A recent report has once again put the spotlight on strokes as the silent epidemic is estimated to claim over 10 million lives a year by 2050— a rise of 50% in 30 years—and lead to losses worth $2.3 trillion. As per The Lancet research, India recorded the highest number of strokes among countries from the southeast Asian region in 2019, with nearly 1.3 million people getting it every year and 9.6 million people living with the consequences.
The southeast Asian region already accounts for more than 40% of the global stroke mortality. “About 185,000 strokes occur every year in India with nearly one stroke every 40 seconds and one stroke death every 4 minutes,” says Dr Tushar Raut, consultant, neurology at Kokilaben Dhirubhai Ambani Hospital, Mumbai.
So, where are we going wrong? The numbers speak volumes about the gravity of the situation as the incidence of stroke is alarmingly increasing in young and middle-aged people, aged less than 55 years. “Strokes are on a rise in the region as there are many patients who are unable to travel (for medical help) due to social or financial reasons. As per the (The Lancet) study, ischemic strokes were more common in urban areas, while risk factors such as high blood pressure and alcohol use were more common in rural areas. Apart from that, an unhealthy and sedentary lifestyle is taking a toll on health, leading to strokes, especially among young people below the age of 45 years,” says Dr Ravindra Srivastava, director neurosurgery, Primus Super Speciality Hospital, New Delhi.
Dr Kunal Bahrani, director of neurology, Fortis Escorts Hospital, Faridabad, Haryana, agrees. “India is going through a developing mission in relation to strokes, as highlighted in The Lancet file. Strokes are occurring at an alarming rate in the US. This is a sizable problem because strokes will have critical and long-lasting effects on a person’s fitness. They can cause paralysis, trouble speaking, or even be fatal,” he adds. Several factors make a contribution to the growing wide variety of strokes in India. “Lifestyle plays a massive role. Bad diets, loss of exercising and increasing strain are expanding the threat factors like high blood strain and diabetes, which make strokes much more likely. Additionally, there is a lack of awareness about stroke prevention and the significance of instantaneous clinical intervention while signs occur,” adds Dr Bahrani.
Look out for signs
A stroke can occur when blood flow to the brain is blocked or there is sudden bleeding in the brain. There are two types of strokes. A stroke that occurs because blood flow to the brain is blocked is called an ischemic stroke. The brain cannot get oxygen and nutrients from the blood. Without oxygen and nutrients, brain cells begin to die within minutes. A stroke that occurs because of sudden bleeding in the brain is called a hemorrhagic stroke. The leaked blood results in pressure on brain cells, damaging them. Signs and symptoms of stroke vary from person to person depending on the area affected. “Stroke occurs because there is a temporary or permanent occlusion of an artery of the brain, and the symptoms will vary as per the area of the brain affected. Remember the word ‘FAST’ (face, arms, speech and time). So, any drooping of the face on either side, disturbances in speech, or weakness of the arms – if you see any of these, then ‘time’ is a factor, because stroke can be treated if the person is brought in as early as possible, but not later than four and a half hours (golden period),” explains Dr Arun B Shah, director, neurosciences, Sir HN Reliance Foundation Hospital, Mumbai.
So, if you think you or someone else may be having a stroke, seek medical help immediately. “And then, you should proceed to a centre which is well suited or ready for the stroke, because after all, treatment of stroke requires a detailed investigation in order to decide which area of the brain is affected, which artery is affected, and whether we can open up the artery in time or not,” says Dr Shah. Acute treatment of strokes includes first doing a CT scan or MRI and ruling out haemorrhage, says Dr Raut of Kokilaben Dhirubhai Ambani Hospital. “Ischemic strokes can be treated by timely initiation of IV thrombolysis clot busting medications. In case of medium or large artery occlusion, use of specialised devices, catheters and stents can help open blockages in arteries and restore blood supply to affected areas. Timely restoration of blood flow can recover the deficit and improve functional status and quality of life,” he adds.
