Stroke—Ischemic or Hemorrhagic: The Earlier You Know, the Higher Your Chance of Survival

• Strokes claim a life every 6 seconds. They are the second highest cause of death for people above the age of 60, and the fifth highest in people aged 15-59.
• Strokes are responsible for more deaths annually than AIDS, tuberculosis and malaria combined.
• Strokes are one of the leading causes of long-term disability worldwide. 2 out of every 3 people who suffer from a stroke live in low and middle-income countries.

A stroke may be caused by a narrowing or blockage of an artery or the leaking or rupture of a blood vessel, resulting in a lack of blood supply to the brain and the damage of brain tissue. A stroke can occur in any area of the brain. When a part of the brain fails to receive sufficient blood supply, this will cause parts of the body to stop functioning normally, resulting in paralysis or even death. There are 2 main types of stroke:

1. An ischemic stroke can be either a thrombotic stroke or embolic stroke. This type of stroke is caused by a blockage or obstruction in a brain artery, resulting in decreased blood flow to the brain. Ischemic strokes account for about 80% of all stroke cases.
2. A hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures, causing blood to spill into the surrounding brain tissue. While this type of stroke accounts for only about 20% of cases, it can be life-threatening.

Stroke risk factors can be classified as either controllable or uncontrollable:

1. Uncontrollable risk factors

• Age: People aged 65 and older have a higher risk of stroke due to vascular degeneration and atherosclerosis
• Gender: Men have a higher risk of stroke than women
• Family History: People with a family history of stroke, especially when a family member has had a stroke at a younger age, have an increased risk of stroke

2. Controllable risk factors caused by behavior and lifestyle

• High blood pressure
• High levels of blood lipids (fats)
• Smoking
• Chronic conditions, such as diabetes and obesity

• Weakness, most often affecting only one half or side of the body
• Numbness or loss of feeling in the body, most often occurring on just one side of the body
• Speech impairment or difficulty speaking
• Loss of balance or coordination, difficulties with walking, and dizziness
• Partial loss of vision and double or blurred vision

These symptoms generally occur suddenly. In some cases, they may be indicative of a transient ischemic attack (TIA), whereby symptoms occur once and then disappear on their own, or they may be recurrent and eventually result in a permanent ischemic stroke.

The main signs and symptoms of a stroke can be identified using the easy-to-remember principles of FAST:

F = Face The face is numb or weak, and when trying to smile and side of the face droops

A = Arm One arm is weak and the patient may be unable to raise one or both arms

S = Speech Speech is slurred or strange

T = Time If you observe any of these signs or symptoms, it’s time to go to a hospital immediately

These FAST warning signs are essential to remember. If any of the above symptoms are present, and particularly if they occur suddenly and without warning, you should get to a hospital immediately. Each minute without proper blood supply to the brain results in the death of up to 2 million brain cells. Therefore, receiving treatment as soon as possible is crucial in helping to reduce the chance of disability and even death.

If signs and symptoms resembling those of a stroke occur and then disappear within a few minutes, this may be the result of a transient ischemic attack (TIA). TIAs can be a warning sign of an eventual more serious stroke if medical help is not received.

Transient ischemic attacks should, therefore, not be overlooked or ignored. Even if the symptoms occur only occasionally and/or disappear on their own, the patient should see a doctor for immediate diagnosis.

The best way to prevent a stroke is to reduce the risk factors by adjusting behaviors and lifestyle.

• Maintain a healthy weight and stay free of obesity which is a major cause of a great many diseases, including stroke.
• Eat a healthy diet with a focus on fruits and vegetables that are high in fiber. Avoid high-fat foods, which are a key cause of high blood cholesterol, and high-sodium foods, one of the causes of high blood pressure.
• Exercise regularly in order to maintain a healthy weight and help reduce blood lipids and blood pressure. Exercise should be carried out appropriately and regularly for at least 150 minutes per week.
• Quit smoking, as this is yet another risk factor for strokes. If you feel you are unable to quit on your own, seeing a doctor for help can be an effective option.
• Reduce alcohol consumption. For men, this means no more than 2 glasses per day and no more than 1 glass per day for women.
• Control diseases that are high risk factors for stroke, such as dyslipidemia, high blood pressure, and diabetes, and be sure to visit your doctor regularly and strictly adhere to your doctor’s advice and recommendations. If you notice any abnormal symptoms, you should see a doctor immediately.
• Don’t neglect your annual health check-ups, they can detect and diagnose any diseases you may be unaware of. The sooner any issues are found, the greater the chance of a cure or, at the very least, of lessening the symptoms.

• Checking of medical history and a physical examination.
• A computerized tomography (CT) scan of the brain in order to see whether there is any damage due to ischemic or hemorrhagic stroke
• A magnetic resonance imaging (MRI) scan in order to create a detailed image of the brain. An MRI can detect brain tissue damaged by an ischemic stroke, which is very important in deciding on the next course of action and method of treatment.
• A cerebral angiography to examine the arteries in the brain. In this test, the doctor inserts a catheter through a small incision in the groin, and guides it through the major arteries and into the carotid or vertebral artery. The doctor then injects a dye into the patient’s blood vessels so that any blockages in the brain become visible under x-ray imaging.
• Ultrasonography, a painless imaging test that uses high-frequency sound waves to create pictures of the inside of your carotid arteries to detect any possible abnormalities in the blood vessels.

• Medications are used to treat ischemic strokes in order to prevent a recurrence. The doctor will consider the use of medication to help thrombolysis If treatment is carried out quickly enough, it may help people who have had a stroke recover more fully.
• Surgery Carotid endarterectomy is a surgical procedure to remove fat deposits clogging the arteries that feed blood to the brain. It can be used to treat ischemic strokes caused by fatty plaque in the carotid arteries that block or restrict blood flow to the brain.

The best methods for stroke prevention are to reduce the controllable risk factors that you can manage on your own, to make sure you visit your doctor for your annual health checkup each year, and to be continually observant of your body and any abnormalities or symptoms, especially warning signs as outlined in the FAST method. Always remember, the sooner you know, the higher your chance of survival.