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12 December, 2016 00:00 00 AM

Learn about stroke

Learn about stroke

Stroke happens when the blood supply to part of the brain is cut off. Without blood, brain cells can be damaged or die. This damage can have different effects depending on where it happens in the brain. It can affect people’s body, mobility and speech, as well as how they think and feel.

Stroke is the leading cause of disability and the second leading cause of death globally. Stroke can happen to anyone at any age. Stroke affects everyone: survivors, family and friends, workplaces and communities.

If we consider an isolated blood vessel, blood flow to the brain tissue can be hampered in two ways:
1.    the vessel clogs within (ischemic stroke)
2.    the vessel ruptures, causing blood to leak into the brain (hemorrhagic stroke)

Ischemic stroke accounts for about 87 percent of all cases.
Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. This condition is called atherosclerosis. These fatty deposits can cause two types of obstruction:
Cerebral thrombosis refers to a thrombus (blood clot) that develops at the clogged part of the vessel.

Cerebral embolism refers generally to a blood clot that forms at another location in the circulatory system, usually the heart and large arteries of the upper chest and neck. A portion of the blood clot breaks loose, enters the bloodstream and travels through the brain's blood vessels until it reaches vessels too small to let it pass. A second important cause of embolism is an irregular heartbeat, known as atrial fibrillation. It creates conditions where clots can form in the heart, dislodge and travel to the brain.

Hemorrhagic stroke accounts for about 13 percent of stroke cases. It results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. The two types of hemorrhagic strokes are intracerebral hemorrhage or subarachnoid hemorrhage.

Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs).

An aneurysm is a ballooning of a weakened region of a blood vessel. If left untreated, the aneurysm continues to weaken until it ruptures and bleeds into the brain. An arteriovenous malformation (AVM) is a cluster of abnormally formed blood vessels. Any one of these vessels can rupture, also causing bleeding into the brain.
Stroke warning signs
These are the warning signs that someone is having a stroke:
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

Stroke is treatable
Stroke is a complex medical issue. But there are ways to significantly reduce its impact. Recognizing the signs of stroke early, treating it as a medical emergency with admission to a specialized stroke unit, and access to the best professional care can substantially improve outcomes.
The right care makes a difference, but many people are not getting the stroke treatment they need.
Six key facts about stroke treatment
1. Early recognition makes a big difference.
Knowing the signs of stroke and getting treatment quickly saves lives and improves recovery. If you think someone may have had a stroke, do this FAST check:
Face – Is one side drooping?
Arms – Raise both arms. Is one side weak?
Speech – Is the person able to speak? Are words jumbled or slurred?
Time – Act quickly and seek emergency medical attention immediately.
2. Around 1 in 10 more people make an excellent recovery when cared for in a specialized stroke unit.
All patients with stroke (ischaemic or haemorrhagic) should be admitted to a specialized stroke unit, which involves a designated ward with a specialized team.
3. Clot-busting drugs (tPA or thrombolysis) increase the chance of a good outcome by 30%.
Clot-busting drugs break up blood clots. This treatment can be administered up to 4.5 hours of symptom onset in many patients with ischaemic stroke. The earlier it is given, the greater the effect.
4. Clot retrieval treatment increases the chance of a good outcome by more than 50%.
Clot retrieval treatment (mechanical thrombectomy) involves removing a blood clot and can improve survival rates and reduce disability for many people with ischaemic stroke caused by large artery blockage.
5. Rehabilitation is a critical step in the treatment process.
Rehabilitation starts in the hospital as soon as possible following a stroke. It can improve function and help the survivor regain as much independence as possible over time.
6. One in four survivors will have another stroke.

Treatments that prevent another stroke include drugs to lower blood pressure and cholesterol, antiplatelet therapies, anticoagulation for atrial fibrillation, surgery or stenting for selected patients with severe carotid artery narrowing.
Lifestyle changes can also greatly reduce the risk of another stroke. Changes include eating well, being physically active, being tobacco-free, managing stress, and limiting alcohol consumption.

