A stroke, sometimes called a cerebral attack, is one of the most dreadful diseases, often leading to permanent disability and sometimes death.
It’s No 3 on the list of top killers in the West, behind heart disease and cancer. In Thailand it’s estimated that 1 per cent of people over 60 are hit by stroke every year – that’s 150,000 cases. The disease inflicts a major burden on the victim, his family, the healthcare system and society as a whole.
A stroke results either from a blood clot blocking a cerebral artery, in which case it’s known as ischemic stroke, or a burst cerebral vessel, leading to a bleeding in the brain – a haemorrhagic stroke.
Most stroke cases, 85 per cent, are ischemic and occur mainly after age 55. The abrupt cessation of blood and oxygen going to the brain can lead to temporary or permanent damage to some neurological functions.
The symptoms appear suddenly and without warning and vary depending on which part of the body is affected. There can be imbalance, weakness or paralysis, loss or abnormal movement in the face or limbs, visual disturbances, difficulties in speaking or severe headache.
The stroke is usually diagnosed after all the signs have been evaluated at the hospital, while the type of stroke can only be determined through scans.
Stroke is a severe medical emergency. Because cerebral cells are so dependent on oxygen and nutrients, every minute counts in restoring the blood supply to the affected tissue.
Treatment is best carried out in a medical centre with a dedicated stroke unit. The first objective is to promptly find out the origin, because treatment of an ischemic stroke could be fatal if applied to haemorrhagic stroke. Imaging technology – CT and MRI scans and an angiography – uncover the precise cause, location and extent of the neurological damage and point to possible treatments.
The rapid clot formation that causes ischemic stroke is located at a cerebral artery (usually on a plaque of cholesterol deposits) or has travelled there through the arteries from a distant vessel such as the carotid artery in the neck or from the heart cavities.
Acute treatment consists of dissolving the clot as quickly as possible with blood-thinning medicine or by inserting a catheter into the obstructed artery.
Haemorrhagic stroke results from a rupture of an already damaged artery in the atherosclerotic process, a weak section of an artery (as in an aneurysm) or an arteriovenous malformation that’s usually inherited.
Emergency treatment in this case focuses on controlling the bleeding and reducing pressure inside the brain, sometimes surgically.
Long-term treatment of either type of stroke includes rehabilitation to limit disability and prevent the risk of a second stroke.
Prevention is not only possible but essential for everyone. You have to control the risk factors that could also bring on a heart attack, including hypertension and abnormal blood lipids, and quit smoking. A healthy lifestyle at normal body weight, with regular exercise, moderate alcohol consumption and control of stress is highly effective in reducing the risk.
Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at firstname.lastname@example.org.