Something interesting happened this morning. After my usual early morning posts about the health benefits of cocoa, a colleague reminded me that today, October 29, is World Stroke Day. The theme for this year’s day is “Cut Stroke in Half” by 2030. The campaigns aims to reduce instances of stroke through an integrated prevention strategy.

World Stroke Day is observed every year on October 29 by the World Stroke Organization (WSO) to highlight the medical condition, raise awareness about the risks and to ensure better treatment (I have used a lot of materials from their website).The framework, developed by an international network of leading stroke clinicians and researchers, builds on strong evidence of impact in the prevention of stroke and circulatory disease.

Stroke is a medical condition, which causes the death of brain cells due to a lack of oxygen. It is caused due to either blockage of a blood vessel or bleeding in the brain.

The history of World Stroke Day dates back to October 29, 2004, when it was first established at the World Stroke Congress held in Vancouver, Canada. In 2006, a working group was formed and incorporated into a World Stroke Proclamation. Two organizations – the International Stroke Society and World Stroke Federation – merged to manage the day and its campaigns every year.

Stroke is an unpredictable health condition that can strike anyone, anywhere and at any time. It is a major cause of disability worldwide and the second-leading cause of death. Reports suggest, every year, around 14 million people are touted to have a stroke, out of which more than five million may die of the condition.’The latest data analysis shows that 1 in 4 of us will have a stroke in our lifetime, just 10 years ago that risk was 1 in 6.A key objective of World Stroke Day is to reduce instances of stroke and its burden on families and livelihoods.

Stroke can have different short- and long-term effects depending on which part of the brain is affected and how quickly it is treated. Survivors of stroke can experience wide-ranging disabilities including difficulties with mobility and speech as well, as how they think and feel. Fast access to treatment saves lives and improves stroke recovery.

There are two main types of stroke, ischaemic and haemorrhage. Ischaemic stroke occursas a result of an obstruction in a blood vessel supplying blood to the brain. An obstruction of blood flow in the blood vessel can cause a blood clot to form. Thisis called a cerebral thrombosis. The main cause of cerebral thromboses are fatty deposits in blood vessels and arteries (atherosclerosis). Blood vessels can also be blocked by a blood clot that has formed in another part of the body, usually the heart or large arteries of the upper chest and neck. Sometimes a portion of a blood clot breaks loose, enters the bloodstream and travels through the brain’s blood vessels until it reaches vessels too small to let it pass. This is called a cerebral embolism. The main cause of this kind of clot is an irregular heartbeat, known as atrial fibrillation (AF). 

A haemorrhagic stroke happens when a weakened blood vessel ruptures and bleeds into the brain. The blood builds up and creates pressure on the surrounding brain tissue. These bleeds can be caused by an aneurysm or an arteriovenous malformation (AVM).

A transient ischaemic attack (TIA)is caused by a temporary disruption in the blood supply to an area of the brain. It can cause symptoms similar to a stroke, but unlike a stroke these symptoms pass quickly and usually fully resolve within 24 hours.In the early stages of a TIA it is impossible to tell whether or not it is a stroke, so it is important to call emergency services.

People who have TIA are also at risk of further TIAs or a full stroke, so it is important that they see their health care provider for a review and treatment.The risk factors for TIA are similar to those for stroke. TIAs also contribute to an increased longer-term risk of dementia.

It is important to know the signs of stroke so as to arrange for early intervention. The first few hours of stroke are very critical. These signs have the acronym FAST. This means one should act fact. The first (F) is Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven or lopsided?

The second (A) is Arm Weakness:Is one arm weak or numb? Ask the person to raise both arms.

Does one arm drift downward? The third (S) is Speech:Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence. The fourth (T) is Time to call emergency services:If the person shows any of these symptoms, even if the symptoms go away, the emergency services should be called immediately.

Additional Symptoms of Stroke include: Sudden Numbness or weakness of face, arm, or leg, especially on one side of the body. Sudden Confusion, trouble speaking or understanding speech. Sudden Trouble Seeingin one or both eyes. Sudden Trouble Walking, dizziness, loss of balance or coordination. Sudden Severe Headache, with no known cause.

he warning signs for posterior circulation strokes include vertigo (like the room, is spinning),  imbalance,  one-sided arm or leg weakness, slurred speech or dysarthria, double vision or other vision problems, headache and nausea and or vomiting. Posterior circulations strokes (a stroke that occurs in the back part of the brain) occurs when a blood vessel in the back part of the brain is blocked causing the death of brain cells (called an infarction) in the area of the blocked blood vessel. This type of stroke can also be caused by a ruptured blood vessel in the back part of the brain. When this type of stroke happens several symptoms occur and they can be very different than the symptoms that occur in the blood circulation to the front part of the brain (called anterior circulation strokes).

There are risk factors associated with stroke. These include age, family history, prior stroke, TIA or heart attack. Other risk factors include high blood pressure (and other heart diseases such as atrial fibrillation, coronary heart disease), smoking, diabetes, diets high in saturated fat, diets high in calories, physical inactivity, excess body weight and sickle cell disease. These are clear indications for the consumption of polyphenol-rich cocoa.

Stroke remains the second leading cause of deaths globally, recording a 26% increase in stroke deaths between 1990 and 2010. In Africa and other LMIC, stroke and other non-communicable diseases have become a great public health concern as current evidence suggests such settings are disproportionately affected by the overall global burden of stroke (Daniels et al.The emerging global health crisis: noncommunicable diseases in low-and middle-income countries. Council on Foreign Relations Independent Task Force Report, vol. 72. 2014).Out of the estimated 5.9 million deaths linked to stroke worldwide in 2010, 71% were from LMIC settings. Furthermore, whereas high-income countries (HIC) show significant reductions in stroke incidence of about 42% over the last 40 years, a 100% increase in stroke incidence occurred in LMIC over the same period.

In Ghana, several studies have also confirmed an increasing stroke burden, with one month in-hospital case fatality as high as 41–43%. A study examining a total of 12,233 stroke admissions over a 30 years period (1983–2013)  found that 28 day mortality during the study period was 41.1% (Sarfo et al. Trends in stroke admission and mortality rates from 1983 to 2013 in central Ghana. J Neurol Sci. 2015;357). The US Centres for Disease Control and Prevention (CDC) has reported that stroke is the fourth cause of mortality in Ghana. As we mark the day let us all be reminded by the risk factors and the need to act FAST and seek early health care intervention.




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