Tag: Stroke

The Federal Government has initiated moves to prevent Nigerians from developing stroke and other preventable conditions by enrolling them for screenings at a fee. But, can the project fly? OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU report.

 

THe minister chose his words carefully. May be because they carry a lot of weight. Minister of Health Prof. Onyebuchi Chukwu says the country is expected to lose an estimated $8 billion to non-communicable diseases. Chukwu said the economic loss to the country would emanate from expenditures by Nigerians on stroke, heart disease and diabetes-related illnesses estimated by the World Health Organisation (WHO) to be within the range of $400 million.

He spoke in Abuja at the World Stroke Day celebration organised by the Nigeria Stroke Assembly. He gave the mortality rate of stroke as between 40 and 50 per cent within the first three months of diagnosis.

He had more shocking facts: “A facility-based study showed that 39 per cent of those who survived stroke after three months died within 12 months and the remaining 12 per cent developed severe disability.”

To curb this scary state of things, the Federal Government has proposed the National Stroke Prevention Programme. He explained that the programme is aimed at encouraging Nigerians to routinely carry out medical check-ups as well as change their lifestyles.

The need for urgent attention to stroke may become more meaningful when experts’ positions are considered. As much as 200,000 Nigerians are killed or disabled by stroke each year, experts estimate.

“We think almost 200,000 Nigerians are suffering a stroke each year,” said Dr Biodun Ogungbo, neurosurgeon with the group, Stroke Assembly. Half of those people are dying each year. The rest of them are becoming disabled.

“The key thing is that stroke is killing Nigerians. Every single Nigerian knows somebody, either within their own family or in the street or chose to them in their neighbourhood who has suffered from a stroke.”

A recent review by three doctors of stroke cases in a military hospital concluded that stroke still contributed significantly to increasing death and injury among patients admitted in hospitals.

The researchers identify the risk factors–including hypertension, diabetics, other cardiovascular events–that can be modified should be “aggressively addressed to reduce the burden of stroke in our society.”

 

What is stroke?

A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen. This can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralysed.

According to Consultant physician/ Endocrinologist, Dr Olufemi Fasanmade, stroke is the part of the leading cause of death in Nigeria and a leading cause of adult disability, yet up to 80 per cent of strokes are preventable.

He said because stroke is a brain attack, it is a medical emergency, and every second counts and the first place to go is the hospital.

Fasanmade said: “Time is of essence. There are simple tricks to the prevention of stroke. And the initiative by the government to set the ball rolling in the anti-stroke battle is commendable.”

The President approved a Nigerian National Stroke Prevention Programme. The programme is to be managed by the Ministry of Health in collaboration with Federal Teaching Hospitals and other hospitals in Nigeria; as well as Nigerians in Diaspora to execute the programme through MOU. The sum of N10,000, is required to qualify for some of the basic medical screenings can be conducted any clinic of the hospitals. The cost of the test, which is about N50, 000, has been reduced by the government through a subsidised arrangement to now cost N10, 000; particularly for indigent Nigerians.

According to Fasanmade: “The policy of N10, 000 per individual to undergo screenings depends on the kinds of routine testing government has in mind. There are procedures for such things. We expect people to participate. The routine screening and other diagnostic belt is elastic, ranging from one naira to a million naira. With N10, 000, some basic medical screenings can be conducted any clinic. Some screenings can be conducted by even a nurse while some need experts like pathologist and other laboratory workers. Affordability depends on the person’s pocket. It could be as expensive as Magnetic Resonance Imaging (MRI) or as cheap as measuring for a Blood Pressure (Bp),” he said.

The reasons why am advancing that people should enroll in the policy include the preponderance of the situation in our clime.

Dr Fasanmade said: “In Nigeria, stroke is responsible for 33 per cent of medical causes of coma; 3.2 per cent of hospital admissions; 7.3 per cent of causes of death in medical (non surgical, non gynaecological adult) wards; it is the commonest cause of disability; second commonest cause of dementia; third commonest cause of death and one of the three top causes of prolonged hospital stay.

“But all these can be halted if the several factors responsible for stroke are prevented or adequately managed so the blockage of a brain blood vessel or bleeding of a brain blood vessel.”

And the factors that cause stroke? They include hypertension; diabetes mellitus; irregular heart-beats; Sickle cell disease; advancing age; smoking and alcohol.

A neurologist at LUTH, Dr Frank Ojini, corroborated what Dr Fasanmade said that more patients were coming to the hospital for diabetes and hypertension, among other NCDs. He called for a change in diets and lifestyle changes.

