood of having haemorrhagic stroke.
• Often colloquially referred to as minor stroke, “TIA”, known as a transient ischemic attack, is a major risk factor for stroke. About 30% of people who have had a TIA go on to develop stroke in the future. TIA can manifest as temporary weakness in the arm or leg, temporary abnormal sensations in the arm or leg, temporary difficulty with speech, or temporary blurred vision especially in one eye.
• A family history of severe headache leading to collapse and death should give concern among other members of their likelihood of having haemorrhagic strokes.
Management of stroke
An individual who has any of the above manifestations must be taken to hospital immediately. One of the goals in the management is prevention of death. In the hospital, doctors recommend appropriate investigations which include brain CT scans, various blood tests, ultrasounds of the neck arteries, and also electrocardiogram to assess the heart’s electrical activity. The various findings would inform the next line of management. Those with haemorrhagic strokes might need surgical interventions.
After a major stroke, there would be a period where rehabilitation might be needed to gain as much function back as possible. Unfortunately, in some individuals, full function may not be regained.
Prevention of stroke
1. Effective management of hypertension. Most adults should aim for a blood pressure not more than 120/70mmhg. A low salt diet is very important in efforts to have good blood pressures. Blood pressure lowering medications may be necessary.
2. Adequate control of blood sugar levels either with oral agents or with insulin in those with diabetes.
3. Proper evaluation of heart rhythm abnormalities by a doctor is vital. Some abnormalities might need prescription of blood thinning medications to lessen the risk of blood clots formation.
4. Keep healthy balance of blood cholesterol. Avoid excessive indulgence in foods rich in saturated fats. Occasionally, medications to control the cholesterol levels might be important.
5. Aggressively manage people who have had a TIA.
6. Individuals with family histories of strokes or sudden deaths in young persons should be evaluated for possible risk of blood vessel abnormalities.
7. A healthy and active lifestyle with adequate exercise and maintenance of healthy body weight is beneficial.
8. Complete cigarette cessation and alcohol consumption in moderation.
9. Avoidance of recreational drugs and intravenous drug use.
10. Regular annual health checks are very important in preventing stroke.
Dr Femi Afolayan obtained his medical degree at the University of Ilorin, Nigeria. He had a stint in internal medicine residency programme at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi state and later National Hospital, Abuja before he relocated to Australia and started out in emergency medicine training as a registrar for 2 years and later a fellowship program in internal medicine about 3 years ago. He is currently a senior registrar in acute care and intensive medicine, general medicine, and geriatrics. He is also an honorary lecturer with the medical school, Deakin University, Geelong, Australia. He enjoys teaching, cooking and playing video games. He can be reached on firstname.lastname@example.org.