Life & Style | Health
Stroke of worry
October 29 is World Stroke Day. Neurologist Dr Arne Brosig tells Shiva Kumar Thekkepat why and how we should guard against this silent killer- second only to heart attacks.
- By Asghar Khan
- Published: 23:55 October 23, 2008
Dan (name changed) looked the picture of health when he walked into Dr Arne Brosig's clinic last month.
At 31, he appeared fit. Then why was he there?
Apparently, the previous day he had experienced problems for a few minutes while speaking and his right arm had felt numb at the time. Also, he had difficulty coordinating his actions. Dan did not like the symptoms and wanted to have a health check up to clear any misgivings.
Dr Brosig ran a series of checks including several brain and heart imaging tests and soon had a dossier of reports.
After studying it, Dr Brosig offered his diagnosis: "Dan had suffered a minor stroke, what we call transient attack, lasting for around 15 minutes. The cause was apparently a form
of migraine that accompanied the stroke."
Millions of people suffer migraines, but very few physicians think such sufferers are at risk of a stroke. "We now know that people who suffer from migraines are at risk," says Dr Brosig.
Dan was lucky to have been diagnosed early and advised preventive measures before a full-blown stroke derailed his life or even stopped it in its tracks.
What is a stroke?
Simply put, a stroke is a blood clot or a burst blood vessel that stops blood flow to the brain. It can also be the result of rteriosclerosis.
According to medical professionals, strokes
now rank second only to heart disease in the UAE as the leading cause of death, and are the most common cause of lifelong disability worldwide.
Neurologists estimate that 'silent' strokes are the most common type. Results from three studies suggest that in 1998, people in the US alone experienced 770,000 clinical strokes, about nine million silent infarcts and approximately two million silent haemorrhages.
A recent article from the Framingham Study suggests that one in ten individuals, with a mean age of 62 years, has a silent stroke.
The word 'silent' is a misnomer. "When subjects with silent strokes are examined they have subtle neuropsychological and neurological deficits," says Dr Brosig. "We prefer to call them 'sub clinical strokes'."
If ignored, sub clinical strokes could prove ominous.
One sub clinical stroke is associated with a higher chance of having others and of experiencing a clinical stroke and/or dementia. The combination of sub clinical strokes and sub clinical Alzheimer lesions may be a background for the association of stroke and dementia given that the lifetime risk of developing either or both is one in three.
What to look out for
If you have blurred or double vision, feel numb or weak in either arm – even if for a few minutes – it could be an early symptom of a stroke.
"If you act immediately then the stroke may be prevented," says Dr Brosig. "If you ignore it, then your chance of suffering a stroke increases by 20 per cent. Remember, if you have a heart attack, you suffer great pain. But with a stroke you feel no pain. So the warning signal is missing. That's what makes strokes so deadly."
Doctors feel that some of the symptoms that elderly individuals manifest, such as changes in judgment, intellectual ability, personality change – particularly depression – may be associated with sub clinical strokes and white matter changes in the brain.
According to Dr Brosig, the reason so many people suffer strokes without being aware of them is the lack of public knowledge. "We need to spread awareness about what a stroke is and what can be done to prevent it," he says. "Because it is one of the most common diseases – not only in the UAE – but in most parts of the world. The number of stroke patients is increasing by the day. Statistics are not available for the UAE, but there are more than 200,000 stroke incidents recorded in Germany every year.
"One of the main problems is the lack of warning. You can recognise a heart attack by the palpitation of the heart and there is an 80 per cent chance of full recovery. But in the case of a stroke more than 80 per cent of the victims are unlikely to be rehabilitated, and even then they would be lucky if they recover fully. That is why it is so important to prevent strokes."
Serious side effects
"It's as serious as getting a heart attack only people – even doctors in some cases – don't take it as seriously," says Dr Brosig. "If the stroke occurs in the left hemisphere of the brain where the speech centre is, then the person will not be able to speak and will also not understand speech.
Communication skills will be affected and this may be permanent. If the stroke results in acute paralysis on the left side of the body, the person will not be able to move and may be confined to a wheelchair.
The impact of a stroke is much more severe than that of a heart attack or even cancer. The cost of treatment after a stroke is very high. About 40 per cent of victims die within two years of suffering a stroke," says Dr Brosig.
Why do strokes happen?
What is the reason for a stroke?
"The primary reason is getting older," says Dr Brosig. "And of course we can do nothing about it! But there is no guarantee that being young precludes a stroke. One of the youngest patients we had is four years old. The risk increases after 40. The main cause is hypertension. People who suffer from it are six times more likely to suffer a stroke. Diabetes is another factor. Smoking increases the risk, and of course if there is a history of stroke or heart attack in the family, it puts you in the stroke bracket."
Another common cause of strokes, which can be treated, is an irregular heartbeat, which becomes more common as you grow older.
More than one of the above factors renders you susceptible to a stroke. "If you are above 40 and suffer from more than two of the above factors, then it's time to start thinking of some manner of prevention,"
Dr Brosig advises.
Detection includes undergoing medical tests, such as an ultrasound that measures the blood flow in the arteries and blood vessels. Another test called a transcranial sonography measures the blood flow in the brain.
The thickness of the artery walls is measured to determine whether a stroke is likely.
Prevention includes lifestyle changes – the most important being treatment of all relevant risks such as high blood pressure, obesity, smoking, drinking and lack of exercise. "But certain genetic factors you just have to live with," says Dr Brosig. "One of the main problems is little knowledge of the symptoms, even among physicians. They all know the factors but preventive measures are not always taken."
World Stroke Day
October 29 is being observed as World Stroke Day to address this issue. This year the aim is to "recognise, treat and prevent vascular cognitive impairment. Sub clinical (silent) strokes occur fives times as often as clinical (obvious) strokes and may affect thinking, mood and personality."
"It may not seem the most important date on the global calendar," says Dr Brosig. "But if you want to be spared the debilitating effects of a stroke, it would be wise
to arrange a check-up with a neurologist."
October 29 is important because you can be checked for free by Dr Brosig at his clinic.
A five-minute screening for vascular cognitive impairment and Alzheimer's disease is what doctors recommend, which can be followed by a 30- and 60-minute battery test if necessary.
If the patient shows executive dysfunction, doctors may suggest brain-imaging to identify the possibility of sub clinical strokes. Early identification is crucial.
"If you have two or three migraine attacks in a month, or wake up in the morning with a lame arm or leg, or discover a sudden drooping at the corner of your mouth, consult a neurologist immediately," advises Dr Brosig. "Because statistically, a shocking 20 per cent of people suffering such transitory attacks
will suffer a more serious stroke within three mnths. The result could be fatal."
– Shiva Kumar Thekkepat is Feature Writer, Friday
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