Recovery after a stroke depends heavily on rehabilitation. “This comprises physical and occupational therapy to help patients regain lost abilities like walking, speaking and daily tasks,” says Dr Bahrani of Fortis Escorts Hospital.
Long-term effects
The long-term effects of stroke can be multifaceted — ranging from movement disorders like tremor, dystonia, parkinsonism and epilepsy to depression and cognitive challenges. Incidentally, a third of all stroke patients fall prey to these health issues, as per Dr Sanjay Pandey, HOD, neurology, Amrita Hospital, Faridabad.
Studies show that stroke reigns as the third-most common cause of death in developed countries and remains one of the leading factors behind fatality among developing nations too when it comes to deaths and disabilities owing to non-communicable diseases. While most healthcare providers focus on the gravity of acute strokes, they often fall short to turn an eye towards the long-term health implications of such strokes. Dr Pandey says, “Most stroke patients undergo epilepsy, yet it is the formidable post-stroke movement disorders that emerge as the true giants, with a staggering morbidity rate of 10-15%. Post-stroke epilepsy follows closely behind at 10-12%, while post-stroke depression, though significant, stands at 5-9%. Regrettably, 50% of stroke survivors go undiagnosed of such post-stroke complications.” Long-term consequences, including post-stroke epilepsy, movement disorders, chronic pain, and paralysis, significantly erode one’s quality of life.
Joint deformities, facial asymmetry, contractures, and bedsores are also common. “Stroke can have its impact on a patient’s mental health too, in the form of anxiety, depression, memory lapses, and concentration difficulties.
In some cases, individuals may develop vascular dementia, which can present itself like Alzheimer’s disease. Cognitive challenges arising out of stroke can impair fundamental tasks such as eating, bathing, and everyday activities for which an individual then has to rely on caregivers. The lingering effects of a stroke can lead to an enduring state of dependence and, in many instances, a loss of employment,” adds Dr Pandey.
Timely prevention
Preventing strokes involves adopting a healthy lifestyle and managing risk factors. Here are some key changes to help in stroke prevention, as per Dr Atul Prasad, principal director and HOD, neurology, BLK-Max Super Speciality Hospital, New Delhi:
Manage blood pressure: Keep your blood pressure in a healthy range through diet, exercise and medication, if necessary.
Maintain a healthy diet: Eat a balanced diet rich in fruits, vegetables, whole grains, lean protein and low in saturated fats, cholesterol and salt.
Exercise regularly: Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity exercise per week.
Maintain a healthy weight: Achieving and maintaining a healthy weight reduces your risk of stroke.
Quit smoking: Smoking is a major risk factor for stroke. Quitting significantly lowers your risk.
Limit alcohol consumption: If you drink, do so in moderation. Excessive alcohol can raise your risk.
Control diabetes: Manage blood sugar levels through diet, exercise and medication, if needed.
Manage cholesterol: Keep your cholesterol levels in check through diet, exercise and medication, if necessary.
Reduce stress: Practise stress-reduction techniques such as meditation, yoga or deep breathing exercises.
Get regular check-ups: Visit your healthcare provider for routine check-ups and follow their recommendations.
Medication adherence: If prescribed medication for conditions like hypertension or atrial fibrillation, take them as directed.
Stay hydrated: Drink plenty of water to maintain good circulation.
Atrial fibrillation (irregular heart rate) management: If you have atrial fibrillation, work with your doctor to manage it as it can increase stroke risk.
Healthy sleep: Aim for 7-9 hours of quality sleep each night.
Be cautious with birth control: Women on birth control pills should discuss stroke risk with doctor.
Know family history: Understand your family’s medical history, as genetics can play a role.
“Lifestyle changes and risk factor management are essential components of stroke prevention, but it’s crucial to consult with a healthcare professional for personalised advice and regular check-ups,” adds Dr Prasad.
