Stroke is a fairly common problem which usually has very profound consequences on the life of a victim and it can be fatal.

It is a life-changing kind of condition and the recovery from it among those who survive can be long and difficult. A stroke occurs due to a reduction in the blood supply to the brain or due to a blockage of the blood supply.

The problem can develop slowly over a period of time or it can happen suddenly. Any person suffering from a stroke requires immediate treatment. Many of us have probably heard of or been witnesses to situations in which a stroke has struck an individual while performing a public duty.

Sometime early in this year, there was a viral video of an individual who was dancing at some public function when he suffered from such an attack and fell to the ground where he began to have a seizure which people mistook as part of the dance and failed to rush over to his aid.

There have been people speaking in public when they suddenly fell to the ground or gradually did so as they lost power in their limbs to such an extent that they were unable to stand. Personally, one has witnessed such a thing at a wedding reception where the chairman of the reception slumped suddenly and had to be rushed to a nearby hospital. In the same way, one has been involved in the early management, as a young medical officer, of a middle-aged gentleman who was alone in his car as it swerved off a road in the Palmgrove area of Lagos and fell into an open drain. In some cases, very serious lone accidents have occurred when similar events happened to people who were driving at high speed on any of the nation’s highways.

It is estimated that strokes occur an average of once every 40 seconds around the world. However, doctors have made a great deal of progress in the management of this problem of which there are different types. We shall look at these different types and see how they are brought about. By doing so, we will also develop some ideas about how to prevent them.

There are three major types of stroke.

The first is the ischaemic stroke which happens when a blood clot forms at a point in the brain such that both blood and oxygen are prevented from reaching an area of the brain supplied by the branches of that blood vessel.

Ischaemic stroke is the most common type of stroke and affects more than 80 per cent of all stroke victims. If you will recall when we discussed what the consequences of deep vein thrombosis are on this page, you would remember that this event was one of the end results of that condition.

The second type of stroke is the haemorrhagic stroke which results when a specific blood vessel ruptures and causes blood to escape into the brain. This occurs usually from an aneurysm or an arterio-venous malformation in which the wall of the vessel is weak at the site of the defect thus making it prone to a rupture much like when a tyre bursts.

The last type of stroke is called the transient ischaemic attack during which blood flow to a part of the brain is disrupted for some time before being fully restored.

The last type of stroke often resolves without treatment and is referred to by some people as a mini-stroke. Sometimes, a mini-stroke like this also called a TIA (transient ischaemic attack) may be the harbinger of a bigger kind of trouble on the way and a true stroke can often follow such an attack.

Many strokes these days are treatable when medical attention has been obtained promptly. Some others are likely to lead to life-changing problems and still others lead to death. Perhaps, those who end up with disabilities are the most difficult of all to handle because they then become so dependent on others that their own lives become something of a challenge.

In some other cases, relatives, unable to rely on any form of extension services which the hospitals ought to be able to offer, ultimately abandon their relatives. When this kind of neglect occurs, such people succumb to simple infections, disease and death.

The intensive kind of physical therapy which is so critical to getting such people back to some measure of independence is either not available or it is not sustainable often due to lack of funds and the patients are left to their fate.

Ischaemic stroke is fundamentally different from haemorrhagic stroke. The former happens because the blood vessels are narrowed or blocked. The latter happens because the vessels rupture like a burst water-pipe. The treatment of this condition has to focus on reducing the pressure on the brain by controlling the bleeding and stopping it.

The treatment must start with the use of drugs that will reduce the blood pressure, prevent convulsions from taking place and any sudden constrictions in the blood vessels. If a person is taking medications at this time that prevent clot formation or to break down clots, like warfarin, vasoprin or clopidogrel, they can be given medications to counter the effects of such drugs.

Pressure-relieving holes can be made into the skull by neurosurgeons to relieve pressure on the brain and stanch further bleeding. And if it is an aneurysm, they can do likewise to repair the damaged vessels. In the same way, if an ischaemic stroke is a problem, blood thinners like aspirin are administered and a medication such as tissue plasminogen activator (TPA) can then be given within 4-6 hours of the stroke happening to be effective.

There are other procedures that surgeons and interventional radiologists often perform to reduce the risk of strokes or of transient ischaemic attack. One such option is angioplasty in which a balloon is inserted into a blood vessel and inflated to widen a vessel enough to accommodate a mesh tube. This prevents that vessel from narrowing again.

A stroke is a condition that can have a lasting effect on a person. Successful recovery is not said to have taken place unless such persons have undergone adequate rehabilitation. Speech therapy, occupational therapy and physical therapy will all have to be engaged to restore as much independence as possible to the sufferer and help them to a great degree to return to a normal life.

If there are support groups that often aggregate similar victims together to share experiences, that is a wonderful place to put such an individual. In our communities, such amenities are hardly known and people have no choice but to depend on family and friends for the serious support that they might need.

Some other people develop such psychological disturbances that some kind of psychiatric support will also have to be engaged. Every such available hand often has to be on deck to provide all the support needed.

PUNCH