Brain stroke or acute brain attack, as neurologists would like stroke to be understood by the public at large is an important cause of death and disability worldwide. It is the third most important cause of death and the most common cause of acquired disability.

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Broadly speaking, two types of stroke exist. Nearly 80% of strokes are on account of impaired blood supply to the brain, resulting in the death of nerve cells in the affected area. The remaining 20% of strokes are due to bleeding into the brain which damages the brain by releasing toxic substances and by compression and pressure effects on the brain.

The symptoms of a brain stroke range from weakness in one-half of the body, blurred vision, speech impairment and incontinence to loss of balance and difficulties with memory and higher mental function. It is critical that we are aware of the early warning signs and symptoms of stroke and seek treatment at a hospital which is equipped with facilities such as CT scan and MRI, ICU as well as neurological and neurosurgical expertise round the clock. The reason to act fast when a stroke is suspected is because for every second that a brain stroke is untreated, 1.4 million neurons are irreversibly lost, for every hour that passes without treatment, the brain ages 3 years; and a very efficacious clot buster treatment which dissolves the clot that has cut off blood supply to the brain is safe and effective only within the first 4.5 hours after onset of symptoms. The earlier the treatment is started after symptom onset, the more effective and safe it is for the patient.

Following a brain stroke, a patient is left with weakness in one-half of the body, difficulty with speech and swallowing as well as problems with control of the body’s excretory functions. These problems take time to resolve and need good rehabilitative measures like physiotherapy, speech therapy and occupational therapy for recovery. There is also lifelong medications and follow-up care that is needed.

Brain stroke is a devastating illness and every effort must be made to prevent it. Fortunately, the bulk of risk factors for stroke are amenable to early detection and treatment. The most important risk factors for stroke are high blood pressure, diabetes, high blood cholesterol, heart disease, tobacco smoking and vitamin deficiency, to name a few. For those individuals in whom these disorders have been diagnosed either in isolation or in combination, every effort must be made to ensure that they are optimally treated. Keen attention to a healthy lifestyle is a must as these risk factors are typically the outcome of an unhealthy lifestyle. It is imperative to exercise daily, eat a balanced diet which is low in salt, fat and refined carbohydrates with adequate lean protein, fresh fruit and vegetables. Adequate sleep and work-life balance is as important as diet and exercise.

In the last few years, some really exciting advances in the area of stroke treatment have brought about a paradigm change in the manner in which neurologists treat brain stroke. While the clot buster injection is a highly efficacious treatment for stroke, not all patients respond adequately to the injection alone. These patients usually have blockages of larger and more critical blood supplying arteries. Such patients are now treated with the use of stents and direct removal of the clot that is blocking blood supply to the brain by a team of doctors. The newer treatments are more expensive but safe and effective when chosen correctly.

Another trend that has come to the notice of neurologists who treat patients with stroke is the appearance of stroke in relatively younger patients. While most stroke patients tend to be in the sixth and seventh decades of their lives, of late, it is not uncommon to see younger individuals in their fourth and fifth decades of life felled by a stroke. Stroke in the young largely has the same risk factors as those in older individuals described above, yet some additional evaluations are always a consideration in younger individuals with stroke. Diseases affecting the heart such as heart valve problems and heart rhythm abnormalities are high on the list of suspects in young stroke patients. Some disorders of immune regulation may affect the arteries of the brain, causing them to lose their non-sticky surface and attract clots that disrupt blood supply to the brain. Recreational drug abuse, especially cocaine, is known to cause devastating strokes by causing clots and also bleeding into the brain.

Thus, brain stroke is a devastating condition that is amenable to prevention by fairly simple and cost effective measures. Once the monster strikes, one needs to act fast to provide optimal and effective treatment. A suspicion of acute stroke is not a situation where time can be whiled away in phone calls to relatives and trips to a GPs office. One needs to act fast and reach a well-equipped hospital, making sure not a second is wasted. If there is one disease where the adage ‘prevention is better than cure’’ holds especially true, it is for acute brain stroke.

The author is a Consultant Neurologist at Fortis Hospital, Mulund.