Acute ischemia attack (brain stroke)

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BETTER TO PREVENT THAN TO CURE

Sudden blunt or weakness of one side of body, difficulty in speech, bad eyesight, dizziness, strong headache, sickness – these are beginning of disorder pointing to AIA

DATA in Serbia show that in 2003 the most common cause of death in women was acute ischemia attack. In addition, the threatening fact is that this neurology disease with highest level of invalidity – even 20-30 % of survivors are not able for independent life. Calculations show that medical treatment costs, rehabilitation costs and several years absence costs make to the state expenses 60 to 230 thousand dollars. That tells us the community, medical experts and individuals shall more and more pay attention to this topic.

Even more, this is a disease followed by many mistaken opinions. Unfortunately, it is often mistake to thin that this disease hits elderly population, while the practice in last 20 years shows it happens to the population younger than 45. People should know that modern lifestyle contributes a great deal to it. Risk factors that people can try to avoid are smoking, obesity, fats in blood, physical inactivity, alcohol... Therefore, in order to prevent stroke, first we have to know what it is and how to diminish risk factors in order to avoid undesirable consequences.

What is acute ischemia attack?

Acute ischemia brain stroke (AIA) is defined as focal or global disorder of brain function that appears suddenly, lasts more that 60 minutes and is caused by disordered brain circulation or state in which blood transport is not sufficient for satisfactory metabolic needs of nerve cells for oxygen and glucose.

What is a transit ischemia attack or TIA?

Transit ischemia attack (TIA) is a short episode of neurology disfunction that lasts up to 60 minutes. It is caused by insufficient supply of oxygen and glucose in some parts of brain or eye retina, and in diagnostic method of scanning brain (CT<MR) the acute brain stoke is not registered. It can show the same symptoms as a real brain stroke, while for transit attack it is characteristic to have sudden weakening of eyesight sharpness or complete loss of eyesight on one eye. Diagnostic procedure for TIA is the same as for AIA. Persons who had TIA risk 17 times more having AIA (immediately after TIA and in the period of following month) compared to those without these TIA episodes.

Some numbers about acute ischemia attack

Data in Serbia show that out of total number of lethal outcomes in 2003, AIA was the first cause of death in women (12,44% men and even 18,38% women), and in 2002, the first cause of death in hospital conditions. Apart from high mortality rate there is also very serious fact that this disease has the highest rate of invalidity. It is estimated that about half of survivors return to some sort of employment, while 20 to 30 % are unable for independent life and 16% end in institution for health care. The disease drastically changes quality of life within the family and it represents a huge financial burden for the community as it is calculated that the treatment of one AIA patient in the course of his/her life (including hospitalization, rehabilitation, absence from job) makes between 59.800 to 230.000 US dollars.

What are risk factors for AIA (stroke)?

Brain stroke risk factors include two types – those that can be modified and avoided, and those which cannot. Those not changeable are: sex, age, racial and ethnical origin and genetic inheritage factors. Scientific researches have showed that men are more hit by AIA than women in all age groups, but the lethal outcome is more frequent in women. Concerning age, it is proved that the frequency of AIA is significantly higher with the older age, and the risk is doubled in each new decade of life after the age of 55. Black people have double risk of AIA than the whites. There are also data about the existing AIA in some of family members that increase the risk of its appearance in other members of that family.

Risk factors for AIA  include: high blood pressure, diabetes and disorders of sugar level regulation, smoking, increased level of fats in blood, heart diseases, among which especially: fibrillation of preventricle, dilatative cardiomiopathy, artificial valvules, other disorders of hearth valves, then obesity, physical inactivity, alcohol misuse, increased level of homocisteine in blood, the use of oral contraceptives.

