Prevention and rehabilitation
The considerable burden of stroke is in the low and middle-income countries and is likely to increase unless we have large-scale interventions. The sudden onset weakness or loss of sensation of one half of body, slurring of speech, loss of vision, unsteadiness of gait or loss of consciousness may be the early symptoms of stroke.
Stroke may be due to occlusion (thrombosis) of a blood vessel or rupture (haemorrhage) of a blood vessel. An estimated 80 million people worldwide have had a stroke, and 50 million stroke survivors live with some form of disability.
The occurrence of stroke varies in different countries. In India, the estimated incidence is about 119-145/100000 population, whereas, in the United States, each year, approximately 8 lakh people suffer a stroke.
The risk factors for stroke include age more than 65 years, systemic hypertension, diabetes mellitus, hypercholesterolemia, heart diseases, smoking, excessive intake of alcohol, and lack of physical exercise.
The severity of the stroke and the mortality is higher among the women. Strokes not only affect the individuals but family and society too. It also has an economic impact on society, and hence it is crucial to recognise and treat stroke in early stages.
Early diagnosis and treatment would reduce morbidity and mortality. Face, Arm, Speech, Time (FAST) Pneumonic will help to remember the signs of Stroke.
CT scan and MRI of brain will help to differentiate ischaemic (thrombotic) and haemorrhagic stroke and also to know the exact site and extent of clot/haemorrhage.
Blood clots in the brain can be dissolved using injectable medications (Acylase or Tenecteplase) if presented within 4.5 hours of onset of symptoms.
If there is large artery occlusion, mechanical thrombectomy is required, wherein the blood clot is removed using special devices (Solitaire, Trevo and Penumbra devices) inserted to the affected blood vessel through a femoral puncture.
Haemorrhages, in the brain, can be treated by reducing the blood pressure, and pressure within the skull using medications.
Overall mortality of stroke is around 20 to 40%, a month after the treatment of acute stroke the patient should undergo rehabilitation, which includes physiotherapy, speech therapy, and occupational therapy, which will help in stroke recovery and improve the quality of life.
Every year, the World Stroke Day is observed on October 29 as per World Stroke Organisation (WSO).
This year, the message of World Stroke Day is – Up Again after Stroke. Several Awareness Programmes are being organised for general public and Continuing Medical Education (CME) programmes for doctors, nurses, and paramedics, across the country.
Both state and central governments should initiate projects and programmes not only to make public aware about stroke and the significance of early recognition and treatment but to provide facilities for acute stroke management in all medical colleges and district hospitals at the earliest.
The only treatment available for stroke is the thrombolytic therapy which is expensive. There are few states in India, where this drug is given free. There is an urgent need to make this thrombolytic life-saving drug-free in all states of India.
The current cost of mechanical thrombectomy devices is unaffordable for the majority of the people.
To increase the chances of more people receives thrombectomy treatment; there is a need to have a restriction imposed on the cost of the stent similar to cardiac stents. Also, the government should provide insurance schemes for stroke management and social security schemes for stroke survivors.
The author is the founder trustee and chairman of Epilepsy Foundation