Your Health - Dr. Gita Mathai

http://www.telegraphindia.com/1150803/jsp/knowhow/story_35024.jsp

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A "stroke" is exactly what the word conjures up in the mind - a sudden catastrophic physical event because of a deficiency in blood supply to the brain. The brain cells begin to die when deprived of blood. This leads to a loss of function of the body parts controlled by those parts of the brain.

The loss of blood supply may be because a blood vessel leaks, bursts, or becomes blocked. If there is a disruption in the right side of the brain, it affects the left side of the body and vice versa. The centre for speech is situated on the left side, so if the stroke has affected the left half of the brain, the person will have paralysis or weakness on the right side of the body and be unable to speak as well.

A person who is developing a stroke may suddenly have slurred speech and be unable to comprehend instructions. There may be loss of vision in one eye. There may be weakness or total loss of strength in one half of the face, the arms or the legs. The weakness may cause the patient to lose his balance and fall down. There may be a headache, giddiness, loss of consciousness or even a seizure.

If the block is not complete, the person may appear to recover rapidly. Within 24 hours it is almost as though the stroke never occurred. This often means that the person and relatives do not take the symptoms seriously. These episodes are called TIA (transient ischemic attack). It is followed by a full-blown stroke in the next 24 to 72 hours in 40 per cent of cases.

The risk of having a stroke increases with age, going up exponentially after 55 years. It is commoner in men. Women are more likely to have a stroke if they are on hormone replacement therapy. Pregnancy increases the likelihood of blood clots. Emboli may occur during childbirth. In both sexes, the risk factors for strokes are obesity, physical inactivity, smoking, use of tobacco products or high alcohol consumption. Diseases like high blood pressure, diabetes and elevated lipids can increase the risk of a stroke. Irregular and rapid heart beats can occur as a result of hyperthyroidism, as an aftermath of rheumatic heart disease, heart attacks or because of congenital abnormalities of the heart. This can cause clots to form in the heart itself, which can move to various parts of the body.

The disabilities resulting from a stroke can be temporary or permanent. There may be weakness or loss of movement to one side of the body, making walking, eating and self-care difficult. Speech may be slurred or impossible. There may be loss of memory for recent events. Words may be elusive even with clarity in the thought process. This makes communication difficult. The paralysed parts of the body may have strange sensations or paradoxical pain. Judgment, rational thought and reasoning may be affected.

A stroke is a medical emergency. Prompt treatment and follow up management helps to minimise deaths and complications.

Aspirin prevents blood from clotting further. A tablet of aspirin dissolved in 100ml of water is the emergency treatment for a stroke resulting from a clot. Clot busting drugs like TPA (tissue plasminogen activator) can be given intravenously. Administration should be a maximum of 3-4 hours after the event to be effective. Clots may be removed surgically, stents can be inserted into narrowed arteries and bulging blood vessels clipped.

Rehabilitation with physiotherapy and occupational therapy needs to be started as early as possible.

Rewiring of the brain is possible with training of the nerve cells. This way, other areas of the brain take over some lost functions and the surviving brain cells can be efficiently and optimally utilised.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in