Persons with artery hypertension have three times more risk for AIA, as the frequency of AIA is increased with the increase of systole and diastole blood pressure, while the therapy  for hypertension reduces the AIA risk for 36 to 42%. Frequency of AIA is increased proportionally with increased levels of sugar in blood and the risk is double in diabetes patients. Smoking increases the risk for 50% both in women and men in all age groups. Quitting smoking reduces the risk as for regular population between 2 and 5 years. Correction of disorder in metabolism of fats in blood, reduces the risk for 20 to 30 %. It is estimated that persons with any systematic or asymptomatic hearth disease have twice more chance for AIA compared to those with healthy hearth. Fibrillation of preventricle  is very significant risk factor, as it is responsible for almost 50% in case of AIA.

How to decrease the risk of first brain stroke?

  • Blood pressure should be kept in normal values (<140/<90 mm Hg, or <135/80 mm Hg in diabetics) by change of lifestyle or by medicines.
  • Although it has not been proved that strict control of glykemia in diabetics is related to decreased risk of AIA, it should be insisted on in order to avoid other complications.
  • Medicines for decreasing the level of cholesterol (statines) are recommended for patients in high risk.
  • Quit smoking.
  • Stop consuming exaggerated use of alcohol (more than 2 drinks for men and 1 for women), while moderate drinking can have protective effect in AIA prevention
  • It is recommended to practice regular physical activity (fast walks: 15-20 min. for 1600 m, jogging, and bicycle riding, aerobic).
  • Diet with less salt (less than 6 g daily), rich in good fats, fruit, vegetables, more than 400 g daily).
  • Persons with increased (“body mass index”) should introduce diet under medical control.
  • Hormone substitution therapy (estrogen/progesterol) should be avoided in prime AIA prevention

    

What should be done when first symptoms occur?

The most important for persons with such symptoms is to go doctor AS SOON AS POSSIBLE. In case of brain stroke it is said “Time is life”, because those patients who manage to be transported to specialized institutions for treatment of AIA, do have significantly more chances for better outcome. Today in this country, there are special units for brain stroke treatment, i.e. thrombolic therapy whose aim is to dissolve the thromb which blocked the blood vessel in brain and caused AIA.

How to decrease repeated brain stroke?

Medically, AIA has the tendency of repeating and the rate of repetition is 4 -14 % a year. Generally, it is most often repeated in first 30 days from the first one and the percentage is 30%. More than 50% of survivors have some invalidity. Repetition of AIA can lead to vascular dement ion and cause demention in elderly people. So, secondary prevention is very important. The most important in secondary prevention is prevention of arthrosclerosis risk, so quit smoking, control blood pressure, body weight control, control of sugar in blood, as well as use of anti-thrombic medicines as aspirin. These are also prevention steps against the risk of coronary ischemia disorders.

WHO CAN GET BRAIN STROKE?

This is a disease followed by many mistaken opinions. Unfortunately, it is often mistake to think that this disease hits elderly population, while the practice in last 20 years shows it happens to the population younger than 45. People should know that modern lifestyle contributes a great deal to it. Risk factors that people can try to avoid are smoking, obesity, fats in blood, physical inactivity, alcohol... Therefore, in order to prevent stroke, first we have to know what it is and how to diminish risk factors in order to avoid undesirable consequences.

ASPIRIN

Consuming aspirin does not prevent first AIA, different from hearth infarction, but it is advised to the patients with more risk factors for AIA. Other antiagregation medicines in combination with aspirin are not recommended in primary prevention. Anticoagulation medicines are recommended for patients with potential source of embolus in hearth, and these are patients with atrial fibrillation and artificial hearth valvules.

 ALARM

What are the signs of brain stroke?

These are most frequent signs of AIA:

  • SUDDEN blunt or weakness of one side of body, face, leg or arm on one side of body.
  • SUDDEN confusion, difficulty in speech and difficulty in understanding.
  • problems with eyesight in one or both eyes.
  • problems with walking, sense of lost balance, dizziness and problems in coordination of movement.
  • SUDDEN and very strong headache followed by sickness, vomiting and consciousness disorders

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