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Detecting and dealing with strokes

  • Niken Prathivi

    The Jakarta Post

Jakarta | Wed, July 1, 2015 | 12:04 pm
Detecting and dealing with strokes The aftermath: More than two-third of stroke survivors will be left with some kind of disability, although others recover completely.(Courtesy of the US Center for Disease Control and Prevention)" border="0" height="367" width="511">The aftermath: More than two-third of stroke survivors will be left with some kind of disability, although others recover completely.(Courtesy of the US Center for Disease Control and Prevention)

Early detection and prompt treatment are the only way to deal with one the deadliest silent killers: stroke.

American radio and TV personality Dick Clark is perhaps one of the most visible celebrities to have suffered a stroke.

In 2004, he announced that he had type-2 diabetes, and later in the year he was hospitalized with a stroke, reported neuroaid.com. This is a very common side effect of diabetes, and it left Clark unable to host the New Year’s Eve party from Times Square that year.

Clark did return, but he struggled with dysarthria, difficult or unclear speech articulation, on his telecasts in subsequent years. However, his confidence never seemed to flag, and although he struggled to make himself clear to viewers, he continued his life’s work of entertaining millions until his death in 2012.

In Indonesia, model and TV presenter Egidia Savitri and comedian Tata Dado died of strokes in 2013. Egidia was 33 years old, while Tata was 47.

The US National Stroke Association defines stroke as a “brain attack”. It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die, abilities controlled by that area of the brain, such as memory and muscle control, are lost.

How a person is affected by their stroke depends on where the stroke occurs in the brain and the extent of the damage. For example, a minor stroke may only cause problems such as temporary weakness in a limb.

Courtesy of Heart and Stroke Foundation of CanadCourtesy of Heart and Stroke Foundation of Canad

Major strokes, however, can cause permanent paralysis to one side of the body, or greatly impair speech. Some people recover completely from strokes, but more than two-thirds of survivors are left with some kind of disability.

Indonesian neurologists strove constantly to raise awareness of strokes among the public for several reasons, said neurologist Puspasari

“Twelve of every 1,000 people had a stroke in 2014, according to the Indonesian Health Ministry. In 2011, the ministry revealed that one out seven stroke patients died. In the previous year, strokes were the most fatal illness. Strokes also cause physical dysfunction.

“Nevertheless, 80 percent of strokes can be avoided by handling risk factors,” said Puspasari, an intervention team member at Bethsaida Hospital in Tangerang, Banten.

Risk factors include lifestyle (diet and nutrition, physical activity, tobacco use and smoking and alcohol use) and medical issues (high blood pressure, high cholesterol, diabetes, circulation problems and carotid artery diseases).

“Gender, race and ethnicity and family history are also risk factors,” said Puspasari.

Women, she went on, were more at risk of strokes because of hormonal and psychological problems. “Moreover, women tend to live longer, and strokes are caused by old age.”

High rate of success: The digital subtraction angiography (DSA) device can be used for both diagnostic and interventional angiography and is claimed to have a 90 percent success rate at detecting strokes.(Courtesy of Siemens)

The aftermath: More than two-third of stroke survivors will be left with some kind of disability, although others recover completely.(Courtesy of the US Center for Disease Control and Prevention)

Early detection and prompt treatment are the only way to deal with one the deadliest silent killers: stroke.

American radio and TV personality Dick Clark is perhaps one of the most visible celebrities to have suffered a stroke.

In 2004, he announced that he had type-2 diabetes, and later in the year he was hospitalized with a stroke, reported neuroaid.com. This is a very common side effect of diabetes, and it left Clark unable to host the New Year'€™s Eve party from Times Square that year.

Clark did return, but he struggled with dysarthria, difficult or unclear speech articulation, on his telecasts in subsequent years. However, his confidence never seemed to flag, and although he struggled to make himself clear to viewers, he continued his life'€™s work of entertaining millions until his death in 2012.

In Indonesia, model and TV presenter Egidia Savitri and comedian Tata Dado died of strokes in 2013. Egidia was 33 years old, while Tata was 47.

