National Stroke Day will be observed on February 28. The National Stroke Association of Sri Lanka declared National Stroke Day in 2001-their main goal being promoting stroke awareness among Sri Lankans and convey the message that it is not only treatable if diagnosed early but also that it is no longer a disease of the elderly.
In an interview with the Sunday Observer President National Stroke Association of Sri Lanka, Consultant Neurologist Dr. Harsha Gunasekara reiterated the importance of this year’s message and why it is so important to know that stroke is no longer a disease of the elderly.
Responding to our initial inquiry on the current data on stroke victims in Sri Lanka, he told Medi Snips, “ According to community studies in Sri Lanka, around 10 people per 1,000 fall victim of stroke.”
Asked how strokes are caused, he said, “Strokes are caused by a sudden disturbance of the blood supply to a particular area of the brain resulting in death or damage of the brain nerve cells. The mechanism is the same as with a heart attack. Thus stroke can be correctly termed a “brain attack”. It is estimated that 1.9 million nerve cells are destroyed every minute after a stroke and permanent damage could occur within a few hours. The lifetime risk of a person having a stroke has increased by 50% from one in six to one in four”.
Asked if there were different forms of stroke, he said, “There are two forms. One is caused by a sudden blockage of a feeding vessel of the brain. This is the commonest where 85 per cent of the cases reported are of this nature. Next is the rupture of a feeding vessel resulting in a brain bleed.”
Replying to our query on symptoms, he said, “Symptoms can vary depending on the area of the brain affected. These range from paralysis to loss of vision, numbness of body on one side, loss of balance, loss of speech and so on.”
On how to recognise symptoms he said, “ The easiest way to recognise such symptoms causing a stroke is to use the stroke scale called FAST. The letter F stands for facial drooping, A for arm weakness, S for disturbed or slurred speech and T is for time to recognise quickly and to dispatch the patient immediately to the hospital is crucial.
Prevention
Where prevention is possible, the focus should rest there. Explaining further, Dr. Gunasekara said stroke occurs as a result of multiple risk factors. There is no single cause. “There are four types of unhealthy lifestyle practices associated with stroke. Smoking, heavy alcohol use, unhealthy and poor diet which includes the consumption of fast food and processed food with a higher percentage of salt, sugar and fat. The fourth is lack of physical exercise, together which leads to obesity.”
He also said that in the not too distant past, Stroke was considered a disease of the elderly with advanced age as the most important non-modifiable risk factor. However, the latest global stroke fact sheet published by the World Stroke Organization in the International Journal of Stroke in 2022 shows that 16 percentof all stroke types and 23 percent of haemorrhagic strokes (“brain bleeds”) occur in the age group 15-49 years. Overall, 63 percent of all strokes occur in people less than 70 years of age. Only 37 percent of all strokes and 32 percent of brain bleeds occur in the age group over the 70 years,“ he said.
He said the report also shows that 15 percent and 57 percent of healthy life lost due to stroke related death and disability occurs in the age groups 15-49 years and under 70 years. Over a third (34 percent) of deaths due to stroke occur in people less than 70 years of age. 89% of global stroke deaths and disability combined occur in low and low-middle income countries like Sri Lanka. This is largely due to inadequacy of resources for acute stroke treatment in these countries.
Alarming feature
The most alarming feature that this report gives is the fact that up to 80% of strokes and heart attacks occur in people with a low or moderate absolute risk of cardiovascular disease. This stresses the need for everyone, irrespective of their risk status, to strictly adhere to the preventive measures.
Prevention
Focusing on prevention of stroke, the report highlights 10 key risk factors linked to stroke globally. The most important out of these is uncontrolled high blood pressure which accounts for 56 percent of all strokes. In the order of frequency of occurrence, the other risk factors are unhealthy diet (31 percent), high body mass index (24 percent), high fasting blood glucose levels (20 percent), air pollution (20 percent), smoking (18 percent), high LDL cholesterol levels (10 percent), kidney disease (8 percent), alcohol use (6%) and low physical activity (2 percent). Out of these, air pollution and kidney disease are new emerging risk factors compared to the previous reports of other traditional risk factors common to other non-communicable diseases, especially heart disease, cancer and dementia.”
What has the NSA of Sri Lanka done since its inception?
In reply to our query as to what the National Stroke Association of Sri Lanka has done since its inception to raise awareness on this disturbing health issue, he said, “The World Stroke Organization (WSO) leads many advocacy efforts through their membership, targeted efforts in low- and middle-income countries, and through the strong voice of affiliated Stroke Support Organizations such as National Stroke Association of Sri Lanka. Over the last 20 years, the association has carried out many campaigns on mass media and social media to educate the public on prevention of stroke and carried out advocacy for improvement of acute stroke care and stroke rehabilitation. The World Health Organization (WHO), non-communicable disease (NCD) unit of the Ministry of Health have been active stakeholders of islandwide stroke prevention campaigns currently being carried out. The public need to pay more attention to the risk factors applicable to them and adapt control measures effectively, irrespective of their risk status.
In his message to stroke patients Dr. Gunasekera said. “During this post-pandemic situation, they should take their medication regularly and adhere to their healthy lifestyle. If stroke symptoms occur, come to the emergency unit. All patients are screened for Covid-19 so, there won’t be unnecessary exposure. We see patients coming to the hospital late; missing the opportunity for urgent treatment. Statistics show that one in four survivors suffer another stroke. A second stroke can be disastrous and it should be prevented.”