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30 October, 2018 10:40:54 AM / LAST MODIFIED: 30 October, 2018 10:44:13 AM


Dealing with cerebrovascular disease

Stroke or cerebrovascular disease is the second leading cause of death worldwide, and more people die because of stroke than because of AIDS, tuberculosis, and malaria put together
Mohammed Abul Kalam, PhD
Dealing with cerebrovascular disease

The World Stroke Day (WSD) aims at reducing the burdenof stroke. Stroke(Cerebrovascular disease) is the second leading cause of death worldwide, andmore people die because of stroke than because of AIDS, tuberculosis, and malaria put together.

However, the heaviestburden incurred by stroke is not death but severe disability ofwhich stroke is the leading cause. The fact is that 1 in 6 people experience a stroke during his/her lifetime. Stroke is a common disorder. Every other second someone experiences a stroke and every sixth second someone dies of a stroke. Stroke spares no age, sex, ethnic origin, or country—it could be me or my  beloved one. Fifteen million people experience a stroke each year. Six million of them do not survive. About 30 million people have had a stroke –most have residual disabilities. A global stroke initiative is needed to reduce the enormous human suffering and costs incurred by stroke. We must fight the old nihilism that in stroke nothing can be done.
Stroke (also known as cerebrovascular disease) occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so it starts to die. The extent and location of the brain cell damage determines the severity of the stroke, which can range from minimal to catastrophic. Because different areas of the brain control different functions, the specific effects of a particular stroke depend on which area of the brain is injured. A small stroke in a critical area of the brain can be permanently disabling. Because brain cells do not regenerate, damage to the nerve cells is permanent. Millions of brain cells die each minute a stroke is untreated. Ruptured blood vessels cause hemorrhagic or bleeding strokes.

The panorama gets evendarker because 85% of all strokes occur in developing countries with limited resources for stroke care. This meansthat the majority of stroke patients do not have access tostroke unit care, rehabilitation, and evidence-based secondaryprevention. The most effective way to reduce the burden ofstroke is primary and secondary prevention, and we know therisk factors for stroke.

The first step in this war against stroke is a call to arms todistribute evidence-based information worldwide that strokecan be prevented and it is possible to recover from it, and themeans how to do it.

What we need to know about stroke/cerebrovascular disease? Cerebrovascular disease refers to a group of conditions that can lead to a cerebrovascular event, such as a stroke. These events affect the blood vessels and blood supply to the brain.If a blockage, malformation, or hemorrhage prevents the brain cells from getting enough oxygen, brain damage can result.Cerebrovascular diseases can develop in various ways, including deep vein thrombosis (DVT) and atherosclerosis, where plaque builds up in the arteries.

Stroke/Cerebrovascular disease, transient ischemic attack, aneurysms, and vascular malformations are all types of cerebrovascular disease.Other examples include a narrowing or blockage in the carotid, intracranial, or vertebral arteries, known as stenosis.

Here are some key points about stroke/cerebrovascular disease: (1) Cerebrovascular disease refers to a group of conditions that affect blood supply to the brain, (2) Early symptoms of a cerebrovascular attack include weakness and difficulty communicating, (3) Symptoms of a cerebral hemorrhage include a sudden, severe headache, and (4) A cerebrovascular event is a medical emergency.

Symptoms: The signs and symptoms of cerebrovascular disease or a cerebrovascular attack depend on where the blockage or damage occurs, and how much cerebral tissue is affected.Different events may have different effects, but common signs and symptoms include: (a) a severe and sudden headache (b) paralysis of one side (hemiplegia), (c) weakness on one side (hemiparesis), (d) confusion (e) difficulty communicating, including slurred speech (f) loss of half of vision (g) loss of balance, and (h) loss of consciousness.

The American Stroke Association urges the public to know the F.A.S.T. acronym as an aid to recognizing the warning signs of stroke:Face drooping, Arm weakness, Speech difficulty, and Time to call a medical emergency.Urgent medical attention is needed if anyone has symptoms of a cerebrovascular attack, because it can have long-term effects, such as cognitive impairment and dementia.