He said: “Most NCDs are due to westernization lifestyle. Our people are now becoming more western in their lifestyle because they eat more fast food than proper solid natural food. Most fast food tends to contain much salt and sugar. This is because they are over processed and canned.”

On way out, Ojini advised that people should exercise regularly by at least engaging in 30 minutes daily brisk walk, change their diet and try to live a stress-free life.

At the Lagos University Teaching Hospital (LUTH), more patients are attended to for diabetes and hypertension than the other communicable diseases, which were responsible for major hospitals’ attendants and admissions.

“Records showed that patients visit diabetic and hypertension clinics more than before. It may be because people are more aware of the dangers of diabetes and hypertension and want to access treatment,” she added.

 

Types and prevention tips

 

Fasanmade said there are two

main types of stroke- ischemic

stroke and hemorrhagic stroke.

He said: “Ischemic stroke accounts for about three-quartres of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.

“A hemorrhagic stroke occurs when a blood vessel on the brain’s surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).

“Both types of stroke result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain. The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking, and incontinence and bladder problems.”

He gave further preventive tips: “Good diet; engage in physical activity; be careful of drugs eg aspirin, statins, that thin blood; monitor your blood pressure (Bp). It is essential to diagnose stroke early and get patient to hospital as soon as possible as some can be reversed or disability limited by active management. Also call for help e.g call 767 or ambulance. And Quit unhealthy habits; take BP medications regularly if on treatment; take diabetes mellitus (DM) drugs regularly if on them. Stroke is a brain attack and management has to be coordinated by multidisciplinary professionals. It is best prevented and those who already have should be extra careful.”

Ojini said the rising incidence may be due to adoption of westernisation which has impaired lifestyle, especially the consumption of fast food.

“People are now taking more calories than they need. They take soft drinks, fizzy and carbonated sweetened drinks in place of water, which is quite harmful,” she said.

Explaining the dangers inherent in such drinks, she said: “A bottle of soft drink has between 140 and 200 calories while water has zero per cent. Now if a person takes three bottles of soft drink, such would have taken 600 calories. This means the same person would have increased his calories intake by more than 30 per cent. However, the quality of his exercise is still the same. This is why people are pre-disposed to obesity and diabetes.”

Medics advise people to eat natural food, befriend fruits and water.

They warn against juices, which are not devoid of sugar.

“It doesn’t matter what names they are called, they all contain extra calories. The juices with the inscription: ‘No added sugar’, still contains sugar. The producers may just be talking about specific types- fructose, lactose, sucrose, and glucose and other forms of simple or complex sugar. But they all contain sugar. They all also contain calories,” they added.

Fasanmade said power drinks are dangerous because they contain stimulants like caffeine, sugar and other extra calories.

“So, it means the person who drinks them is at risk of developing various health problems, apart from being overweight or obese. Most stimulants can induce stress. This means they can cause negative effects on the heart and other respiratory organs,” he said.

Many Nigerians are living with symptoms of stroke undetected because of lack of facilities and poverty in the country, a Nigerian based United Kingdom medical expert, Mrs Gloria Ekeng-Ewa, has said.

Ekeng-Ewa, the chairperson of Stroke Care International, a non-governmental organisation (NGO), said people should know that stroke is real, it is not a cause adding, it is preventable and manageable with adequate intervention and supervision.

According to her, stroke happens when there is no sufficient blood flow to some parts of the brain which may result in brain and heart attack. “It also leads to loss of mobility of the affected part of the body, she explained,” she said.

Ekeng-Ewa, who spoke to our correspondent during a free medical test on blood pressure and diabetes, sponsored by her organisation in Lagos, said she was motivated to bring stroke awareness to Nigeria because it is a major killer sickness.

Stroke, she said, is caused by uncontrolled blood pressure that makes the victim hypertensive which if not properly managed could lead to haemorrhage as a result of burst in the blood pressure in the brain. She said a type of stroke, ischemic stroke happens when the clot in one of the blood vessel is broken.

She said diabetes can lead to stroke if not managed well and added that blood genetic has also been identified as a major cause. “People should undergo blood test regularly. I advise Nigerians to modify their life style by being conscious of what they eat; junk food, fried food and fizzy drinks are not good for consumption all the time. Nigerians should cut down the in-take of salt, saturated fat and carbohydrate. They should rather take a lot of fruits and vegetables,” she said.

Stroke is a largely preventable disease; its risk factors are well known and many are related to modern lifestyle.

