Dealing with post-Covid stroke
The article has been authored by Dr Arvind Sharma, secretary, Indian Stroke Association.
When Covid-19 wreaked havoc on the mankind, the medical fraternity had not possibly anticipated the severe impact of the pandemic on the stroke or brain stroke, the second-most common cause of death worldwide. Around two million people in the 18-50 age group are estimated to experience stroke annually, and the number continues to rise alarmingly.
During the initial stages of Covid, strict lockdown measures had resulted in a large number of stroke patients unable to reach hospitals in the window period. What was particularly worrisome was the spike in ischemic stroke cases among the young. Besides the heart and lung, many young people developed clots in the brain. Luckily, biomarkers such as erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) gave treating doctors important clues about the magnitude of the stroke disease.
Things started improving only when the “don’t stay at home” campaign began in the later stages of Covid, the infection of which can also cause stroke. It was because of this reason that during the Covid times, Indian Stroke Association (ISA) had published guidelines on how to approach a stroke patient. The fact is India presents a worrisome picture with as many as 18 lakh stroke cases being reported every year. As much as 25% of these cases are reported from a young population.
Stroke is a sudden onset of symptoms which can strike a person who apparently looks fine. Unfortunately, few people know what a stroke is and how to recognise it when it happens. Rapid response during the critical ‘golden hour’ is crucial because stroke patients have a much greater chance of surviving and avoiding long-term brain damage if they arrive at the hospital and receive prompt treatment within that first hour.
According to a study by the American Heart Association, every minute that a stroke remains untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses, and seven miles of axonal fibres. With each passing hour without treatment, the brain loses as many neurons as it does in almost 3.6 years of normal ageing.
Besides being the second highest contributor to fatality, stroke is the third-most common cause of disability. The Indian Global Burden of Disease Study (1990-2019) has identified stroke to be the largest contributor to Disability Adjusted Life Years (DALYs).
Roughly, 85-88% of victims suffer ischemic stroke, which is the result of blockage of a blood vessel in the brain. There is a second variety: Haemorrhagic stroke, which is rarer, and is caused when a blood vessel ruptures in the brain, high blood pressure being the main cause.
Post-Covid, there is a heightened risk of ischemic stroke. We need to address this grave situation without any delay. The best way to do this is to mitigate the impact of the disease.
The ISA has been working ceaselessly to create awareness about the stroke and ways to mitigate its impact on individual health and performance. Every year it selects a key theme to accelerate its stroke management messaging to society. This year, its message for the World Stroke Day on October 29 is ‘Act FAST, Strike @ Stroke’.
We need to create widespread awareness among people on how to identify a stroke when a person experiences it. Knowledge about symptoms of a stroke and the rapid response needed are the key to saving lives. We need to drill into the minds of everyone the slogan ‘Act FAST, Strike @ Stroke’, where FAST is a protocol that everyone must know and Strike @ Stroke a veritable SOS operation that every individual must be ready to mount to save a life.
F stands for ‘Face’. Ask the patient to “show your teeth” and smile. A crooked smile is an indicator of stroke. A signifies ‘Arms’. Ask the patient to hold up both arms with palms facing skyward. Look to see if one arm drifts down or cannot be lifted. S denotes ‘Speech’. Slurred or garbled speech indicates a stroke, as does a strange giggle while talking. T stands for ‘Time’ to call emergency assistance. Also, never feed a suspected stroke victim anything as they may have trouble swallowing and may choke to death.
Though stroke remains a killer, continued medical advances are improving survival rates every year. The right care, if done right away and at the right time, can save lives and quality of life.
The article has been authored by Dr Arvind Sharma, secretary, Indian Stroke Association.