Learn how to prevent a stroke
Here are six steps anyone can take to reduce the risk and the danger of stroke:
1.    Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol.
2.    Be physically active and exercise regularly.
3.    Maintain a healthy diet high in fruit and vegetable and low in salt to stay a healthy state and keep blood pressure low.
4.    Limit alcohol consumption.
5. Avoid cigarette smoke. If you smoke, seek help to stop now.
6.    Learn to recognize the warning signs of a stroke.

Low salt diet
It is recommended that salt intake be reduced to less than 5g a day to lower the risk of having a stroke.
1.    Salt raises our blood pressure
2.    The higher our blood pressure, the higher our risk of stroke
3.    Adults should have less than 5grams of salt a day, and children even less
4.    It is particularly important that children do not eat too much salt, as blood pressure first starts to rise in childhood
5.    Much of the salt we eat is in everyday foods such as bread, sauces, cheese and processed meat, as well as salt added at the table and during cooking
6.    Take time to get used to lower salt food, and you will enjoy it as much, if not more, than salty food
Atrial fibrillation and other heart conditions

Atrial Fibrillation (AF) is an under-diagnosed and under-treated heart condition and a major risk factor for stroke. AF causes the two upper chambers of the heart (the atria) to quiver instead of beating effectively, resulting in blood not being completely pumped out, which in turn causes pooling and can lead to clotting. These clots can travel to the brain and trigger a major and often fatal stroke. Stroke due to AF is highly preventable by anti-clotting drugs.

WSO recommends that persons who have experienced a heart attack, have been diagnosed with a heart ailment or have irregular heart rhythm, to regularly visit health services in order to prevent the occurrence of a stroke.

Stroke warning signs
The FAST test is an easy way for everyone to remember and recognize the signs of stroke. FAST stands for Face, Arms, Speech and Time to act:
Face - Check their face. Has their mouth drooped?
Arms - Can they lift both arms?
Speech - Is their speech slurred? Do they understand you?
Time - Is critical. If you notice any of these warning signs, act FAST. Call your local emergency medical services or get to the nearest hospital immediately.
Think FAST. Act Fast. Stroke is a medical emergency.

The facts behind "1 in 6"
The theme of the campaign is "1" in 6". The reason behind this is to emphasize how widespread stroke is. Not many people are aware of this fact. One in six people in the world will suffer a stroke in their lifetime; on this page, you will find the data and references behind that statistic and others.

The lifetime risk of stroke is 1 in 5 for women, 1 in 6 for men:

 Disorders after stroke
Paralyzed shoulder muscles are not able to help tendons keep the upper end of the arm in the shoulder joint. As a result the arm drops from the joint which is very painful and can prevent rehabilitation of the hand and arm.

Depression after stroke, as after any severe illness, is very common, often goes without diagnosis, reduces the patient's capacity for rehabilitation, and impairs his/her quality of life. Furthermore this affects not only stroke survivors but also their spouses or next-of-kin who take care of the patients. For many of the patients, their spouses and their children, this burden is long-standing.

Cognitive decline
Stroke can lead to cognitive decline, and it is even more common after a recurrent stroke. This is also the case after recurrent subclinical strokes which are often not diagnosed due to missing classical symptoms of stroke. Yet, they cause more and more damage and reduce the mental capacity of patients.

Spasticity is like a "wicked charley horse." Brain injury from stroke sometimes causes paralyzed muscles to involuntarily contract (shorten or flex) after trying to move a limb. This creates stiffness and tightness. The contracted muscles often freeze the joints of the hand and arm permanently into an abnormal and often painful position. When a muscle can't complete its full range of motion, the tendons and soft tissue surrounding it can become tight. This makes stretching the muscle much more difficult.

Spasticity in the arm can cause a tight fist, bent elbow and arm pressed against the chest. This can seriously interfere with a stroke survivor's ability to perform daily activities such as dressing. Spasticity in the leg may cause a stiff knee, pointed foot and curling toes. All of these disorders can be diagnosed and there are treatments available for most of them.

Source: World Stroke Campaign; World Stroke Organization



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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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