Risk factors

Whether we’re reading, writing or ruminating, our brains need a constant fresh supply of oxygenated nutrient-rich blood. When that flow is interrupted in any way, we have what some experts call a brain attack. Most people know it as a stroke.

Around 150,000 Britons suffer a stroke every year. Some 85 per cent of strokes are ischaemic, caused by a blocked artery. The other 15 per cent are caused by a bleed in the brain known as a haemorrhagic stroke.

The real frustration for specialists, such as Professor Anthony Rudd, national clinical director for stroke, based at Guy’s and St Thomas’ NHS Foundation Trust, is that many strokes could be prevented through better knowledge of the risk factors.

“The most important risk factor is high blood pressure as it can damage or narrow the arteries,” says Professor Rudd. “If everyone had well controlled blood pressure, below 130mmol/80mmol, it would prevent 60 per cent of strokes.”

He adds: “Smoking is also a significant problem: the toxins in the smoke cause vascular damage and smoking speeds up the rate at which arteries become furred up. The narrower the arteries, the more chance there is of a blood clot causing a blockage.”

Being diabetic also increases the risk of furred-up arteries, so weight gain, especially around the stomach, which may lead to that condition, is an increasing risk factor partly due to the rise in obesity.

Recreational drugs in younger people may be contributory, Professor Rudd warns, with ecstasy and amphetamine-type drugs causing surges in blood pressure, which may lead to haemorrhagic stroke. Other drugs can cause inflammation in the brain.

“There is no doubt that alcohol increases risk,” he says. “Possibly there is some truth that a little alcohol regularly is good or doesn’t do any harm – a glass of red wine or a beer at night is fine – but don’t save up your weekly units for a Friday night: binge drinking causes huge surges in blood pressure.”

Sleep, or lack of it, is another contributory factor. “If you snore loudly and briefly stop breathing in the night due to sleep apnoea, you have an increased risk of vascular disease and stroke,” he explains.

US researchers from the University of Alabama at Birmingham, who observed 5,666 people for up to three years, reported last year that habitually sleeping less than six hours a night significantly increases the risk of stroke symptoms.

The study’s lead author Megan Ruiter says: “In employed middle-aged to older adults, relatively free of major risk factors for stroke, such as obesity and sleep-disordered breathing, short-sleep duration may exact its own negative influence on stroke development.”

Her team speculated that short-sleep duration is a precursor to other traditional stroke risk factors and, once these traditional stroke risk factors are present, then they may become stronger risk factors than sleep duration alone.

And there are other, perhaps quirky, reasons for stroke too, as BBC broadcaster Andrew Marr demonstrated when he discussed his own stroke recently, claiming it was caused by an energetic session on a rowing machine.

“Very vigorous exercise, the sort that makes your face bright red, like weightlifting, can cause damage to arteries,” says Professor Rudd. “This can also happen to women putting their heads backward into sinks at the hairdresser or to people being spun violently around at a fairground.”

According to the Stroke Association, there are some stroke risks you cannot change. Most people who have strokes are aged over 55 and the risk increases as you get older.

However, more men under 75 have strokes than women, although middle-aged women are more likely to have a stroke than men in the same age group.

Ethnicity matters too. Researchers don’t know why, but people of South Asian, African or African-Caribbean origin are more likely to have a stroke than the rest of the population.

Some of us are born with a congenital risk, such as a hole in the heart called a patent foramen ovale (PFO). This small, flap-like opening allows oxygenated blood from the placenta to bypass the lungs, typically closing shortly after birth.

But when this flap remains open, it can potentially allow dangerous clots to pass from the right side of the heart to the left, travel up to the brain and cause a stroke. “A quarter of us are born with a PFO and more of us with this condition have a stroke than not,” says Professor Rudd.

A particular problem within the heart is atrial fibrillation (AF), the most common cardiac arrhythmia or irregular heartbeat. Professor John Camm, professor of clinical cardiology at St George’s, University of London and current president of the Arrhythmia Alliance, says AF accounts for 15 per cent of all strokes.

“When AF occurs, the upper chambers of the heart don’t function properly. They try to pump far too fast – 600 times a minute. You’d have to be the size and weight of an insect wing to be able to do that,” he says. “Instead, the chambers of the heart look like a bag of worms squirming, blood becomes static and doesn’t move properly and clots form.” These clots can break off and fly around the circulation, obstructing arteries leading to the brain.

