Mrs. Otobore Efeoghene, 68, was living a vivacious life in a sleepy community in Delta State. She had no premonition that she could be struck and knocked down by any illness. In September 2013, the farmer was visited by a stroke at the middle of the night.
Initially, her children and some of her family members took the illness for a spiritual attack. They ran helter-skelter seeking for a solution where it existed not, until it dawned on them that their mother was suffering from stroke.
According to experts, stroke is the disruption of oxygenated blood to the brain. It occurs when the blood supply to the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. When this happen, within minutes, brain cells begin to die. This could lead to partial or full paralysis in certain parts of the body.
No doubt, stroke is a medical emergency that is dreaded by all. Prompt treatment is crucial. Early action can minimise brain damage and potential complications. However, the good news is that strokes can be treated and prevented, and many fewer Americans die of stroke now than in the past.
Researchers found that the risk of stroke for people over the age of 25 ranges from eight per cent to 39 per cent, depending on where in the world they live. It discovered that the Chinese had the highest risk with more than a 39 per cent lifetime risk, followed by people in Central and Eastern Europe. The lowest risk was among those living in sub-Saharan Africa.
As reported by one of the leading world medical journals, The Lancet, stroke is the second leading cause of death globally, resulting in more than five million deaths worldwide every year. It is also a leading cause of disability, with many individuals who survive a stroke left with long-term and often lifetime disability.
According to a review of 22 studies in the United States of America, on average, female stroke survivors reported more limitations in their day-to-day activities than male survivors did.
Dr. Oludara David, a general practitioner, based in Lagos, said there were two major types of stroke – Ischemic and Haemorrhagic, while there is a third more minor stroke called Transient Ischemic attack (TIA).
He said: “An ischemic stroke can be caused by a blood clot that formed in the heart and travelled to the brain or by atherothrombosis. Haemorrhagic strokes conversely are caused by a rupture in the blood vessels that causes bleeding within the brain. A TIA is a blood clot that temporarily interrupts blood flow in the brain and is a major risk factor for future strokes that could cause more serious damage.
“Stroke is a disease of the brain. It is usually a medical emergency and has nothing to do with spiritual as many Nigerians may claim. What it requires is a prompt medical intervention from professionals. Prompt treatment of a mini-stroke could reduce the likelihood of having a full-blown stroke by roughly 80 per cent, according to different reports. However, more people survive these brain attacks, but the health problems that cause stroke aren’t going away.
“But there is no cause for alarm because stroke is something that can be managed. It is expensive to treat anyway, especially as most Nigerians pay for treatment from their pockets. And you know there is nobody that saves money purposely for sickness. That is why we always canvass prevention as the cheapest and best way to manage stroke. Living a certain lifestyle could predispose one to stroke and living a healthy lifestyle, especially for some persons, can prevent the disease. Stroke does not just occur on its own. There are certain accumulated health challenges that will eventually result in stroke. Once you are conscious of your health, it is difficult to be caught unaware.”
On when to see a doctor, he advised Nigerians to seek immediate medical attention if they notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. He stressed that every minute counts, warning that the longer a stroke goes untreated, the greater the potential for brain damage and disability
Watch out for these signs and symptoms if you think you or someone else may be having a stroke. Pay attention to when the signs and symptoms begin. The length of time they have been present can as well affect the patient’s treatment options. There could be trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech.
Other signs are paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg. 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. You may stumble or experience sudden dizziness, loss of balance or loss of coordination.
There could be trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, and you may see double. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you are having a stroke.
A new study has revealed that smoking marijuana could raise the risk for any stroke by 15 per cent and 29 per cent for an Ischemic stroke, which is the most common kind of the disease. Also, it was discovered that how much one sleeps might affect one’s stroke risk. In the study, black men who slept less than six hours a night were less likely to have a stroke than average sleepers, while white men who slept nine or more hours had a higher risk of stroke. Diabetes and high blood pressure are seen as the leading causes of stroke.
A stroke may be caused by a blocked artery (Ischemic stroke) or the leaking or bursting 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.
According to The Lancet, about 80 per cent of strokes are Ischemic strokes. Ischemic strokes occur when the arteries to your 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 reduced blood flow (atherosclerosis) or other artery conditions.
On the other hand, 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.
The journal also reported that hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain haemorrhages can result from many conditions that affect your blood vessels. These include: Uncontrolled high blood pressure (hypertension), overtreatment with anticoagulants (blood thinners) and weak spots in your blood vessel walls (aneurysms).
A less common cause of haemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation). Types of hemorrhagic stroke include: Intracerebral haemorrhage. In an intracerebral haemorrhage, 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 and other conditions may cause an intracerebral haemorrhage.
Transient Ischemic Attack (TIA)
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 five minutes.
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.
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. It’s not possible to tell if you’re having a stroke or a TIA based only on your symptoms. Even when symptoms last for under an hour, there is still a risk of permanent tissue damage.
Lifestyle risk factors
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: Being overweight or obese, physical inactivity, heavy or binge drinking and use of illicit drugs such as cocaine and methamphetamines.
Medical risk factors
The medical risk factors are: Blood pressure readings higher than 120/80 millimetres of mercury (mm Hg), cigarette smoking or exposure to second hand smoke, high cholesterol, diabetes, obstructive sleep apnoea, cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm and personal or family history of stroke, heart attack or transient ischemic attack.
Other factors associated with a higher risk of stroke include: Age —People who are up to 55 years 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.
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include: Paralysis or loss of muscle movement. You may become paralysed 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.
There could be difficulty in 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 (dysphasia) 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.
Cases of memory loss or thinking difficulties are common. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts. Also, people who have had strokes may have more difficulty controlling their emotions, or they may develop depression.
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.
People also may be sensitive to temperature changes, especially extreme cold, after a stroke. This complication is known as central stroke pain or central pain syndrome. This condition generally develops several weeks after a stroke, and it may improve over time. However, because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments.
There are usually changes in behaviour 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.
Experts have noted that as with any brain injury, the success of treating these complications varies from person to person.
Knowing your stroke risk factors, following your doctor’s recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you have had a stroke or a Transient Ischemic Attack (TIA), these measures might help prevent another stroke. The follow-up care you receive in the hospital and afterward also may play a role as well.
Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:
Controlling high blood pressure (hypertension) is said to be one of the most important things you can do to reduce your stroke risk. If you have 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, trans fat and saturated fat in your diet 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.
Smokers are advised to quit tobacco use. Smoking raises the risk of stroke for smokers and non-smokers exposed to second hand smoke. Quitting tobacco use reduces your risk of stroke.
Another way to prevent stroke is by controlling diabetes. You can manage diabetes with diet, exercise, weight control and medication. Maintaining a healthy weight is also key. 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 is very helpful. A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke. Following the Mediterranean diet, which emphasises olive oil, fruit, nuts, vegetables and whole grains, may be helpful.
There is the need for regular exercise. Aerobic or “cardio” 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 brisk walking, jogging, swimming or bicycling — on most, if not all, days of the week.
Drink alcohol in moderation if you must. Alcohol can be both a risk factor and a protective measure for stroke. Heavy alcohol consumption increases your risk of high blood pressure, Ischemic strokes and Hemorrhagic strokes. However, drinking small to moderate amounts of alcohol, such as one bottle drink a day, may help prevent Ischemic stroke and decrease your blood’s clotting tendency. Alcohol may also interact with other drugs you are taking. But it is important to talk to your doctor about what is appropriate for you.
On treatment, experts have warned people to avoid illegal drugs because 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.