ANOTHER NIGERIAN DIES OF STROKE

ANOTHER NIGERIAN DIES OF STROKE

Stroke is a leading cause of morbidity and mortality worldwide, and it is likely to worsen in developing countries over the next two decades based on the projections by the World Health Organization (WHO).
The current prevalence of stroke in Nigeria is 1·14 per 1000 while the 30-day case fatality rate is as high as 40%. Management of the disease is largely conservative . Primary prevention is the key to reducing the burden of the disease in a country with such poor resources.

Stroke is not a new word in Nigeria, almost everyone knows somebody close, whether young or old that is either paralysed by stroke or that has died from stroke.

A stroke is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism or due to a hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or inability to see one side of the visual field. In the past, stroke was referred to as cerebrovascular accident or CVA, but the term "stroke" is now preferred.
A stroke is a medical emergency and can cause permanent neurological damage, complications, and death. It is the leading cause of adult disability and , it is the second most common cause of death

Predisposing Factors
Risk factors for ischaemic stroke include:

[1]Age (the risk doubles with every 10 years)
[2]High blood pressure
[3]High cholesterol
[4]Smoking
[5]Diabetes mellitus
[6]Heart disease
[7]Previous stroke
[8]Family history of stroke
[9]Atrial fibrillation (irregular heart rhythm)
[10]Transient ischaemic attacks (TIA) - warning strokes. Even though the symptoms disappear after a short time, TIAs are strong indicators of a possible major stroke.
[11]Thrombophilia (conditions that make the blood more prone to clotting, especially in young patients).

Progression
As mentioned earlier, ischaemic stroke can be due to thrombosis, embolism or systemic hypoperfusion.

Thrombotic stroke:
Thrombotic strokes are those in which clot formation reduces blood flow, or a clot breaks off and travels to a later part of the blood vessel. Thrombotic strokes can be divided into large and small vessel disease. Thrombosis-related symptoms progress in a stepwise or stuttering fashion, with some periods of improvement.

Embolic stroke:
Embolism (particles of travelling debris originating elsewhere) may be from the heart, the aorta or other large vessels. Symptoms often start suddenly and improve very quickly.

Systemic hypotension:
Reduced blood flow is more global and does not affect isolated regions. Symptoms are more generalised and without a particular focus, in contrast to thrombosis and embolism.

What are the symptoms of a stroke?
The functions of the different parts of the body are controlled by different parts of the brain. So, the symptoms vary depending on which part of the brain is affected, and on the size of the damaged area.
Symptoms develop suddenly, and usually include one or more of the following:

[1]Weakness of an arm, leg, or both. This may range from total paralysis of one side of the body, to mild clumsiness of one hand.
[2]Weakness and 'twisting' of one side of the face. This may cause you to drool saliva.
[3]Problems with balance, co-ordination, vision, speech, communication, or swallowing.
[4]Dizziness or unsteadiness.
[5]Numbness in a part of the body.
[6]Headache.
[7]Confusion.
[8]Loss of consciousness (occurs in severe cases).

What is a mini-stroke (a TIA)?
A mini-stroke is a set of symptoms similar to a stroke, but which last less than 24 hours. It is due to a temporary lack of blood to a part of the brain. It is more correctly called a 'transient ischaemic attack' (TIA). In most cases, a TIA is caused by a tiny blood clot that becomes stuck in a small blood vessel (artery) in the brain. This blocks the blood flow, and a part of the brain is starved of oxygen. The affected part of the brain is without oxygen for just a few minutes, and soon recovers. This is because the blood clot either breaks up quickly, or nearby blood vessels are able to compensate.Unlike a stroke, the symptoms of a TIA soon go. However, you should see a doctor urgently if you have a TIA as you are at increased risk of having a 'full' stroke. (See separate leaflet called 'Transient Ischaemic Attack' for more detail.)

A quick guide for the general public to remember
Both a stroke and a TIA are medical emergencies and need immediate medical attention. As a way of helping the general public become more aware of the symptoms of a stroke or TIA, a simple 'symptom checklist' to remember has been devised and publicised.
This is to think of the word 'FAST'.
That is:
F - Facial weakness. Can the person smile? Has their mouth or eye drooped?
A - Arm weakness. Can the person raise both arms?
S - Speech disturbance. Can the person speak clearly? Can they understand what you say?
T - Test for each of the above three things.
If any of these symptoms suddenly develop, then the person needs to see a doctor urgently. So call an ambulance FAST.
The FAST checklist does not cover every possible symptom of stroke or TIA. However, it is easy to remember and it is estimated that about 8 or 9 in 10 people with a stroke or TIA will have one or more 'FAST' symptoms.

