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When managing stroke, time is brain!

<p></p><p><span style="font-family: helvetica;">If you experience a sudden onset of a headache, dizziness, speech difficulty, drooping of one side of the face, weakness on one side of the body and loss of balance, you may be having a stroke.</span></p><p><span style="font-family: helvetica;">A stroke occurs when the blood supply to a part of the brain is interrupted, or reduced, preventing brain tissues from getting oxygen and nutrients. This may be due to a clot or bleeding. When blood flow cannot reach a particular region of the brain that controls a specific body function, that part will not work properly. For example, moving of one hand can be difficult.</span></p><p><span style="font-family: helvetica;">A person can suffer from a major stroke which causes a severe outcome to certain parts of their body, or a minor one which causes damage that can be reversed by the help of quick medical intervention. </span></p><p><strong style="font-family: helvetica;">What are the risk factors for stroke?</strong></p><p><span style="font-family: helvetica;">Although many patients diagnosed with stroke are older adults, strokes can occur at any age. There are many factors that can increase a person&#39;s chances of getting a stroke.  These include:</span></p><ul><li><span style="font-family: helvetica;">Trauma e.g. from an accident or a fall </span></li><li><span style="font-family: helvetica;">Being overweight </span></li><li><span style="font-family: helvetica;">Excessive consumption of alcohol</span></li><li><span style="font-family: helvetica;">Smoking cigarettes</span></li><li><span style="font-family: helvetica;">High blood pressure and cholesterol
</span></li><li><span style="font-family: helvetica;">Diabetes, or cardiovascular diseases</span></li></ul><p><strong style="font-family: helvetica;">Are there warning signs days before a stroke?</strong></p><p><span style="font-family: helvetica;">The signs of a stroke often appear suddenly. However, some people experience symptoms such as headache, numbness or tingling several days before they have a serious stroke.</span></p><p><strong style="font-family: helvetica;">What is a ministroke?</strong></p><p><span style="font-family: helvetica;">A ministroke occurs when part of the brain experiences temporary lack of blood flow. Unlike a full blown stroke, pre-stroke or mini strokes only last a few minutes and does not cause permanent damage. One experiences the symptoms of stroke for this period. Nevertheless, it is a warning sign that a possible stroke may be coming in the future and it is therefore important to seek immediate medical care. </span></p><p><strong style="font-family: helvetica;">What is a silent stroke?</strong></p><p><span style="font-family: helvetica;">A silent stroke refers to a stroke that doesn&#39;t cause any noticeable symptoms. Most strokes are caused by a clot or a bleeding that blocks a blood vessel in the brain. But sometimes, the area of damage is quite small and occurs in a part of the brain that doesn&#39;t control any vital functions, so the stroke remains undetected. </span></p><p><strong style="font-family: helvetica;">How fast should I be seen if I experience signs of stroke?</strong></p><p><span style="font-family: helvetica;">People who experience the signs of stroke are advised to go to the nearest hospital immediately. It is also critical that patients receive the right care by well-trained clinicians. At Aga Khan University Hospital, Nairobi (AKUH,N) we have put in place a standardised clinical pathway which is followed by all our clinicians when a patient who has suffered a stroke comes to us. Our standard is benchmarked against the American Heart Association. In recognition of these standards, the Hospital, has been accredited as a Centre of Excellence for the management of Acute Primary Stroke by Joint Commission International (JCI), the recognised global leader in health quality standards. </span></p><p><strong style="font-family: helvetica;">What is the standard care for patients suffering stroke?</strong></p><p><span style="font-family: helvetica;">Research has found out that patients have better outcomes when they receive care within 4 hours from the onset of the symptoms of stroke. </span></p><p><span style="font-family: helvetica;">When a stroke patient gets to a hospital, they should immediately inform the nurse at the casualty section of their symptoms for them to be attended to immediately.  At AKUH,N a stroke patient is fully assessed by an Accident &amp; Emergency doctor within 10 minutes of arrival. A brain scan is done and reviewed within 45 minutes of arrival. If there is a blood clot causing the stroke, a clot-busting drug is administered to help re-establish blood flow to that part of the brain and improve chances of recovery. This is done within 60 minutes of arrival. Sometimes the clot may be too big, requiring to be removed mechanically within 75 minutes of arrival, a procedure called mechanical thrombectomy which in Kenya is provided routinely only at AKUH,N by a fully trained vascular neurosurgeon interventionist.</span></p><p><strong style="font-family: helvetica;">Is a stroke reversible?</strong></p><p><span style="font-family: helvetica;">The effects of a stroke can cause temporary, or permanent disabilities depending on the extent of the damage.  However, the health outcomes for stroke patients are different depending on the time between the onset of symptoms and care, the level of care and rehabilitation received, other underlying conditions among other factors. </span></p><p><span style="font-family: helvetica;">In the past, there were no treatments available to reverse stroke, but now the situation has changed dramatically over the last decade and treatments are available that can restore stroke patients to a better level of function and minimise disability. Some stroke patients have even been reversed back to normality within hours.</span></p><p><span style="font-family: helvetica;">Rehabilitation is also part of stroke treatment. This includes speech, physical and cognitive therapies and relearning sensory skills. Early action and effective treatments can help prevent brain damage and other complications caused by a stroke. </span></p><p><em style="font-family: helvetica;"><strong>By Dr Margarita Mwai, Head of Accident and Emergency, Aga Khan University Hospital, Nairobi​</strong></em></p>

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