National Stroke Week is commemorated annually from October 28 to November 3 to raise awareness about the symptoms of stroke and the importance of taking treatment.
To shed light on what is a stroke, the Advertiser spoke to Dr Robert Khonje, who is the principal specialist at Tambo Memorial Hospital.
According to Khonje, a stroke is a medical condition when there is an interruption or reduction of blood supply to part of the brain. This results in the deprivation of oxygen and nutrients to the brain tissues concerned.
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“Unless this is reversed immediately, the affected part of the brain will die in time and the patient will exhibit neurological deficits that will be proportional to the extent of the damage and the part of the brain involved.
“From a clinical point of view, patients who suffer mild strokes have a disability that allows them to still live an independent life while those with major strokes are rendered dependent from their severe disabilities.”
Khonje said strokes are therefore a disease of the blood vessels of the brain (cerebrovascular accident) and can either be from thrombosis (clot or ischaemic) or rupture of a blood vessel in the brain (haemorrhagic).
“Often affected individuals will show symptoms of motor deficiency or weakness on one side of the body (hemiplegia) or swallowing difficulty, sensory deficits (deafness, speech impediments and loss of vision), and will have difficulty to discern emotional lability and personality changes.
“Occasionally, a stroke caused by a small clot resolves and its symptoms disappear completely within a day as this is called a transient ischaemic attack, or TIA.”
The doctor said in this instance the clot managed to disintegrate quickly and blood circulation is restored before the brain suffers permanent damage. He added that sometimes the symptoms improve without the clot being completely resolved as the affected part of the brain establishes some blood flow through other nearby blood vessels.
Risk factors of stroke
Khonje said the primary risk factors to suffer a stroke are high blood pressure, diabetes and heart disease. Atrial fibrillation, a condition where the heart beats at an irregular pace, is also a common cause of clots in the chambers of the heart.
“These clots may then break up into small fragments which are then carried to the head through the bloodstream where they lodge and obstruct blood flow (stroke) in the small vessels of the brain. Patients with heart failure, autoimmune disease and arterial disease (atherosclerosis) are also at risk for both ischaemic and haemorrhagic strokes.
“Because strokes occur very suddenly, it is difficult to anticipate when they will occur. Therefore, the only way to prevent them is to adequately treat the diseases and address risk factors.”
Treatment
Khonje said hypertension and diabetes need to be well controlled to prevent their damaging effects on the cerebral blood vessels. Patients with atrial fibrillation will need to be on blood-thinning medications and anti-coagulants to prevent the development of clots in the heart.
“The use of Warfarin or the newer oral anticoagulants are recommended. Aspirin is used to prevent stroke in a patient with arterial disease (arteriosclerosis) of the neck arteries.
“For patients who remain with neurological deficits after the acute phase of the illness, we find that physiotherapy, occupational and speech therapy are invaluable modalities of therapy.”
He said nutritional advice from dieticians is essential and patients who cannot swallow can be fed by the use of tubes placed in the stomach either through the nose or the abdominal wall.
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