AF is usually due to ageing, but can also be caused by cardiovascular disease. Worryingly, it is often a silent condition, with many not knowing they have it until the day they suffer a stroke, and these types of events are large and more often fatal, warns Professor Camm.

Yet, there are practical treatments for both AF and PFO. For the latter, occluding devices are proving to be very effective, literally closing the gap in the heart. With AF, drugs or a procedure called catheter ablation can get the heart back into a normal rhythm, he says.

During ablation, several flexible catheters are introduced into the patient’s blood vessels and pushed towards the heart. Local heating or freezing is used to destroy the abnormal tissue causing the heart rhythm disturbance.

Lifestyle changes, which ought to be easy, seem more difficult for the public to take on board. This could be partly to do with myths, such as strokes “can’t happen to younger people”. Yet Professor Rudd says younger people are not immune, having seen a 25 year old in his clinic recently.

Another myth Professor Rudd hears is that it is OK to smoke for a long time before the danger becomes real. “The risk increases as soon as you start,” he says, “but as soon as you stop, the risk comes down very, very quickly. Within a year or two, your risk is no higher than a non-smoker; even the day you stop, the risk falls.

“Stroke is a really horrible condition: once the brain is damaged, it can’t repair itself. You can recover, but you cannot repair a hole in the middle of the brain.

“People think: ‘Oh you’ve got to die of something’. But stroke is largely preventable and it cuts lives short, and ends people’s ambitions for the rest of their life when they do survive.”

 

What does a stroke look like?

• Inside the arteries, the flow of blood is interrupted by a blockage – a clot of blood cells has jammed an artery

• The area of the brain relying on blood is immediately starved

• Within moments, the area of brain cells affected begins to die, even while other local capillaries try desperately to divert blood to the stricken area

• Perhaps an artery has burst, haemorrhaging blood cells which die rather than reach the area of brain tissue expecting them

• If the blood is not helped to flow again, through the use of clot-busting drugs, or the bleeding is not stopped and swelling relieved, then damage may be permanent causing disability

• Our brains are divided into regions from where different functions, such as speech or movement, are controlled – with the right half of the brain controlling the left side of the body and vice versa

• So as the cells begin to die off, in minutes messages to different parts of the body stop being processed via neurotransmitters

• The tiny muscles and nerves which support the face may be the first to lose instruction

• They stop working, and the facial skin sags and feels prickly, then numb

• If the area affected is where we process speech and language, then talking becomes a problem; but any of the senses may be affected

• As the area of dead cells spreads in the brain, areas of the body further away from the brain quickly begin to be affected

• The arm on the opposite side of the body to the area of cell death may become weak and numb; the legs may not hold you up or propel you forward

 

High blood pressure

People with high blood pressure may not have any symptoms, so it is important to check your blood pressure regularly. Your doctor can prescribe medication to help with conditions that increase the risk of stroke, including high blood pressure, heart disease, diabetes, high cholesterol and irregular heartbeat. But a healthy diet and regular exercise are important.

 

Atrial fibrillation

Atrial fibrillation (AF) is a type of irregular heartbeat, affecting around 800,000 people in the UK. Symptoms include palpitations (being aware of your heart beating fast), breathlessness, chest pain, fatigue; or you may have no symptoms, but an irregular pulse. A doctor or nurse will need to run tests, including a 24-hour heart monitor, to find out if you have AF.

 

Excess alcohol

Drinking too much alcohol increases your blood pressure. Binge drinking, (more than six units of alcohol within six hours), can cause your blood pressure to increase rapidly which greatly increases the risk of stroke. Don’t drink every day or exceed the recommended limits (for women no more than two to three units a day; for men no more than three to four units).

 

Smoking

You are twice as likely to have a stroke if you smoke. Ask your GP to refer you to a stop smoking group or try self-help books for advice. Nicotine replacement chewing gum, sprays and patches can help, but may not be suitable for people who have already had a stroke.

 

Poor diet

Eating your five a day and having plenty of fibre can reduce your stroke risk. But high-fat foods can raise your cholesterol and a lot of salt in your food can cause high blood pressure, the biggest risk factor for stroke. Cut down on salt, (check food labels on pre-prepared meals for “hidden” salt). Keep a food diary and use smaller plates to control your portion sizes.

 

Lack of exercise

Regular physical activity lowers your blood pressure, helps balance fats in your body and improves your ability to handle insulin. Plan to exercise at least 30 minutes, five days a week, but build up slowly. Warm up and cool down with several gentle stretching exercises, important for letting your heart rate return to normal after exercise.

 

•Culled from theraconteur.co.uk