February 20, 2020

Interview with Dr Ankush Sharma, DM Neurology PGI Chandigarh

Stroke is one of the leading causes of death and disability in India. The estimated prevalence of stroke range from 84 to 262 per 100,000 in rural and 334 to 424 per 100,000 population in urban areas. Based on the recent population- based studies the incidence rate of stroke range from 119 to 145 per 100,000 population. In Jammu and Kashmir, Stroke is also very common. As a part of our health awareness initiative , I interviewed Dr Ankush Sharma ( DM Neurology PGI Chandigarh) regarding Stroke. The excerpts from the interview are following:

1. Sir what is a Stroke in simple terms?

A stroke is sudden reduction of blood supply to brain tissue due to blockage of a blood vessel or sudden rupture of a brain blood vessel. In both cases brain tissue is deprived of oxygen and nutrients and hence begins to die.

2. Is Stroke a medical emergency?

Yes, a stroke is a medical emergency. Prompt treatment is crucial as we lose nearly 2 million neurons every minute after stroke. Early action can minimize this damage and potential complications.

3.Sir what are the most common signs and symptoms of stroke?

Stroke can present in different ways. Common sign and symptoms are
•Sudden onset trouble with speaking and understanding. You may experience confusion. Your speech may be slurred or there can be difficulty in understanding speech.
•Sudden onset weakness or numbness of the face, arm or legs. This often happens just on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.
•Sudden onset trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
•Sudden severe headache which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you’re having a stroke.
•Sudden onset walking difficulty. You may stumble or experience sudden dizziness, loss of balance or loss of coordination. Note that these things happen SUDDENLY.

4. Sir when to seek medical attention?

I emphasized earlier that a stroke is a medical emergency. So you should seek medical attention as soon as possible. “BE FAST”.
5. Sir what does this ‘BE FAST’ stands for ?

BE FAST is an acronym that stands for BALANCE, EYE, FACE, ARMS, SPEECH & TIME. You should keep in mind this acronym it will help anyone to diagnose stroke at the earliest

Balance – Is there a sudden loss of balance or coordination?

Eyes – Is there sudden double vision or blurring of vision or sudden?

Face – Ask the person to smile. Is one or both sides of the face drooping?

Arms – Ask the person to raise both arms. Does one side drift downward? Is there weakness or numbness on one side?

Speech – Does the person have slurred speech or loss of speech? Can he/she repeat simple sentences?

Time – Call for immediate medical attention if you note any of these signs. Also, do take note of time of onset of these symptoms.
Don’t wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. Remember “TIME IS BRAIN, each minute costs 2 million neurons.

6. Sir what are the most common causes of stroke?

A stroke may be caused by a blocked artery (ischemic stroke) or the rupture of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn’t cause permanent damage.

7. What is this Ischemic stroke in simple terms?

This is the most common type of stroke, about 80 percent of strokes are ischemic in nature. It happens when the arteries to the brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:

Thrombotic stroke: A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduction in blood flow (atherosclerosis).

Embolic stroke: An embolic stroke occurs when a blood clot or other debris forms away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.

8. Sir what is Hemorrhagic stroke in simple terms?

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels.

Types of hemorrhagic stroke include: Intra cerebral hemorrhage. In an intra cerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure, trauma, vascular malformations, use of blood-thinning medications, weak spots in blood vessels (aneurysms) and other conditions may cause an intra cerebral hemorrhage.

Subarachnoid hemorrhage: In a subarachnoid hemorrhage, an artery bursts and spills blood into the space between the surface of your brain and its covering membranes. This bleeding is often signaled by a sudden, severe headache with or without loss of consciousness.

9. Sir what is Transient ischemic attack (TIA) in simple terms?

A transient ischemic attack (TIA) — sometimes known as a mini stroke — is a temporary period of symptoms similar to those you’d have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which may last as little as few seconds to an hour. Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your nervous system — but there is no permanent tissue damage and no lasting symptoms. You should seek emergency care even if your symptoms seem to clear up. Having a TIA puts you at greater risk of having a full-blown stroke, causing permanent damage later. If you’ve had a TIA, it means there’s likely a partially blocked or narrowed artery leading to your brain or a clot source in the heart.

10. Sir what are the most common risk factors for a stroke ?

Many factors can increase your stroke risk. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include:
Lifestyle risk factors

Being overweight or obese

Physical inactivity

Heavy or binge drinking

Use of illicit drugs such as cocaine and methamphetamines

Medical risk factors

High blood pressure

Cigarette smoking or exposure to secondhand smoke

High cholesterol

Diabetes
Obstructive sleep apnea

Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm.

Personal or family history of stroke, heart attack or transient ischemic attack.

Other factors associated with a higher risk of stroke include:

Age —People age 55 or older have a higher risk of stroke than do younger people.

Race — African-Americans have a higher risk of stroke than do people of other races.

Sex — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they’re more likely to die of strokes than are men.

Hormones — use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth.

11. Sir what are the common complications of a stroke?
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacked blood flow and which part was affected. Complications may include:

Paralysis or loss of muscle movement: You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities affected by paralysis, such as walking, eating and dressing.

Difficulty talking or swallowing:A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly (dysarthria), swallow (dysphagia) or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. Therapy with a speech-language pathologist might help.

Memory loss or thinking difficulties: Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts.

Emotional problems: People who have had strokes may have more difficulty controlling their emotions, or they may develop depression. Pain. Pain, numbness or other strange sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm.

Seizures: Many people can develop secondary seizures after a stroke. Changes in behavior and self-care ability. People who have had strokes may become more withdrawn and less social or more impulsive. They may need help with grooming and daily chores. As with any brain injury, the success of treating these complications varies from person to person.

12. Sir what are the best possible measures that one can take to prevent a stroke?

Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:

Controlling high blood pressure (hypertension): This is one of the most important things you can do to reduce your stroke risk. If you’ve had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke.Exercising, managing stress, maintaining a healthy weight and limiting the amount of sodium and alcohol you eat and drink can all help to keep high blood pressure in check. In addition to recommending lifestyle changes, your doctor may prescribe medications to treat high blood pressure.Lowering the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaque in your arteries. If you can’t control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.

Quitting tobacco use: Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.

Controlling diabetes: You can manage diabetes with diet, exercise, weight control and medication.

Maintaining a healthy weight: Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Losing as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.

Eating a diet rich in fruits and vegetables: A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke. Following the Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful.

Exercising regularly: Exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.

Avoiding alcohol : If at all. Alcohol can be a risk factor for stroke. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes.

Avoid illegal drugs: Certain street drugs, such as cocaine and methamphetamines, are established risk factors for a TIA or a stroke. Cocaine reduces blood flow and can narrow the arteries.

Preventive medications: If you’ve had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke. These include:
Anti-platelet drugs: Platelets are cells in your blood that form clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin. Your doctor can help you determine the right dose of aspirin for you.
Anticoagulants: These drugs, which include heparin and warfarin reduce blood clotting. Heparin is fast acting and may be used over a short period of time in the hospital. Slower acting warfarin may be used over a longer term.

The Interviewer: Dr Tasaduk Hussain Itoo is a Practicing Physician, motivational speaker, columnist, activist, educator, Journalist, drtasadukitoo@gmail.com.

The Interviewee: Dr Ankush Sharma is a Senior Consultant Neurologist at Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Jammu).

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