Introduction
There are over 800,000 strokes that happen annually in the United States. That's one every 45 seconds. Stroke is a leading cause of disability in Nigeria and worldwide, which is of course a great concern to the medical community and should be concerning to the public.
In Africa, a data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%.
In 2005 the prevalence of stroke in Nigeria is 1.14 per 1000 while the 30-day case fatality rate is as high as 40%. Presently, there is insufficient information on the epidemiology of stroke in Nigeria.
Many stakeholders have advocated for accurate, up-to-date information on stroke incidence and survivorship to assist in identifying individuals, groups, or geographic areas that are at increased risk or poorer outcomes of stroke in the country
Our brains is what makes us human. Our thoughts, words, emotions, the way we connect with each other in the world, it's all in the works of the powerful human brain. Brain is the organ that's affected by stroke.
We often hear stroke being referred to as a brain attack, but also stroke is related to as an accident. And as physicians, we know that this is very far from the truth. All strokes have underlying causes, but could be unknown to us. Today I will share information with you that will help you understand stroke and how to prevent and overcome it.
Types of Stroke
Stroke results from a sudden disruption of blood flow to the brain. And there are two major types of stroke.
- Ischemic stroke
- Hemorrhagic stroke
Ischemic stroke is the one that results from blood vessel being occluded or plugged by a piece of a blood clot. The other type of stroke result from a rupture or a burst blood vessel in the brain, that type of stroke is called hemorrhagic stroke.
Human brain is a very needy organ and that's why it requires a high blood volume. When the blood flow is disrupted, like for example, in a case of a tiny blood clot traveling to the brain vessel and occluding it, brain cells begin to die. This can happen within minutes from the blood flow disruption. And that's why stroke is an emergency.
And we want you to contact any local medical emergency response to get you to the hospital as soon as possible. Patients experiencing any type of stroke, no matter how minor it is, should seek urgent medical evaluation for us to increase the chances that we can prevent the damage, decrease the disability, and worse yet, death.
Risk Factors for Stroke
Stroke is just the tip of an iceberg, it's not a disease in itself. It's a manifestation of an underlying problem in the body. More than three quarters of stroke have a clear underlying cause, which we can directly link to the blood vessel damage in the brain that causes the stroke.
Those well-known conditions are called risk factors because they're directly connected to the risk of stroke. The most common risk factors for stroke are conditions that are well-known and highly treatable. These include but not limited to:
- High blood pressure
- Diabetes mellitus
- High cholesterol level
- Smoking, and
- Excessive alcohol use.
All of these can be treated very effectively and prevent majority of the strokes that are happening in the Nigeria and around the globe. In a smaller proportion of patients, we are unable to find the underlying cause, no matter how hard we look. We refer to those strokes as cryptogenic, which means of unknown source.
Although in truth, these are most likely related to genetic underlying conditions or environmental exposures that we're not able to identify. In this case, we do everything we can to educate and counsel patients to prevent the strokes in the future and to optimize their medical management.
We know since before now that age is a risk factor for stroke and that for any individual over age 55, with every decade, stroke risk is increased proportionally.
We also know that strokes are more frequent in individuals of African-American descent as well as those of Hispanic ethnicity, as an example of a health disparity in the United States.
For some individuals, risk of stroke is somewhat elevated because their parents had a stroke and were referred to that condition as familial, even though stroke is not a genetic disease. But whatever your individual story is though, the one thing to remember is that you are not a victim of stroke and there is also a reason for optimism. We have a saying, stroke is preventable, treatable, beatable.
Signs, Symptoms and Management
Thousands of medical professionals around the world work together as a team to make sure that the stroke disability and death are a thing of the past. The fact that we can identify most of the underlying causes of stroke gives us great optimism, because if we can diagnose them, we can effectively treat them and therefore prevent strokes in the future. But despite our best efforts, strokes will happen.
The single best thing that one can do is to educate yourself and your loved ones about stroke like what we're doing right now. Know your risk of stroke, take every measure to prevent it, but know the signs and symptoms of stroke and act FAST to maximize the chance of stroke recovery.
FAST is the acronym developed by the Department of Public Health that helps raise awareness of stroke symptoms.
F is for face, A is for arm, S is for speech and T is for time. If you see somebody having a face droop or arm weakness or speech difficulties, call any emergency services to get you to the hospital FAST.
