Global Health Asia-Pacific September 2022 September 2022 | Page 159

How do I know if this is a stroke ? What can be done ?

This article aims to refamiliarise the reader with stroke care . The first step is of course getting the diagnosis correct .
The symptoms of stroke include : 1 ) Weakness of the limbs ( arms or legs ), with our without face ‘ drooping ’ 2� Speech di�culty or slurring 3 ) ‘ Blurred ’ vision 4 ) Dizziness ( that is not ‘ isolated ’ i . e . the dizziness is associated with one of the symptoms listed above ).
The use of acronyms like “ FAST ” ( Face drooping , Arm weakness�numbness , Speech di�culty , Time to act !), “ BEFAST ” (“ Balance , Eyes , Face , Arms , Speech , Time ”) is catchy and helps to create public awareness . The down side is that the described symptoms are not specific to stroke and may be caused by many other diseases .
So the first important step is for the patient to get to a doctor early , so treatment can start within 4 1 / 2 hours from the onset of symptoms . The doctor will do what is needed to establish an accurate diagnosis . This includes listening to the patient , examining the patient and a computerised ‘ brain scan ’ ( cranial CT scan or MRI ).
If it is indeed a ‘ fresh ’ stroke , and the cause is bleeding in the brain , the patient is cared for by a neurosurgeon primarily . If it is an ischemic stroke ( i . e . blocked blood vessel ), the treatment is determined by a few factors , one of the most important being the time that has lapsed since stroke started .
If treatment can be started within 4 1 / 2 hours , injection of a clot buster (“ rTPA ”) helps many patients recover well , though there are real risks so the patient warrants careful close monitoring . In some specialised centres , the clot within the artery can be retrieved using intra-arterial catheters .
The path to recovery after a stroke includes measures to prevent stroke recurrence . Though tablets are important ( for example ‘ anti-platelets ’ or ‘ anticoagulants ’ in some ), the role of committed sustained improvement in lifestyle cannot be over stressed . Patients who smoke should stop smoking , immediately ! Be it traditional cigarettes , electronic cigarettes , cigars or pipes ! It is amazing how good people are prepared to pay to buy disease , when they buy cigarettes !
There are many options in dietary care and it is well worth spending time with a dietician / nutritionist to optimise the patient ’ s diet . Rehabilitation therapy in all its components , namely physiotherapy , occupational therapy , speech therapy play an important role in optimising recovery . The Rehabilitation Physician is ideally suited to ensure this . Regular exercise , stress management , lifestyle modification and other measures are all beneficial� it is best the patient and family discuss these with the attending neurologist .
The spectrum of outcome in stroke survivors can vary from full recovery to challenging scenarios of persisting neurological deficits . Achieving best outcome re�uires super early treatment and a partnership between the patient , the patient ’ s family , the attending doctors and supportive medical�health staff .
Dr . Haniffah B . Abdul Gafoor Consultant Neurologist
If it is indeed a ‘ fresh ’ stroke , and the cause is bleeding in the brain , the patient Is cared for by a neurosurgeon primarily .
GlobalHealthAsiaPacific . com OCTOBER 2022
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