Cerebrovascular disease and Stroke (Brain Attack) is the third leading cause of death in India, according to a joint report released in January 2013 by the Government of India and the Centres for Disease Control, Atlanta, US. More Indians die of cerebrovascular disease than due to tuberculosis, malaria, HIV/AIDS or road traffic accidents. Whereas there are national programmes for control of tuberculosis, HIV and malaria, there is no such programme for prevention and management of stroke and cerebrovascular disease in India.
The annual incidence of stroke in the country has increased from 13 per 100,000 in 1969 to 145 per 100,000 in 2006. The costs of acute care and managing these patients in long term are astounding. In another study, the overall DALYs (Disability Adjusted Life Years) lost due to stroke were 795.57 per 100,000 person years. This means that if 100,000 people were to live for one year, about 800 people will be disabled due to stroke and will not be able to go to work.
Despite the explosive epidemic, there is little awareness among the people in India. Up to 80 per cent of strokes may be prevented by appropriate risk factor management. Stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a stroke occurs, it kills brain cells in the area surrounding where the clot or breakage occurs. A brain attack should warrant the same degree of emergency care as a heart attack. Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. Treatment of acute stroke should be made available in specialized stroke centres, as some options are most effective if administered within the first three hours after experiencing symptoms. Recognition of stroke and timely referral by a general practitioner to a stroke centre is crucial. Hence, it is also important to create awareness among general practitioners and physicians in other specialties.
Pre-hospital management of stroke forms an important aspect in the management of stroke. Appropriate evaluation and documentation of the severity of stroke and communicating with the stroke centre before the arrival of the patient remarkably reduces the delay in treatment. The simple pneumonic FAST (F=Face, A=Arm, S=Speech, T=Time) can help the paramedics to diagnose stroke and take necessary action. The introduction of telemedicine and teleradiology helps to administer the initial treatment for stroke at the referring hospital before the patient is transported to a specialized stroke centre.
Creating awareness about stroke and cerebrovascular disease involves assessment of the existing knowledge of people, assessment of the barriers to effective communication and the available resources, planning strategies to impart knowledge while overcoming the barriers, implementing the programme and periodic assessment of the effectiveness of the programme. In addition, collaboration between the physicians of various specialties such as neurology, neurosurgery, cardiology, diabetologists and general practitioners is essential for adequate control of the risk factors. Social media can also play an important role in spreading awareness among people and the physicians.
Many people don’t recognize stroke symptoms. A 2001 National Stroke Association survey reported that many older Americans could not identify stroke symptoms. A 2009 study revealed that despite numerous national stroke public awareness campaigns, public knowledge of stroke symptoms and risk factors has not improved over the last five years. People don’t want their fear of stroke to be confirmed. Stroke is one of the most terrifying medical emergencies because many people would rather die than be disabled. Yet quick confirmation of stroke is the best way to receive the treatments that are proven to greatly reduce disability after stroke. Many people are also worried about the cost of stroke treatment. Studies show that acute treatment is significantly less expensive than the costs of extensive rehabilitation and long-term care.
Unless a strong programme for control and management of cerebrovascular disease and stroke is brought in action, it is not long that it will be the cause of the highest number of deaths and disability. It is high time that the people and the physicians take necessary steps to curb the epidemic of stroke in the country.
Dr Sudheer Ambekar
Clinical Fellow, Department of Neurosurgery,
Louisiana State University Health Sciences Centre (LSUHSC) – Shreveport, US
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