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Submitted by PatientsEngage on 31 October 2017

Stroke is the third leading cause of death in India and a leading cause of disability. Dr. Atulabh Vajpeyee, neurologist and founder of the Stroke Support Group Udaipur (SSGU), talks about the magnitude of the problem of stroke, how to rein in your risks and the importance of correct and timely management of the disease.

Stroke is the second most common cause of death after coronary artery diseases. What are the different types of stroke?

It is the second leading cause of death in the world, comprising approximately 10 percent of all deaths and killing 5.5 million people each year, 44 million disability adjusted life-years (DALYs) lost. Having a stroke means something has cut off your brain’s blood supply. It is an emergency, because without oxygen and nutrients from the blood, the part of your brain that’s affected quickly starts to die. There are two types of stroke- Ischemic Stroke and Hemorrhagic Stroke. An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. Ischemic stroke accounts for 87% of all strokes. Hemorrhagic stroke occurs when a weakened blood vessel ruptures and spills blood into brain tissue. The most common cause for the rupture is uncontrolled hypertension (High Blood pressure).

What are the major risk factors for stroke?

Risk factors can be classified under two headings, Controllable and Uncontrollable. Uncontrollable risk factors are Age, Sex, Race, Previous Stroke, TIA and heart attack. Controllable risk factors are:

  1. High blood pressure
  2. Cigarette smoking
  3. Diabetes
  4. High blood cholesterol
  5. Poor diet
  6. Physical inactivity and obesity
  7. Carotid or other artery disease
  8. Peripheral artery disease
  9. Atrial fibrillation
  10. Other heart disease
  11. Sickle cell disease (also called sickle cell anemia).

​These stroke risk factors can be modified by 

  1. Controlling high blood pressure
  2. Moderate exercise 5 times a week
  3. Eat a healthy and balanced diet,
  4. Reduce your cholesterol,
  5. Stop smoking and avoid second–hand exposure,
  6. Reduce alcohol intake, manage diabetes.
  7. These can be modified by doing following:

What stroke risks are unique to women?

Apart from the general risk factors women are having some additional risk factors like taking birth control pills, being pregnant, having migraine, using hormone replacement therapy. Moreover women having higher life expectancy have higher chance of having stroke because of advanced age.

Can stress increase the risk of a stroke?

Not directly but it may lead to hormonal changes in blood which may lead patients to have one or more of above risk factors as persons having stress are more prone to smoke, develop hypertension or have a sedentary lifestyle.

Stroke can sometimes cause severe and lasting disability. Is there any way of reducing disability after stroke?

Yes, Stroke rehabilitation can help a long way in limiting or improving disability due to stroke. It involves occupational therapy, speech therapy and social workers which help patients with vocational training amongst other things.

  • Training to improve mobility and ability to do daily tasks.
  • Individually tailored post stroke exercise program
  • Access to cognitive/ engagement activities
  • Books, games, computer
  • Speech therapy, if stroke caused difficulty speaking
  • Eye exercise, if stroke causes a loss of vision
  • Balance training for those with poor balance or fall risk.

FAST is an acronym to recognise and detect stroke symptoms. Could you elaborate on it and others symptoms to identify a stroke?

F:  Face drooping. Does one side of the Face droop or is it numb?
A:  Arm weakness or numbness. Is one arm weak or numb?
S:  Is Speech slurred, are they unable to speak, or they hard to understand?
T:  Time, if the person shows any of these symptoms, even if the symptoms go away, Call to Stroke Ambulance and get to the hospital immediately.

Apart from this two others are frequently included which are

B:  Balance Loss or dizziness.
E:  Eye changes in the form of double vision or blurring of vision.

Are Stroke survivors at high risk of having another one? What are the odds and how can one reduce risks?

2 in 10 Stroke patients will have a recurrent stroke if not adequately treated. Secondary prevention is the term used to treat and modify the risk factors of stroke survivors which includes controlling blood pressure, managing diabetes, adopting healthy life style changes, taking blood thinners, avoiding drugs which put the patient at high risk of stroke.

How important is post stroke rehabilitation? How does it help the victim?

Yes. As mentioned above stroke rehabilitation helps the patient in getting back to normal by various training methods like vocational training.

Is someone is having a stroke what are the 3 things one should do and 3 things one should not do?

Do’s

  • Recognise early and contact your doctor as soon as possible
  • Take medicines regularly
  • Adopt a healthy lifestyle and do proper rehabilitation therapy as advised.

Don’t

  • Don’t panic
  • Don’t waste time on homes remedies
  • Don’t forget to take medicines as advised.

How does your organisation, the Stroke Support Group, help make life more healthy and meaningful for stroke survivors and families?

The ideology behind the Stroke Support Group is that stroke treatment doesn’t end with the discharge from hospital. Many of these patients need to continue support and motivation. Having said that, not all the patients fully recover and different patients have different disabilities. Someone who himself/herself has gone through the phase of having and persuading to go that extra mile in achieving a disease and disability free life. Together with the help of supporting organisation they can help each other in coming out of the physical and mental trauma that stroke comes with.

What is the most common treatment for stroke?

The only FDA approved treatment for ischemic strokes is tissue Plasminogen activator (tPA, also known a Alteplase (IV r-tPA), given through an IV in the arm). Alteplase (IV r-tPA) works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If administered within 3 hours (and up to 4.5 hours in certain eligible patients), Alteplase (IV r-tPA) may improve the chances of recovering from a stroke.

A significant number of stroke victims don’t get to the hospital in time for Alteplase (IV r-tPA) treatment; this is why it’s so important to identify a stroke immediately.

Another strongly recommended treatment option is an endovascular procedure called mechanical thrombectomy, in which trained doctors try to remove a large blood clot by sending a wire- caged device called a stent retriever to the site of the blocked blood vessel in the brain. To remove the clot, doctors thread a catheter through an artery in the groin up to the blocked artery in the brain. The stent opens and grabs the clot, allowing doctors to remove the stent with trapped clot. Special suction tubes may also be used. The procedure should be done within 6 hours of acute stroke symptoms, and only after a patient receives Alteplase (IV r-tPA).

What are the current treatment and development of modern therapies for stroke?

Current era is the era of stroke therapeutics in which we are progressing fast from a time of Nihilism to stroke patients to a time where stroke not only can be prevented but treated and the patients can be back to his /her normal pre stroke life. Still, there is a need to address more effective therapy for those patients not receiving tPA or endovascular treatment. Stem cell which can help in regenerating dead brain tissue can help if proven effective but currently the research has thus far been negative for stem cell as well as neuro-protection.

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