Achieving Stroke Recovery: Complications and Prevention-Dr Suresh

Stroke is a medical emergency where the blood supply to the brain is interrupted

There are over 12.2 million new strokes each year. Globally, one in four people over age 25 will have a stroke in their lifetime. Globally, there are over 101 million people currently living who have experienced stroke. From the current Indian population, approximately 1.8 million people may suffer from stroke annually and about one-third of them may die.2 Approximately, 12% of all strokes occur in the population <40 years of age. This entails the issue of prevention and treatment of stroke serious attention for India.

Stroke is a medical emergency where the blood supply to the brain is interrupted. It can be of 2 types – hemorrhagic stroke or ischemic stroke. Ischemic stroke happens when blood flow to the brain is blocked due to the blocking of vessel by a clot or plaque formation. The majority of the strokes are of this kind.
Long-term complications of stroke:

Long-term consequences of stroke occur weeks to months after hospitalisation.

• Seizures occur in 5–9% of stroke survivors.
• Neurogenic bladders cause inadequate bladder emptying after strokes, resulting in frequent urination, and urgency to urinate.
• New-onset faecal incontinence after stroke is common
• Cerebrovascular disease is increasingly recognised as a major cause of dementia and cognitive impairment in old age.
• Musculoskeletal complaints after stroke usually affect one side of the body and may not appear for weeks or months.
• Depression after stroke is common and often misdiagnosed. 2

Early diagnosis and treatment of a stroke:
Early diagnosis and treatment of a stroke are crucial for minimizing the risk of long-term complications and improving the chances of a full or near-full recovery. In each minute, 1.9 million neurons are destroyed and compared with the normal rate of neuron loss in brain aging, the ischemic brain ages 3.6 years each hour without treatment. The sooner blood flow is restored, the less damage occurs. Early treatment can help preserve as much brain tissue as possible, which can directly impact a person's long-term functioning. The treatment of acute ischaemic stroke (AIS) is based on pharmacological or mechanical revascularization therapies that can be delivered within specific time windows. It is recommended that intravenous thrombolysis (IVT) be administered with alteplase within 4.5 hours of the onset of symptoms, and mechanical revascularization be administered up to 24 hours after the theoretical onset of symptoms (last time the patient was well) by Mechanical Thrombectomy.

Prevention of Stroke:
This includes measures to reduce the risk of recurrence of stroke in patients who have had a stroke. These guidelines apply to the vast majority of patients with stroke although some of the recommendations may not be appropriate for those with unusual cause of stroke, like trauma, infections, etc.
Evaluation for modifiable risk factors: Every patient should be evaluated promptly for modifiable risk factors.

This includes5:
• Hypertension: Follow up regularly with the doctor and keep an eye on blood pressure. Take medicines if advised by a doctor.
• Diabetes: All patients should be screened for diabetes and treated to achieve target HbAIC
• Dyslipidemia: The Doctor can advise certain medicines to lower the lipid levels.
• Lifestyle risk factors - All patients who smoke should stop smoking and avoid environmental smoke. All patients who can do regular exercise should do so for at least 30 minutes each day. All patients should do yoga, use low-fat dairy products and products based on vegetables, fruits, whole grains, and plant oils, and reduce intake of sweets and red meat. Overweight/obese people should lose weight. All patients, but especially those with hypertension should reduce their salt intake by not adding extra (table) salt to food, using as little as possible in cooking, avoiding preserved foods, pickles etc. and choosing low-salt foods.

• Atrial fibrillation or other arrhythmias: Managing Atrial fibrillation is very important to prevent another stroke
• Obstructive sleep apnea (OSA): All patients should be screened for OSA/sleep apnoea and refer to a higher centre for treatment

Rehabilitation of stroke patients:
Stroke rehabilitation helps you regain skills lost after a stroke. Rehabilitation can help with daily activities, speech, stamina, and mobility following stroke, depending on the affected brain regions. Rehabilitation after a stroke improves independence and quality of life.6 A physician, physiotherapist, occupational therapist, nurse, speech and language therapist, clinical psychologist, orthotist, nutritionist, and social worker collaborate on stroke rehabilitation.

Ischemic stroke secondary prevention is highly individualized, and the specific approach may vary from person to person based on their unique medical history and risk factors. It is crucial for individuals who have had an ischemic stroke to work closely with their healthcare team to develop a comprehensive secondary prevention plan.

The World Stroke Day 2023 theme is "Greater than stroke”. Act by preventing strokes through healthy living. Act by treating strokes promptly to minimize damage. Act by raising awareness and advocating for improved stroke care. Together, we can beat stroke and save lives. Time is of the essence, and our actions can change the course of this disease. Let's stand united against stroke and make a lasting impact.

Disclaimer: Issued in public interest by Medtronic. Views expressed are independent views of the Dr Suresh intended for general information and educational purposes only and is not medical advice.

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