What are the long-term effects from having a stroke?
The type and extent of disability caused by a stroke can vary greatly. It depends on the extent of the damage to the brain.
A large stroke can cause death. A small stroke may cause minor problems, which may go completely over time. In many cases, the effects are somewhere in between these two extremes.The sort of problems that may occur include one or more of the following:

[1]Weakness of one side of the body. This may cause problems with walking if a leg is affected, or problems using an arm or hand properly.
[2]Problems with balance and co-ordination.
[3]Swallowing problems are common. In some cases this can be dangerous as food may go down the windpipe rather than down the gullet when you eat. Because of this it is usual to do a 'swallow test' on all people with a stroke before they are allowed to eat or drink. This is to make sure that swallowing is safe. If there is severe difficulty with swallowing then you may need to have food and drinks passed into your stomach via a tube.
[4]Speech and communication difficulties. This may range from a difficulty in finding the correct words to say in the middle of a sentence, to being completely unable to speak. Also, understanding speech, reading, or writing may be affected.
[5]Difficulty with vision. If a part of the brain that deals with vision is affected then problems may arise. For example, some people who have had a stroke have double vision, and some people lose half of their field of vision.
[6]Difficulties with mental processes. For example, difficulty in learning, concentrating, remembering, etc.
[7]Inappropriate emotions. For example, following a stroke, some people cry or laugh at times for no apparent reason.
[8]Tiredness.

The above are just some examples of what may occur following a stroke. Every stroke is different and the problems and difficulties have to be assessed for each affected person.In the first few weeks after a stroke the swelling and inflammation around the damaged brain tissue settles down. Some symptoms may then improve. In time, sometimes other parts of the brain can compensate for the damaged part of the brain. With rehabilitation and appropriate therapy, there may be a gradual improvement.Of those who survive a stroke, about 3 in 10 are fully independent within three weeks, and this rises to about 5 in 10 within six months. However, it is common for some degree of disability to remain.

Are any tests needed?
A doctor can usually diagnose a stroke by the typical symptoms and signs which develop suddenly. Tests which are commonly done include:

[1] A brain scan (CT scan or MRI scan). This can determine the type of stroke (ischaemic or haemorrhagic) and may detect rarer conditions which may have caused the stroke, or which may mimic a stroke.
[2] Blood tests to check on such things as blood sugar level and cholesterol level. High levels can increase the risk of a further stroke.
[3] Chest X-ray and ECG (a heart tracing) to check for heart or lung conditions which may be a cause of stroke (for example, atrial fibrillation).
[4] Ultrasound scan of the carotid arteries in the neck to check if there are large patches of atheroma in these arteries.

What is a Carotid Colour Doppler Ultrasound Test?:
Carotid Doppler Ultrasound is a non-invasive test that uses sound waves to measure the flow of blood through the large carotid arteries that supply blood to the brain. These arteries can narrow due to arteriosclerosis or other causes and this can lead to TIA (mini-stroke) or CVA (stroke). This test can help doctors to determine stroke risk and help determine preventive measures.

Why do I Need To Have a Carotid Colour Doppler Scan?:
If you have had a TIA your doctor may order a carotid doppler to evaluate your carotid arteries. If there is narrowing of the one or both of these major arteries it is highly probable that the TIA was caused by this narrowing. Additionally if you have had a TIA caused by carotid stenosis (narrowing) you are at much higher risk of having a large stroke. If stenosis is diagnosed there are treatments avaialable that can help open up the arteries and prevent a large stroke.
What treatment and care is usual for people who have a stroke?
If you suspect that you (or a person you are with) is having a stroke, then call for an ambulance immediately. You should be admitted to hospital.


At JOAS MEDICAL DIAGNOSTIX Ikotun Lagos Nigeria ,with our latest 4D Colour Doppler Ultrasound Scan Machine , we offers comprehensive check of the Neck vessels for Carotid Stenosis. for all vascular ultrasound scans for DVT [limbs], Carotids [neck vessels] and Arteries [limbs] contact JOAS MEDICAL DIAGNOSTIX Ikotun lagos Nigeria.


Regards

Dr. Victor Efughi
Consultant Clinical Specialist Sonographer

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