Stroke: A major cause of disability and death

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Stroke: A major cause of disability and death
STROKE A Major Cause of Disability and Death
Qaiser Toqeer MPH MD
A Diplomat of the American Board of Psychiatry and Neurology, Inc., a Member of the American Board of Medical Specialties.
Novant Health Inc.
Dept. of Neurology

Brain is a very complex organ and controls significantly important functions such as being able to speak, understand, movement, behavior, breathing, heart rate, and sensations such as touch, vision, smell and hearing. Stroke can lead to deficits in some or all of these functions depending on the severity of disease. Stroke has long been known as a leading cause of death in the United States. According to American Heart association and American Stroke Association statistics published in 2017, approximately 800, 000 people are diagnosed with stroke each year. On average one patient has stroke every 40 seconds and 1 patient dies of stroke every 4 min (AHA, ASA Statistics 2017). Unfortunately, our communities still lack understanding of this lethal disease. There are two main types of strokes and each has different implication and treatment. Ischemic strokes account for approximately 85% of all strokes whereas rest of the strokes are hemorrhagic. Ischemic strokes are caused by a lack of blood flow to one part of the brain, caused by tightening or occlusion of blood vessels; whereas hemorrhagic stroke is bleeding inside the brain. Main risk factor for both types of stroke is high blood pressure. Treatment options for ischemic strokes can be therapeutic or preventive. The therapeutic option is highly dependent on recognizing warning signs and presenting them to emergency room immediately. The American Stroke Association (ASA) has come up with the FAST acronym which helps recognize warning signs of the stroke. FAST stands for facial droop, arm weakness, slurring of speech and time to call 911. If any or all of the above signs are present 911 should be called immediately. Unfortunately, lifesaving treatments have to be initiated within 3 hours of symptoms onset to avoid major disability or death. In rare cases this can be extended to only 4.5 hours. On the other hand surgical treatment has to be initiated within 6 hours. Therefore presenting to emergency room immediately is the key to the treatment.

Prevention is the mainstay of treatment which focuses on reducing risk factors for stroke and heart disease. Risk factors include Hypertension, diabetes, hypercholesterolemia, a sedentary lifestyle, and most importantly smoking. People who suffer from high blood pressure are at higher risk. The American Heart association recommends blood pressure to be less than 120/80 especially for those individuals who have the risk factors mentioned previously. To achieve this goal, an individual must consult with a primary physician to adjust blood pressure medications. In addition, salt intake must also be less than 3 grams daily. Weight loss is also associated with drop in blood pressure; each pound lost translates into a 1 mmHg drop in blood pressure.

Diabetes or high blood sugar also leads to hardening of blood vessels by binding to hemoglobin found in red blood cells. Diabetes is measured by hemoglobin A1C which is a blood test that tells your physician an average of your blood sugar at any time for the past 3 months. ASA recommends hemoglobin A1C to be around 6.5%. In order to achieve this goal exercise and at times medications are necessary.

Hypercholesterolemia is a disease which leads to elevated bad cholesterol and decrease in good cholesterol. Cholesterol plays a major role in plaque formation inside the blood vessels. Plaques are globules of bad cholesterol with blood cells. These plaques rupture because of high blood pressure and occlude the blood vessel leading to lack of blood flow to the brain. ASA recommends bad cholesterol (LDL) to be less than 100 and in cases of concurrent diabetes goal is to reduce the bad cholesterol (LDL) below 70 for stroke prevention. Smoking is strongly associated with major cancers and cardiovascular disease. It accelerates the progression of disease and complete cessation will slow down the progression to a significant degree. There are various resources available that can help quit smoking include medications, gums and patches.

In summary, stroke is a 5th leading cause of death in the United States and leads to major disability and deaths. Many risk factors are associated with stroke and mainstay of treatment involves modifying these risk factors. Therapeutic treatment is limited and requires prompt recognition of signs of stroke. FAST is utilized to recognize signs of stroke which stands for facial droop, arm weakness, slurring of speech and time to call 911. If you experience any of these symptoms, have general concerns regarding heart disease or need help with smoking cessation, call your physician for information on therapy and prevention.

References

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I dedicate this article to my beloved father Toqeer Mehmood who encouraged me for this work.

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