Management and prevention of stroke
Stroke or Cerebrovascular Accident (CVA) is a condition which results when blood supply to a part of the brain is reduced or cut off. The part of the brain thus deprived of oxygen and nutrients, begins to malfunction, causing the signs and symptoms of stroke. If not treated, death or disability from stroke is very high.
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We are all familiar with the fact that the water supply to our homes can be cut off when either the pipe carrying the water gets burst by high pressure on its walls leading to spillage of water into surrounding areas, or when there is a blockage in the pipe somewhere between the water source and our house.
The blockage could be a piece of material or debris which finds its way into the pipe. Areas before the blockage or burst pipe will continue to receive water supply but the house (situated after the blockage) will not.
Similarly, the blood supply to a portion of the brain can be cut off when the blood vessel supplying that part of the brain gets burst or ruptures due to high blood pressure (hypertension) or if there is a blockage in the vessel (infarction). The blood vessel can get blocked as a result of progressive narrowing of its lumen due to deposition of cholesterol or fats.
Signs and symptoms
Stroke can be recognised by the signs and symptoms the person presents with, the most common being sudden inability to walk or move the limbs (hands and legs). CVA can also present as sudden collapse, loss of consciousness or difficulty in speaking. Warning symptoms of stroke include dizziness, numbness of hands and feet, severe headache and blurred vision.
Stroke can be mild or severe depending on the extent of damage to the brain, which consists of two halves, the left and right cerebral hemispheres. The left hemisphere controls the movement of the right side of the body while the right hemisphere is responsible for movement of the left.
For the majority of the population, the left brain (hemisphere) is usually dominant (domineering) over the right and this may explain why the majority of the population are right-handed. In a considerable number of people who are left-handed, there is right brain dominance while the rest have left brain dominance.
The speech and language centre of the brain, which controls ability to speak and communicate effectively, is located in the side of the brain which is dominant.
Thus a right-handed person (with left brain dominance), who develops stroke affecting the right side of the brain, may only develop weakness of the left half of body (hemiparesis) or total inability to move the left half of the body (hemiplegia or paralysis). If he develops stroke affecting the left half of the brain, then in addition to developing paralysis of the right side of the body, the speech is likely to be affected as well.
The muscles of the face may also be paralysed, recognisable as inability to close the eye on the affected side and deviation of the mouth to the opposite side. In the normal state, the mouth is set in the middle position due to the fact that there are two opposing muscles (left and right muscles) pulling equally on each side of the mouth at any given time.
If the stroke affects the right side of the body, the mouth may twist to the left due to the fact that the left muscles of the mouth will still be active and without any strength from the opposing right muscles of the mouth, the pull is towards the left.
Management and prevention
Management of stroke involves identifying the underlying cause, including hypertension and its effects such as bleeding into the brain (cerebral haemorrhage) or cerebral infarction and treating appropriately. Physiotherapy is recommended for those with paralysis.
Stroke can be prevented by ensuring that our blood vessels do not get blocked or ruptured. As already stated, blood vessels are likely to be blocked when the levels of fats and cholesterols in the blood are high and, therefore, get deposited in the walls of the vessels.
Foods containing high amounts of fats or cholesterol should, therefore, be avoided. People with high blood pressure should ensure that it is always controlled and those who do not know they have high blood pressure should go for regular check-up to know their status.
Checking fat content of blood
Regular checking of fat content of blood (lipid profile) is highly recommended. Maintaining healthy lifestyles such as regular exercise, regular intake of fruits and vegetables, low salt diet as well as avoidance of smoking, alcohol and stressful conditions can help reduce the incidence of stroke. Ensure optimum body mass index (BMI) and avoid obesity.
The BMI relates a person’s weight to his or her height and for any given height, there is a corresponding acceptable weight. People with diabetes or any form of heart disease, as well as those with family history of stroke are at an increased risk of developing stroke and must regularly go for check-up.
It must be emphasised that management of stroke is very expensive and may involve long periods of hospitalisation, even with unpredictable outcome. Prevention, therefore, remains the best form of control.
— The writer is a Medical Director at the Royal Medical Agency and Clinic,
e-mail:kwakukesey@gmail.com)