By Nkiru Odinkemelu
If anyone had told Mama Blessing Nwosu that she might be spending her latter years partially paralysed and dependent on caregivers, she would not have believed it.
As a middle aged woman, Nwosu bubbled with health, energy and strength. In her community, she was both loved and respected as an industrious woman. Never depending on anyone, not even her husband for upkeep, she had her hands virtually in every trade that could earn her money. She was a farmer, trader, supplier, employer; name it. But above all, she loved God and never joked with her church meetings whether in or outside her community. However, her life retracted when she lost two grown up daughters within a space of three years. That event shattered her life. The ever happy and energetic woman became a shadow of herself; depressed, withdrawn, and like the biblical Rachael, she never stopped mourning her daughters especially when she saw those who were of same age bracket with them.
One day, Mama Blessing slept and woke up with a ‘Wake-up stroke’, a condition which has left her partially paralyzed to this day. Everywhere around the globe, stroke is a medical emergency. Every two seconds, someone, somewhere in the world is having a stroke; every six seconds, someone dies of a stroke or someone will permanently be physically disabled due to stroke.
According to World Health Organization, stroke has already reached epidemic proportion. It claims 6.2 million lives each year. In Nigeria, 153 per 100,000 Nigerians die from stroke every year, according to estimates. Considering the population of about 182million, 280,000 Nigerians die of stroke every year, 770 every day, 32 every hour and at least one every two minutes.
In this part of the world, Stroke is almost synonymous with paralysis; the common way to identify someone who has had a stroke is by the aftermath paralysis. If it is not the hand that is paralyzed, it is the leg or both. Sometimes, the mouth is slightly adjusted to one side, or the person is permanently bed ridden. However, medical experts with Nigerian Stroke Campaign Organization (NSCO) have stressed that the scenario could be different if right steps are taken at the right time. Although stroke is shown to be one of the leading causes of long-term disability, the experts affirmed that the effect is reversible if the sufferer is brought to an equipped hospital within an hour of the occurrence.
According to the experts, stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by blood clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so it starts to die. The extent and location of the brain cell damage determines the severity of the stroke, which can range from minimal to catastrophic, because different areas of the brain controls different functions. The specific effects of a particular stroke depend on which area of the brain is injured.
The American Stroke Association (ASA) further explains that if the stroke occurs toward the back of the brain, it is likely that some disability involving vision will result.
“However, because one side of the brain controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the other side of the body. For example, if the stroke occurs in the brain’s right side, the left side of the body and the left side of the face will be affected, which could produce any or all of the following: paralysis on the left side of the body, vision problems, quick, inquisitive behavioural style and memory loss
“If it occurs in the left side of the brain, the right side of the body will be affected, producing some or all of the following: paralysis on the right side of the body, speech/language problems, slow, cautious behavioural style and memory loss.
“When stroke occurs in the brain stem, depending on the severity of the injury, it can affect both sides of the body and may leave someone in a ‘locked-in’ state. When a locked-in state occurs, the patient is generally unable to speak or achieve any movement below the neck”, noted the ASA. There are mainly two types of stroke: Ischemic and hemorrhagic stroke. The ischemic stroke happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes blocked. These blockages lead to ischemic strokes; while Hemorrhagic Stroke occurs when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them causing a hemorrhagic stroke. Then there is the Transient Ischemic Attack (TIA) sometimes called a mini-stroke. TIA is different from the major types of stroke because blood flow to the brain is blocked for only a short time, usually not more than 5 minutes.
“ It is important to know that: TIA is a warning sign of a future stroke and more than a third of people who have a TIA and do not get treatment have a major stroke within 1 year; also, as many as 10 per cent to 15per cent of people will have a major stroke within 3 months of a TIA.
Factors that increases chances of stroke
Things that predispose or increase the chances of an individual to get a stroke are divided into modifiable and non-modifiable factors. Giving more insight into this, Prof. Njideka Okubadejo, a Consultant Neurologist and vice president, NSCO said “The first thing that is peculiar to us that we cannot change is our heritage. The fact that we are Africans put us at an increased risk of having a stroke; Gender: men are at increased risk of having a stroke up to 60 to 65 and then, women take over.