One of the most common mistakes people do is they wait for the symptoms of stroke to go away. We have a saying in neurology, time is brain. With every minute passing by, brain cells are dying and causing irreversible damage to the brain.
Another common mistake people make is taking an aspirin like they would for a heart attack. In stroke, this is wrong and potentially dangerous because as we've learned already, not all strokes are created equal. In case you're having a hemorrhagic stroke, not an ischemic one, this could be a dangerous and potentially a deadly mistake. Instead, get yourself into the hospital as soon as possible where we could do early and very effective diagnostics.
One of those diagnostic tests is a brain scan called a CT scan or computed tomography. A brain scan is like a powerful X-ray that helps us differentiate between a hemorrhagic or bleeding stroke and ischemic or clotting stroke. Also, if we add a dye to that diagnostic, we might be even able to see a clot.
When you arrive to the hospital early, as we urge you to do, we might be able to administer powerful medications. One of them, a powerful clot buster called TPA, has to be delivered within a very narrow time window, four and a half hours. That's why we're asking you to get to the hospital as soon as possible, no matter how minor your stroke symptoms are.
Another type of therapies we can offer is something that's called thrombectomy. Thrombectomy is a surgical intervention which is similar to cardiac catheterization, except that the catheter is going all the way into the brain vessels to remove the clot directly. This is a special procedure that is done by very highly trained doctors at the stroke centers.
That's why sometimes in advanced countries ambulances will take you from your local communities to the nearest stroke center where these procedures can be done and your chances of recovery can be improved. Once your stroke is diagnosed and managed in the very early stages, your doctors will formulate a personalized plan for your prevention, treatment, and recovery. You will also likely require physical, occupational, or speech therapy to help you recover after stroke.
Because everybody recovers at a very different rate after stroke, it is very important for you to stay in touch with your primary care doctor and with your neurologist to help you in your recovery. I often get asked about strokes in women and whether they're different than those in men. And my answer is yes and no.
No, because stroke is largely dependent on the area of the brain that is being affected either by ischemia or by bleeding. So in that way, whether you experience difficulty speaking or paralysis, men and women experience stroke very similarly. However, women frequently experience stroke in a different way where the symptoms could be milder, they could be accompanied by a headache or a feeling of unwellness.
And that's what makes stroke in women different. In addition, women are often stoic. Primary caretakers for others, they tend to underestimate the severity of their stroke and under-report them.
Even medical professionals underestimate symptoms of stroke in women. This leads to misdiagnosis and worse outcomes after stroke. My message to women is to know stroke symptoms and to be proactive in seeking emergency care they deserve.
Prevention of Stroke
Take care of yourself to be able to take care of others and act fast. It's fundamentally unfair to have a stroke when you're young and otherwise known to be healthy. I dread every time when I see a 20 or 30 something year old admitted to the hospital overnight with a stroke because I know that their lives might never be the same.
But at the same time, taking care of these individuals is an inspiring and hopeful feat because of the perseverance and a greater recovery that they invariably achieve. Stroke is often seen as a disease of older age and it is true that most strokes occur in older individuals. However, it's often not when, but why.
Prevention of Stroke in the Young
The same risk factors that we usually see in older individuals we now see in a 40, 30 and 20 year olds. Some of the most common risk factors for stroke in young adults are the usual suspects, high blood pressure, diabetes, high cholesterol, substance abuse and smoking. Some of the others include infections, including COVID as we've learned in 2020 and exposures to the over-the-counter supplements including so-called health supplements and energy drinks.
There are of course rare conditions that affect the risk of stroke in younger individuals that they have no control over, but we have to control what we can control. Preventing stroke is easier than you think. Following decades of research, the American Heart and American Stroke Association professionals developed a simple formula called Life's Simple 7. This is a set of measures that they propose to prevent heart disease and stroke.
- Stop smoking
- Manage blood pressure
- Eat better
- Control cholesterol
- Get active
- Reduce blood sugar
- Lose weight
All these measures have scientific underpinning and specific goals. For example, we ask our patients to exercise a minimum of 150 minutes a week.
Moderate exercise like walking will do and it's better if you do it daily. Also, mindfulness could be a measure to getting handle on stress. There are also targets for blood pressure, sugar and cholesterol, but to make it easier for you, I urge you to talk to your doctor and to understand your risk of stroke.
Closing Thought
Remember, stroke is preventable, treatable, beatable. You're not a victim and together we can beat stroke.
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