Stroke is a condition when the blood supply to parts of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. It’s a medical emergency! Immediate treatment in the first 4.5 hours after onset of symptoms minimize brain damage and potential complications tremendously.

Symptoms

The onset is always sudden and may include

• Trouble with speaking by slurring words or understanding.
• Muscle weakness of the face (drooping corner of the mouth) arm or leg on one body side.
• Numbness of the face, arm or leg on one side.
• Trouble with seeing in one or both eyes by seeing blurred or blackened vision or double.
• Limitation of visual field to one side.
• Dizziness, loss of balance or loss of coordination.

Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think "FAST" and do the following “FAST Test”:

• Face. Ask the person to smile. Does one side of the face droop?
• Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise?
• Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
• Time. If you observe any of these signs, call 999 immediately.

Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. An adult brain has a total of 5-6 billion brain cells. When a stroke occurs, brain cells start to die. It has been estimated that 1.9 million brain cells die per minute in a stroke case.

If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.

Causes

Ischemic stroke 80%

• by a narrowed or blocked artery causing severely reduced blood flow (ischemia).
• by a blood clot (thrombus) that obstructs the blood supply. A clot may be caused by atherosclerosis or embolic (embolus) if the clot forms in your heart and is swept through the bloodstream to the brain arteries.

Haemorrhagic stroke 20% by rupture of a blood vessel inside the brain. Associated diseases are

• Uncontrolled high blood pressure (hypertension).
• Overtreatment with anticoagulants (blood thinners).
• Weak spots in the blood vessel walls (aneurysms).

Lifestyle associated risk factors:

• Overweight and obesity.
• Physical inactivity.
• Cigarette smoking.
• Heavy or binge drinking.
• Use of illicit drugs such as cocaine and methamphetamines.

Medical risk factors:

• Blood pressure readings > 120/80 mm/Hg.
• High cholesterol.
• Diabetes.
• Obstructive sleep apnoea.
• Cardiovascular disease, including abnormal heart rhythm.
• Personal or family history of stroke, heart attack or transient ischemic attack.

Other factors associated with a higher risk of stroke include:

• Age > 55 years.
• Male.
• Hormones — use of birth control pills or hormone replacement therapies that include oestrogen.

Stroke by numbers in UAE:

• 50% of stroke patients in the UAE are < 45 years (80% of global average are >65 years).
• Stroke is the second leading cause of disability after road accidents.
• Annually 8,000-10,000 patients in the UAE suffer stroke = 1person every hour.
• Incidence of 100 to 120 cases per 100,000 people.

In the UAE:

• 18 -20% of population suffer obesity.
• 20% of population suffer diabetes.
• Salt consumption is 7 time (15g/day) above the required limit (2g/day).

Treatment

In the first 4.5 hours after onset the clot can get dissolved by a clot-busting drug (venous thrombolysis) restoring the blood flow or by endovascular procedure the clot busting drug can be applicated via a catheter directly into the area where the stroke is occurring (intra-arterial thrombolysis) or the clot can get removed by a stent retriever.

In case of contraindication platelet aggregation inhibitors can be given to thin the blood.

After emergency treatment, stroke care focuses on rehabilitation including physiotherapy, occupational therapy, recreational therapy, speech therapy, psychologist, dietitian, social worker.

Prevention: Up to 80 % of strokes can be prevented!

• awareness of risk factors.
• yearly health screenings.
• Controlling high blood pressure (hypertension).
• Controlling diabetes.
• Lowering the amount of cholesterol and saturated fat in your diet.
• Limiting the amount of sodium.
• Quitting tobacco use.
• Maintaining a healthy weight.
• Exercising regularly. Aerobic or "cardio" exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
• Treating obstructive sleep apnoea (OSA).
• Take your prescribed medications.