“However, the ones that we can do something about, we call them the big four. Chief among them is Systemic Hypertension. Worst still is that a third of people that have hypertension do not know because they are not checking their blood pressure. Many people think that when they have hypertension, they have a headache or that is when they do not sleep well. No, we call it a silent killer. If you don’t check, you don’t know it is there. “Another third that have hypertension are not taking their drugs and there are many reasons for this: they have taken it, the blood pressure normalised and they stop, or they do not have money to buy their drugs or they do not know the implication of not taking their drugs. Another third who are on their drugs are not adequately controlled of their medication.
“The second factor is diabetes mellitus. Diabetes and hypertension are twins but they are not twins in a good way. We call their co-existence a scenario where you have fireworks and light a match at it, that is the way the duo behaves when they occur simultaneously in a person’s body.
“Then there are social things like cigarette smoking, alcohol ingestion. Other risk factors include sickle cell disease, particularly in our own environment and the reason why sickle cell disease is important for us is because it predisposes people to stroke at a younger age than they are typically meant to. So it is bad enough that strokes occur in people, but with sickle cell, you see people in their 20s and 30s. “To be candid, if we can deal with hypertension and compliance with anti-hypertensive, we will see a drastic reduction in incidence of stroke in our environment”, said Prof. Njideka.
Warning signs of stroke include sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes and sudden trouble walking, dizziness, loss of balance or coordination, said Prof. Yomi Ogun, Professor of Internal medicine and Consultant Neurologist with Lagos State University Teaching Hospital (LASUTH).
Corroborating this, Prof. Njideka said it was important to recognise the warning signs of stroke to be able to help a sufferer, adding that the FAST test is an easy way for everyone to remember and recognise the signs of stroke. FAST stands for Face, Arm, Speech, and Time.
“Face: if you notice that a person’s face is twisted, move to one side or is drooping, and it starts suddenly, that may be stroke; Arm: If you notice that there is weakness in the arm, if the person is not able to lift the arm, that is a warning sign; Speech: If the speech is slurred, or you cannot understand what the person is saying, and this started suddenly, that may be warning sign of stroke; and Time: This is critical. If you notice any of these warning signs, act fast. If you are in Lagos, you can call the emergency service to get the person to hospital. But if there is a vehicle ahead the person can settle in, take her as quickly as possible to the nearest hospital but preferably a hospital where you have specialists practising.
Prof. Ogun said, “Time is brain. If you suspect that anybody is having a stroke, you need to understand that there are two hundred billion of neurons in brain, every one minute that you waste, you are losing 2million neurons, that is to say that there is no point wasting any time.
“Even if you cannot remember FAST and you can spell STROKE, S: let the patient smile and you will notice the facial problem; T: let the patient talk and see if he has problem with that and R: let him raise his hands and see that he cannot do it.
How recovery is enhanced
Prof. Mustapha Danesi, Consultant Physician and Neurologist at the Lagos University Teaching Hospital (LUTH), explained that the effects of stroke could be reversed or recovery enhanced if the patient is presented earlier. He warned of home remedies, pointing out that they do more harm than good.
“If you present early in either of the strokes, the chances of recovering are enhanced. For example, within an hour of a clot forming in the brain, in those centres that already have equipment and facilities, it is possible to burst that blood by giving a clot dissolving injection. Or sometimes when there is equipment, they can physically remove the blood. Normally, if you come too late, it is dangerous to do such thing. You cannot burst the clot after you have come four, five hours later without creating more havoc. So coming early allows that doctor to give you maximum treatment. These days, there are people who come within an hour in sophisticated centres and they can just remove the clot and within a week, the person is already walking about. Coming early is very important. Even here where we cannot burst or dissolve a clot, if you come early, we are going to be able to help to prevent the stroke from getting worse.”
When Mama Blessing was confronted with this finding, she said she never heard of it. She talked about most myth associated with stroke in local communities. “In my village, we used to see stroke as a spiritual attack,” she said, adding that such knowledge that hospital should be the first point of call was not available in her local community in Abia State as people tend to always run to herbalists believing that it was a spiritual attack. She charged the government and health workers to spread the information so that other local people could benefit.