Stroke has over the years become the second cause of disability and death worldwide. World Stroke Day is observed on 29th October every year. The message of this year‟s World Stroke Day is “Join The Movement” It indicates that one in 4 of us could have a stroke. Being active reduces our risk of having a stroke. This is the time to reiterate and reinforce the need for solutions to treat acute stroke patients timely to reduce disability and prevent further strokes.
Burden of stroke affects more the individuals from resource-poor countries where there is scarcity of essential services like swift and specialized treatment, prevention and rehabilitation. Incidence of stroke varies in different countries. In India, the estimated incidence is about 120-145/100,000 population. After a stroke, 20-40% of them die within one month and 30-50% are left with moderate to severe disability. Stroke burden affects not only the individual but the family and society as well and has a huge economic underpinning and hence the importance of early recognition and treatment.
Stroke may be caused by either a blockage of a blood vessel (also known as an Ischemic stroke) or rupture of a blood vessel causing bleeding in the brain (also known as intracerebral hemorrhage). Recognition of stroke in the early stage and its treatment will reduce the morbidity and mortality. FAST (Face, Arm, Speech, Time) mnemonic will help to remember the early signs of stroke. A sudden onset of weakness or loss of sensation of one half of the body, slurring of speech, loss of vision, unsteadiness of gait or loss of consciousness may be the early symptoms of a stroke. It may also leave patients with residual disabilities like difficulty in understanding and speaking, depression, seizures and physical dependence.
Timely treatment is extremely essential for improving outcomes after a stroke. In an ischemic stroke, the clot in the blood vessel in the brain can be dissolved using injectable medications (known as thrombolysis), if presented within 4.5 hours of onset of symptoms.
In eligible patients, a procedure called mechanical thrombectomy is performed to remove the blood clot using a device that it inserted through a blood vessel to reach the location of blockage in the brain. Patients with brain hemorrhage can be treated by reducing the blood pressure and pressure within the skull using medications and surgery. Overall mortality of stroke is 20-40%. After the treatment of acute stroke, the patient should undergo rehabilitation which includes physiotherapy, speech therapy and occupational therapy for a speedy recovery and for improving the quality of life.
Stroke management needs a multi-disciplinary approach that is not limited to neurology. There are not enough neurologists in the country and hence general practitioners need also be trained in stroke medicine. The training of the physicians is now being done by neurologist in few states, but we need to do this at a national level and equip them with expertise in the management of stroke too.
Awareness programme for the public and Continuing Medical Education (CME) programmes for doctors, nurses and paramedics should be organised across the country. Both the Central and state governments should initiate projects and programmes to provide facilities for acute stroke management in all medical colleges and district hospitals at the earliest. The only specific treatment available for stroke is thrombolytic therapy which is expensive. There are few states in India where this drug is given free. There is an urgent need to make this thrombolytic lifesaving drug free in all states of India. The current cost of mechanical thrombectomy devices is unaffordable to majority of the people. To increase the chances of more people receiving this treatment, we need to have restriction imposed on cost of „stentrievers‟ for acute ischemic stroke therapy similar to cardiac stents. There is an urgent need to have endovascular thrombectomy centres in the government sector so that more patients can have avail this treatment.
In the last few years, there is a major increase in the availability of basic stroke treatment facilities across the country in both government and hospitals and the dream is to have each and every patient with stroke to be treated in stroke units.
It would be a great idea if well equipped hospitals, start displaying signboards, saying they are „stroke-ready‟ similar to trauma care. There is a need to have equipped ambulance services, trained paramedical and nursing personnel, dedicated stroke units and rehabilitation facilities.
Ayushman Bharat, the world‟s biggest health insurance scheme which envisages providing government-sponsored health coverage for families based on income criteria, has been launched and such an initiative must be properly leveraged as an insurance cover for all aspects of treatment of stroke that affects both the urban and rural population.
This year the Indian Stroke Association [ISA] is organizing awareness campaigns and webinars with the intention of improving stroke awareness and reduce the stroke burden.