Causes: Stroke/Cerebrovascular disease happens for a variety of reasons.If damage to blood vessels in the brain leads to a cerebrovascular attack, there will be little or no blood supply to parts of the brain. No blood means no oxygen, and, without oxygen, the brain cells will start to die. Brain damage is irreversible. Emergency help is needed.

Atherosclerosis is one type of cerebrovascular disease. It occurs when high cholesterol levels, together with inflammation in the arteries of the brain, cause cholesterol to build up in the vessel as a thick, waxy plaque that can narrow or block blood flow in the arteries.This plaque can limit, or completely obstruct, blood flow to the brain. In time, this can cause a cerebrovascular attack, such as a stroke or a transient ischemic attack (TIA).

Types: Some common forms of stroke/cerebrovascular disease are stroke, transient ischemic attack (TIA), sometimes called a mini-stroke, and subarachnoid hemorrhage.An ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot or plaque. A clot, or thrombus, may form in an artery that is already narrow. A stroke happens when the lack of blood supply results in the death of brain cells.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. This puts pressure on the brain tissue, causing tissue damage. The hemorrhage can also cause a loss of blood supply to other parts of the brain.An aneurysm or a subarachnoid hemorrhage can result from defects in the blood vessels of the brain. If a blood vessel ruptures, the flow of blood that follows can damage brain cells.

An embolism happens when a clot breaks off from elsewhere in the body and travels up to the brain to block a smaller artery. This may cause an embolic stroke. This is more common in people who have arrhythmias, such as atrial fibrillation.A tear in the lining of the carotid artery can lead to ischemic stroke in people aged less than 40 years. The tear lets blood flow between the layers of the carotid artery, narrowing the artery and reducing blood flow to the brain.

Risk factors: Stroke is the most common type of cerebrovascular event.It is more likely among males aged over 65 years, and especially if they or a close relative have previously had a stroke.Factors that increase the risk of stroke and other types of cerebrovascular disease include: (1) hypertension, or blood pressure of 140/90 mm Hg or above, (2) smoking, (3) obesity, (4) poor diet, and lack of exercise, (5)   diabetes, and (6) high blood cholesterol of 240 milligrams per deciliter (mg/dL) or over.

Some of these can be prevented by making healthful lifestyle choices.The same factors increase the risk of a cerebral aneurysm, but this can also happen to younger people with a congenital defect, or following a head trauma.

Diagnosis: Any cerebrovascular event is a medical emergency and must be contacted for evaluation and support.A brain scan can show damage to blood vessels and reveal which areas of the brain are affected.At the hospital, a physician will ask about the patient's medical history and look for specific neurological, motor, and sensory deficits, such as changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes.

A cerebral angiography, vertebral angiogram, or carotid angiogram may be used. Dye that is injected into the arteries can reveal any clots and show up their size and shape.A CAT scan can help diagnose and detect hemorrhagic strokes, because it can distinguish between blood, bone, and brain tissue. However, it cannot always reveal damage from an ischemic stroke, especially in the early stages.An MRI scan can detect strokes, including in the early stages.An electrocardiogram (EKG or ECG) can detect cardiac arrhythmia, a risk factor for embolic strokes.

Prevention: Ways to reduce the risk of cerebrovascular disease include: (1) not smoking (2) getting regular physical exercise (3) eating a low-fat diet (4) maintaining a healthy weight (5) controlling blood pressure, and (6) lowering blood cholesterol with diet and medications if necessary. Individuals with heart arrhythmia should ask their doctor if they should be taking a blood thinner to prevent strokes.

Stroke and other cerebrovascular events can be fatal, but with rapid medical attention, a full or partial recovery is possible. People with cerebrovascular disease should follow healthy lifestyle tips and their doctor's instructions to reduce the chance of an attack.All of these disorders can be diagnosed and there are treatments available for most of them.

The writer is former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh

E-mail: med_sociology_iedcr@yahoo.com



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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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