Doris Obinna
Each year, more women suffered from stroke than men. According to the National Stroke Association (NSA), stroke a leading ailment worldwide. The World Health Organisation (WHO) projected that it is likely to worsen in developing countries in the next two decades.
A survivor, 55-year-old Mrs Franca Nnadi told Daily Sun: “I was always in great health according to my doctor. I had a malformation in the brain stem that burst on July 31, 2016, resulting in a haemorrhagic stroke. It was something I was born with, though there was no way of knowing it was there until it burst.
“It has taken all these months to learn to swallow, walk and read correctly. My face still droops and my left eye is facing my nose. I still have tingling that comes and goes in my right arm, and the left side of my face, though not as bad as in the beginning.
“The coming and going is what I don’t understand. I think I am better, but find myself confused. It seems I am more and more fatigued everyday. Up till this moment, I have never given up my therapy.”
Chief Medical Director, Gods Goal Hospital, Lagos, Dr Gabriel Omonaiye, told Daily Sun that strokes or cerebrovascular accident (CVA) are a mixed group of disorders involving, sudden, focal interruption of blood flow in the brain causing deficiency in neurological functions:
“It is a medical emergency and a leading cause of deaths in the Western world (the third most common). In the United States, it is the fifth cause of death, causing one death every five minutes. More than 100,000 cases are recorded yearly in Nigeria.
“Stroke also known as brain attack is a real medical emergency. It needs immediate intervention by highly trained group professionals using the best medical knowledge, skills, drugs, interventions, equipment and technology for the afflicted to have the best possible outcomes. But unfortunately here, there is a conspiracy of unfavourable factors and beliefs, which works to cause the patient to hold the short end of the stick.
“Such issues as poverty, health illiteracy, superstitious beliefs and dearth of diagnostic machines and absence of the latest cutting edge technology adversely hinder the prognosis of patients with stroke.”
He said though strokes do occur in the two genders, all age groups and races, there are known risk factors that increase the probability of having CVA: “Strokes are common in old people and this is related to the weakness of the cerebral blood vessels with advancing age, atherosclerosis.
“In Nigeria, hypertension is a major risk factor, especially when it is poorly controlled. Other risk factors are cigarette smoking, alcohol drinking, diabetes mellitus, high cholesterol levels, family history of stroke, previous history of stroke in a person, sickle cell disease, the use of harmful recreational drugs such as cocaine and amphetamines, atrial fibrillation (a form of heart disorder), intracranial aneurysm and the male sex.”
Causes
Omonaiye said: “When a portion of the brain is deprived of blood supply, the lack of oxygen and nutrients to that part of the brain will cause the death of the cells (neurons) in the particular area.
“The death of these neurons will cause the neurological deficit. Since different regions of the brain have different functions, the observed deficits will correspond with the affected area of the brain. Physicians use the knowledge of the neurological deficit to know the affected areas of the brain. The size of the affected part of brain (whether small or big) is directly proportional to the severity of the symptoms, signs and clinical presentation.
“Also, migraines are a form of headache. Usually severe, throbbing, and pounding are commoner in females than males. There may be other symptoms such as abdominal pain, nausea, vomiting, and loss of appetite. In some people they have an aura.
“It has, however, been discovered that in young women with migraine aura, there is a slightly increased occurrence of thrombotic stroke. The observation is, however, not causal. What is common to the two (migraine headache with aura and thrombotic stroke in some young ladies) is the presence of the risk factors of cigarette smoking and the use of contraceptive pills. This is a research area.”
He noted that some patients while having stroke might experience what looks like a migraine headache: “In migrainous aura, patient with aura symptoms lasting longer than one hour, may actually be having a brain infarction and should be evaluated for the same.”
Types of stroke
Omonaiye disclosed that there are two types of stroke; ischaemic stroke, from thrombosis and embolism, constituting 80 per cent and haemorrhagic stroke: “Ischaemic stroke is due to the blockage of the blood vessels supplying a part of the brain from blood clot from a distant origin (embolism) such as the heart or deep vein thrombosis or clots formed in the cerebral blood vessels (thrombosis). Risk factors for the development of thrombosis include cerebral arthreoscleroscis, plaque formation and hypercholesteroleamia. Ischaemic stroke tends to have a better outcome.
“Haemorrhagic strokes are due to the rupture or tear or burst of cerebral blood vessels, cutting of blood supply to the territory of the brain supplied by the damaged artery or arteries. In addition, there is an accumulation of blood in the cranial cavity leading to the raised intracranial pressure and swelling of the brain. The raised pressure in the head, brain swelling and accumulation of blood except rapidly treated through drugs and sometimes neurosurgery, may cause death.
“Haemorrhagic stroke are of two types, intracerebral and subarachnoid haemorrhage (SAH). Subarachnoid haemorrhage is sudden bleed into the subarachnoid space, the most common cause being a ruptured aneurysm.
“This could be spontaneous, or due to head trauma, arterovenous disorders, mycotic (fungi) aneurysms. The symptoms include sudden, severe headache, usually with loss or impairment of consciousness. Transient Ischaemic Attack (TIA) can be defined as stroke symptoms lasting less than one hour and usually does not damage brain tissue.”
Omonaiye said: “For ischaemic stroke, the symptoms and signs depend on the part of the brain affected. Deficits may become maximal within several minutes of onset, typically in embolic stroke. But the deficits may evolve slowly over 24 to 48 hours, commonly in thrombotic stroke. Embolic strokes tend to occur during the day, with headache preceding the neurological deficit.
“Thrombotic stroke tends to occur often in the night and are first noticed on awakening. Ischaemic stroke produces motor paresis (usually on one side of the body), speech defect, ataxia, weakness, deviation of the mouth to one side. Intracerebral hemorrhage tends to be sudden, often during activity. Sudden headache, nausea, vomiting delirium and focal or generalised seizures are common.”
Treatment
“This is usually a multi disciplinary in nature involving cardiologists, neurologists, nurses, interventionists, physiotherapists, radiologists and neurosurgeons. Clinical assessment and laboratory work up (full blood count, blood sugar, imaging studies CT, MRI), drug therapy and round the clock nursing are parts and parcels of the management. Residual problems will need rehabilitation, occupational therapy, speech therapy, technological aids and a loving family giving emotional support.”
Prevention
Omonaiye continued: “Diagnosis and adequate control of hypertension cannot be over emphasised. Other measures include, control of diabetes, low fat diet. Reduction of high cholesterol, weigh reduction and regular exercise. Stop smoking; stop the abuse of cocaine and other harmful substances. Alcohol intake should be reduced.”
Lifestyle and recovery
He said: “Lifestyle changes can help you recover from a stroke and may help prevent another one. Examples of these changes include quitting smoking, following a healthy diet, maintaining a healthy weight and being physically active.
“You may experience changes in your relationships because of new limitations and challenges. Both your income and expenses may be impacted by stroke. There is still so much we don’t know about how the brain compensates for the damage caused by stroke.
“In some cases, the brain cells may be only temporarily damaged not killed and may resume functioning over time. In other cases, the brain can reorganise its own functioning.
“Once in a while, a region of the brain ‘takes over’ for a region damaged by the stroke. Stroke survivors sometimes experience remarkable and unanticipated recoveries that can’t be explained.”