All India Radio Program

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All India Radio aired  an hour long  live discussion with Prof. D.K. Mandal, FounderPresident,Stroke Foundation of Bengal on the various aspects of Stroke on the 30th March,2015 in their weekly feature “Swasthya Jigyasa” (About Health).   Prof.Mandal explained in details about what the word “Stroke” implies. It indicates only a brain attack, which happens due to a lack of blood supply to a part or parts of the brain. He also talked about the two specific types of stroke- ischemic and hemorrhagic.  The important thing to remember is that the hemorrhagic stroke is relatively higher in our place. On being asked about how to understand that stroke has occurred, he said that the symptoms of stroke are varied and depend upon the part or parts where the blood flow is impaired . Common is the weakness or paralysis of one side of the body. However he stressed that equally common is the affectation of speech. It may be slurred or there may be total inability to form words. Sometimes there is complete lack of comprehension. Here the patient may be hearing well but unable to understand the spoken words and often taken to a psychiatrist. Often there is a loss of vision in one eye or part of the field of vision. These patients mostly land up in an eye clinic. In hemorrhagic stroke there may be bursting headache, vomiting and unconsciousness.

To identify stroke we need to learn the FAST sign, Prof.Mandal said. F- Facial drooping ,A- Arm weakness- ,S- Slurred Speech, T- for Time; that is immediate attention is to be paid to one who develops any of these symptoms. Sometimes none of these symptoms or signs are noticed as there may be very small strokes affecting the brain. These “multiple infarcts” usually cause loss of memory- which may be subtle in the beginning often attributed  wrongly to normal aging process. that is why in 2008 the World Stroke Day theme was ‘Little Strokes- Big Trouble”.Prof.Mandal warned that those who are in their fifties or sixties, if they have high blood pressure or diabetes  complain of forgetfulness, need to be investigates for small strokes.

On being asked about how to prevent this devastating disease which cripples families, he said that the risk factors have to be identified and treated in the proper way. Of most importance is high blood pressure or hypertension which is a ”silent killer” because most people do not know that they suffer from hypertension and that they need  regular medications. Any blood pressure > 140/90 mmHg is high and needs treatment. To prevent strokes it is best to keep it near about 120/80. After 30- 40 years of age, blood pressure must be regularly measured particularly in those who have family members suffering from such conditions. Regular walking, decreasing salt intake to 3-4 gms a day and avoiding stress helps prevent hypertension. It is a fact that most people fear to get their blood pressure measured, lest they need to take medicines life long. The second most important risk  factor is tobacco consumption- both smoking and smokeless oral intake, said Prof.Mandal. This is especially true in Indian village women.  If we can control blood pressure and tobacco intake, we will be able to prevent  more than 70% of strokes Prof Mandal  reassured.  Apart from these, high blood cholesterol, diabetes, sedentary life style, obesity, heart disease can also be a harbinger of stroke. High blood lipid levels cause thickening of the blood vessels and lead to clot formation inside them leading to ischemic stroke and also heart attack. Another form of ischemic stroke is cardioembolic where pre existing heart diseases ( rhythm disturbances or rheumatic heart diseases or even after heart attacks) can lead to clot dislodgement to the brain  resulting stroke. Of concern in diabetics is the fact that recovery after a stroke is delayed  in diabetics and disability is more pronounced.  Fasting Blood Sugar< 120 mg/dl and HbAic<7% is ideal. 

Then  it was time to know what to do if someone had a brain attack.  He advised that the patient be transported to the nearest health care facility preferably equipped with a CT scanner. Stroke cannot be treated at home although in remote villages often the nearest hospital is miles away and transport facilities dismal. In such cases the nearest doctor should be called to assess the patient at home for primary treatment. Then they may be shifted to a hospital on his advice. transport of a stroke patient should always be in an ambulance with equipped with oxygen and suction machines. If the patient is unconscious, drooling or vomiting, he should be turned on his side to prevent the stomach contents from  escaping into the lungs. Most deaths in stroke are due to the complications like these rather than of the primary disease itself. The investigation to be done first is a plain CT scan of the brain which immediately picks up a brain haemorrhage. If there is no bleeding in the brain,  antiplatelet medicines which are blood thinners should be started. A brain scan also diagnoses stroke mimics like brain tumor or hematoma following head injury.   Ischemic strokes may not be visible immediately. In these cases a repeat CT scan later or better a MRI of brain is helpful. Prof. Mandal said along side the brain investigations , blood sugars, electrolyes ,ECG and echocardiogram must be done. On beng quizzed about the difference of stroke in males and females, Prof. Mandal said that although the incidence is equal among both genders but stroke in women is increasing because of their longevity, self-   neglect, neglect in most families where women suffer form lack of nutrition and medical aid especially in rural areas. That is why the mortality due to stroke in women is higher- out of ten stroke deaths, six are women. Women are prone to depression more. All these  leaves them with greater disability. Of note is the fact that   contraceptive   pregnancy, post-menopausal hormone therapy, migraine make women susceptible to strokes. A particular type of stroke (Cerebral Venous Sinus Thrombosis or CVt) is peculiar to mainly women. Here the clot forms in side the veins of the brain. Another major role played by women in most stroke families is that of the care giver. That is why  the theme for World Stroke day,2014 was “ I am a  Woman–Stroke Affects Me”.The concluding part fo the program dealt with post stroke rehabilitation and disability limitation. Prof Mandal  reiterated that  disability suffered by a patient depends upon the part of the brain affected by stroke. It could be paralysis of limbs, lack of balance or coordination in movements like walking eating speech disability- inability to speak or inability  to understand spoken words, personality changes ,loss of memory, visual problems or a varying combination of of many of these. Hence the rehabilitation experts might include physiotherapist, speech and swallow therapists, occupational therapists, cognitive therapists  and also psychologists.

Prof.Mandal concluded with the mention of RIBUST study which has used mobile technology and has designed a stroke apps(Stroke Riskometer app) to score the risk burden and chances of stroke in any person in next 5-10 years. Prof.Mandal was optimistic that this was going to be a major boost to spreading stroke awareness around the world and reduce global stroke burden