Stroke-struck, but unaware

Blockages in arteries feeding the brain are a leading cause of stroke, which is the third biggest killer after heart disease and cancer, writes Sanchita Sharma.

Stroke is the third largest killer in India but you seldom hear of people dying from it. The reason is not hard to find: stroke is rarely diagnosed and treated. Though the word ‘stroke’ is medically used to describe a brain attack, most people continue to use the term interchangeably with heart attack, with often fatal results.

When Madhushree Sengupta, 56, collapsed at home last month, her family assumed it was a heart attack and immediately took her to a heart hospital. “She cannot have had a stroke, no one has had a stroke in our family,” was her son Debu’s reaction when told that blockages in the arteries in Madhushree’s brain were the problem, not the ones in her heart.

“Most people associate only paralysis with stroke and do not realise that a stroke can be characterised by symptoms as mild as dizziness just lasting a couple of seconds. If a person is taken to a doctor after a ‘mini’ stroke — called a transient ischemic attack or TIA — a major stroke in the future and its resulting disability can be prevented,” says Dr Pushpendra Renjen, senior consultant, Indraprastha Apollo Hospital.

The most common type of brain attack is ischemic stroke, which is caused by a blockage in one or more arteries that supply the brain. As in cardiovascular disease, the blockage happens when a blood clot (thrombus) or a fatty deposit (atheroma) breaks off and travels in the bloodstream, finally blocking an artery that supplies the brain. “Blood clots form when a fatty deposit in the wall of an artery ruptures, narrowing or completely blocking the artery and stopping the blood flow. This starves the brain of blood and oxygen, leading to a stroke,” says Dr Ajay N Jha, director of Neurosurgery, Max Institute of Neurosciences. Ischemic stroke accounts for 80 per cent of stroke deaths.

The brain and heart have more in common than arterial blockages that trigger attacks. The big debate in neurological circles these days is whether to open arterial blockages with angioplasty using stents — medicated or otherwise — or with surgery. “Carotid artery blockages account for 25 per cent of all strokes. Results from the European Carotid Surgery Trial show that unlike surgery, stents do not lower future risk of stroke,” says Dr Renjen.

Dr Jha, however, says both methods have their advantages. “Each case is unique, but generally speaking, I would recommend surgery for healthy people and younger patients as it has proven results. Stents are, however, getting popular worldwide as they work for people with existing health problems such as heart disease or diabetes. It is also an option for those reluctant to undergo surgery, which leaves a scar in the neck close to the Adam’s apple,” says Jha.

It is vital to identify and treat stroke to minimise brain damage and disability. “Awareness is low even among first-level clinicians, which is a major reason why patients often reach specialists too late,” says Dr Renjen.

Previous TIAs are a good predictor of future stroke, with as many as 23 per cent people with ischemic stroke having had TIAs in the past. That apart, the risk factors for stroke are similar to those for heart disease and include diabetes, smoking, heart disease, low activity levels, high blood pressure and high cholesterol. Compared with the general population, stroke risk is double for people with type 2 diabetes, reports the latest issue of the journal Stroke.

“People with more than one risk factor should get screened for stroke adopt preventive strategies such as healthier diets, exercise, statins to lower cholesterol, blood-thinners like aspirin, and medicines to control blood pressure,” says Dr Renjen.

Carotid Doppler test and MRI can help to detect stroke risk at an early stage. “MRIs are expensive, but the Carotid Doppler can detect a blockage very accurately,” says Dr Renjen.