Dr. G. ARJUNDAS
The Regional Asian Stroke Congress and the First Indian Stroke Association Congress to be held in Chennai from January 5 to 8 will help create awareness about this crippling disease.
THE World Health Organisation (WHO) defines the clinical syndrome of stroke as rapidly developing clinical signs of focal (or global) disturbance of cerebral function with symptoms lasting 24 hours or longer or leading to death with no apparent cause other than vascular origin.
The global burden of stroke needs to be defined for both developing and developed nations. India will face an enormous socio-economic burden to meet the costs of caring for stroke victims. This is because the most affected in the age group 45 to 70 years are mostly the breadwinners of the family.
The awareness of multiple risk factors leading to a stroke is yet to reach the common man. Age, Hypertension, Diabetes, Cardiac disease, Previous history of stroke, Nicotine intake, dyslipidemia, Homocystcinemia are some of the known risk factors. The fact that oral contraceptives, hormone replacement therapy, anaemia, dehydration following diarrhoea can also precipitate a stroke is unknown to many.
Clinical research in stroke unit in Chennai has shown the following results:
Seventy eight per cent of strokes occur between 50 and 80 years. The commonest risk factor is hypertension (72 per cent). This is the most important risk factor, which can be prevented by a physician's prescription. Currently available anti-hypertensive agents can help achieve excellent control of hypertension.
Diabetes mellitus is associated in 30 to 50 per cent and Ischaemic heart disease is present in 33 per cent of stroke patients.
A combination of risk factors worsens the outcome of stroke patients. About 12 to 14 per cent of patients consume tobacco in various forms smoking or snuff or chewing with betel leaves.
Some risk factors are present in families. An awareness of the family's medical history can prevent, or at least postpone, the onset of risk factors like hypertension, diabetes, obesity, hyper cholesterol. Thus stroke incidence can be reduced.
With globalisation and mechanisation of our lives, our lives have undergone a rapid transition. Physical inactivity has led to obesity and sedentary lifestyles have added to the other risk factors.
"The thinking that doctors and hospitals are needed to keep the society healthy is plain rubbish" said Australian Nobel Prize winner MacFarlane Burnett. Every individual should be responsible for his own physical, mental, social and spiritual well-being and for prevention of disease. There are over one billion overweight individuals according to the WHO estimate and the incidence is increasing in developing countries.
In India we need to develop stroke prevention strategies. Public awareness and health education on warning symptoms and risk factors is vital. Mass screening to identify stroke-prone individuals and families should be undertaken to prescribe simple, practical, non-costly remedies. Co-ordinating and sustaining stroke prevention programme at the national level is essential.
Recent developments have enabled doctors to save brain cells if patients reach the hospital within three hours of an attack. "Time is brain" is the present password to minimise disability with prompt treatment. Costs are high but with increase in awareness and demand treatments may become affordable to the common man.
The Regional Asian Stroke Congress and the First Indian Stroke Association Congress is endorsed by the International Stroke Society and the World Stroke Federation. It will also include a workshop on craniometric vascular sonology. A panel of experts from Asia, Australia and Europe will provide their expertise and inputs throughout these four days.
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