The US National Stroke Association defines stroke as a '€œbrain attack'€. It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die, abilities controlled by that area of the brain, such as memory and muscle control, are lost.

How a person is affected by their stroke depends on where the stroke occurs in the brain and the extent of the damage. For example, a minor stroke may only cause problems such as temporary weakness in a limb.

Courtesy of Heart and Stroke Foundation of CanadCourtesy of Heart and Stroke Foundation of Canad

Major strokes, however, can cause permanent paralysis to one side of the body, or greatly impair speech. Some people recover completely from strokes, but more than two-thirds of survivors are left with some kind of disability.

Indonesian neurologists strove constantly to raise awareness of strokes among the public for several reasons, said neurologist Puspasari

'€œTwelve of every 1,000 people had a stroke in 2014, according to the Indonesian Health Ministry. In 2011, the ministry revealed that one out seven stroke patients died. In the previous year, strokes were the most fatal illness. Strokes also cause physical dysfunction.

'€œNevertheless, 80 percent of strokes can be avoided by handling risk factors,'€ said Puspasari, an intervention team member at Bethsaida Hospital in Tangerang, Banten.

Risk factors include lifestyle (diet and nutrition, physical activity, tobacco use and smoking and alcohol use) and medical issues (high blood pressure, high cholesterol, diabetes, circulation problems and carotid artery diseases).

'€œGender, race and ethnicity and family history are also risk factors,'€ said Puspasari.

Women, she went on, were more at risk of strokes because of hormonal and psychological problems. '€œMoreover, women tend to live longer, and strokes are caused by old age.'€

High rate of success: The digital subtraction angiography (DSA) device can be used for both diagnostic and interventional angiography and is claimed to have a 90 percent success rate at detecting strokes.(Courtesy of Siemens)High rate of success: The digital subtraction angiography (DSA) device can be used for both diagnostic and interventional angiography and is claimed to have a 90 percent success rate at detecting strokes.(Courtesy of Siemens)

There are two types of stroke: hemorrhagic and ischemic.

Hemorrhagic strokes are less common. In fact, only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths. A hemorrhagic stroke is either a brain aneurism or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain.

Meanwhile, ischemic strokes occur when a blood vessel carrying blood to the brain is blocked by a blood clot.

This prevents blood from reaching the brain. High blood pressure is the most important risk factor for this type of stroke. Ischemic strokes account for about 87 percent of all strokes.

Besides these two types of stroke, there are also transient ischemic attacks (TIA), which occur when blood flow to part of the brain stops for a short period of time. It can mimic stroke-like symptoms, but which disappear in less than 24 hours. While TIAs generally do not cause permanent brain damage, they are a serious warning sign that a stroke may happen in the future and should not be ignored.

'€œShould you experience stroke symptoms, such as a severe headache with no known cause; trouble seeing in one or both eyes; trouble walking; dizziness, loss of balance or coordination; confusion, trouble speaking or understanding; or numbness or weakness of face, arms or legs, especially on one side of the body, you should go immediately to the nearest hospital,'€ said Puspasari.

To detect and treat strokes, a high-tech new technique called a digital subtraction angiography (DSA) is available in several hospitals in Indonesia, including Bethsaida.

DSA is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using a contrast medium by subtracting a precontrast image or the mask from later images, once the contrast medium has been introduced into a structure.

'€œDSA is a gold standard for arterial imaging,'€ said radiologist Jacub Pandelaki of Bethsaida Hospital.

DSA can be used for both diagnostic and interventional angiography. The technology'€™s high spatial and temporal resolution make DSA a very important tool.

In a DSA, a patient is catheterized, usually via the common femoral artery in the groin. Wires, catheters, clot retrieval devices, stents and aneurysm coils can be passed to the vessel of interest with this access. Iodinated contrast can be injected into a catheter and observed with fluoroscopy, causing the vessel to appear dark relative to its surroundings.

Jacub said that a DSA, which costs up to Rp 25 million (US$1,874) per session, had an up to 90 percent chance of success in detecting strokes. The procedure, however, can only be done with medical indications.

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