STROKE DEVASTATES LIVES ARPUND THE WORLD
Fifteen million people experience a stroke each year. Six million of them do not survive and 5 million have residual disabilities. Stroke is the leading cause of disability and second leading cause of death globally and in Turkey. Stroke can happen to anyone at any age. One in 6 people worldwide will have a stroke in their lifetime. Stroke affects everyone; survivors, family, and friends, workplaces and communities.
Stroke is a focal disturbance of blood flow into or out of the brain, either primarily ischemic (87%) or hemorrhagic (13%). Stroke is not a single disease but the end result of many different pathophysiologies leading to cerebrovascular occlusion or rupture. Ischemic stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Without blood, brain cells can be damaged or Brain cells begin to die within minutes.
This damage can have different effects depending on where it happens in the brain. It can affect the whole body, mobility and speech, as well as how one thinks and feels.
The most common type of stroke is ischemic and accounts for about 80% of all cases. Hemorrhagic stroke accounts for about 15% of stroke cases and underlie vessel ruptures causing blood to leak into the brain. An aneurysm is a ballooning of a weakened region of a blood vessel causing subarachnoid hemorrhage. And finally, venous sinus thrombosis occurs with occlusion of the venous sinuses accounts for about 1% of stroke cases.
There are two kinds of risk factors for ischemic stroke; non-modifiable and modifiable. Non-modifiable risk factors are age, gender, ethnicity, and genetics. Stroke incidence rates increases with age and the incidence rate is 1,3-fold in men. Modifiable risk factors for ischemic stroke are hypertension, diabetes, hyperlipidemia, cardiac diseases such as atrial fibrillation, carotid diseases and smoking. Hypertension is the single most important modifiable risk factor for both hemorrhagic and ischemic stroke. In prospective studies, every 10 mm Hg reduction in blood pressure is associated with a 33% lowered risk of stroke in primary prevention. DM is associated with a 1,8 to 6-fold increased risk for first ischemic stroke. A large meta-analysis found that high low-density lipoprotein cholesterol level was associated with ischemic stroke and very low levels were associated with hemorrhagic stroke. Atrial fibrillation (AF) is the most common significant cardiac arrhythmia and is a major risk factor for ischemic stroke, associated with a fivefold increase in risk. Therefore, it is very important to treat AF properly for stroke prevention. Tobacco use is a significant risk factor for ischemic stroke and subarachnoid hemorrhage. This risk is very modifiable, with risk returning to normal after 10 years of abstinence. Heavy alcohol consumption is also a risk factor for stroke.
The only medication currently approved by the FDA to improve outcome after acute ischemic stroke is intravenous tissue plasminogen activator (IV tPA), administered within 4,5 hours of symptom onset. 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. 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.
Clot-busting drugs (tPA or thrombolysis) increase the chance of a good outcome by 30%. Be FAST because time is brain. 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 are the warning signs that someone is having a stroke. If you notice one or more of these signs, do not wait. Stroke is a medical emergency. Call your emergency medical services and get to a hospital right away.
Recently five positive randomized controlled trials showing the benefit of mechanical thrombectomy (MT) in the management of acute ischemic stroke (AIS) with emergent large vessel occlusion. MT increased the chance of a good outcome by 50%. 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.
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.
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.