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We need policies to reduce stroke attacks in Nigeria – Ogun


Yomi Ogun is a Professor of Internal Medicine/Neurology, Consultant Physician/Neurologist at the Lagos State University College of Medicine (LASUCOM)/Lagos State University Teaching Hospital (LASUTH). He told PAUL ADUNWOKE what government could do to minimize stroke among citizens

What is stroke?
Stroke is the sudden loss of function of a part of the brain, spinal cord or retina, eye, due to insufficient blood supply, resulting in weakness of the face, arm or leg, blurred vision, blindness, difficulty with speech, problems with walking, confusion, headache, vomiting, loss of consciousness or death. It could be little (non-disabling stroke) or severe and catastrophic, causing death due to effects on vital areas. It could be short-lived, come and go, referred to as transient (TIA) lasting minutes/less than 24 hours. Stroke (brain attacks) is a leading cause of disability, death, and a major public-health threat/challenge. One in six individuals will develop stroke in a lifetime. Every six second, one individual develops stroke. In every six cases, one death is recorded in its favour.

How prevalent is stroke in low-income countries?
Over the last decade, stroke incidence has reduced by 12 per cent in high-income countries (HIC), and increased by 12 per cent in low middle-income countries (LMIC), such as Nigeria. Therefore, stroke deaths/delays disability-adjusted life years, years of life lost plus years lived with disability, is seven times higher in LMIC than HIC. LMIC accounts for 85.5 per cent to 87 per cent of global stroke mortality/deaths. This is partly because of the exploding, but neglected burden of non-communicable Diseases (NCDs), such as hypertension (HBP), diabetes mellitus (DM), obesity/unhealthy diets, high cholesterol/dyslipidaemia and other modifiable vascular risk factors, culminating in stroke.

What age, sex, populations are affected most?
Relatively younger age of 15 and averagely age 61.5 years have been reported in Nigeria. However, stroke in young people occurs between ages 15 to 45 (40 percent haemorrhagic), especially in young individuals with HIV, history of substance abuse (heroine, cocaine, methamphetamine, oral contraceptives), sickle cell disease/haemoglobinopathy, heart diseases complicating rheumatic fever, irregular heartbeats, such as atrial fibrillation, mitral valve prolapse, patent foramen ovale; connective Tissue diseases (CTD such as SLE: Systemic Lupus erythomatosis with vasculitis) and complicated migraine, amongst others.

New additions to risk factors include electronic cigarette, obstructive sleep apnea with troublesome snoring and breath holding spells during sleep, high lipoproteins, infectious agents including HIV; cytomegalovirus, chlamydia pneumonia, helicobacter pylori, herpes simplex virus and peridontal diseases have also been implicated.

Stroke occurs through disruption in the blood flow to the brain. This could be likened to water supply through a flexible or expandable pipe to the tap. The pipe could be obstructed by debris or could go into spasm, thereby reducing or stopping the flow. On the other hand, pipe could burst, often as a result of high pressure and pour out water before it gets to the tap. Consequently, little or no water reaches the tap. Blood flow to the brain is the source of energy to the brain, carries oxygen and glucose (food). If the brain is deprived, it starves and could die unless something is done quickly.

What are the types of stroke?
We have three types of stroke, which include cerebral infraction (CI), intracerebral haemorrhage (ICH) and sub-arachnoid haemorrhage (SAH). Cerebral infraction occurs when a little/no blood reaches part of the brain. It causes blockage of pipe, due to spasm, as in migraine, or blood clots/debris, faulty heart with irregular heartbeat. High cholesterol (fat) in the blood leads to debris (plaque) forming in the pipes. This furs up inside making it ragged, narrower, hardened and less flexible (atherosclerosis), plaque can break off and travel into brain pipes and cause further obstruction.

Haemorrhage stroke (ICH) is bleeding into brain and leads to blood clot within the brain. The clot occupies space, and increases the pressure within the skull raised intracranial pressure (ICP). Symptoms and signs include sudden severe headache, vomiting, loss of consciousness, and other symptoms as for cerebral infraction, except that could be more sudden and occurs during activities. This could be temporary with subsequent recovery, or permanent; and could lead to immediate death, if the clot or bleed is very large.

Causes include rupture of a damaged blood vessel in the elderly, hypertension, amyloidosis, malformations of the blood vessels in the brain (aneurysms, arterio-venous malformations), abnormal vessels in tumours, drugs such as amphetamines and cocaine and other brain stimulants. Sub-arachnoid haemorrhage (SAH) intracranial haemorrhage occurs in the SAS alone or in conjunction with bleeding elsewhere in the brain. Of the three types, this could equally be devastating.

How can government help to alleviate incidences of stroke?
Stroke is a huge problem, and a major financial burden on the inadequate health services in Nigeria. There is need for effective strategies for prevention, treatment and rehabilitation. There is need for provision of state/national stroke policies and guidelines, with emphasis on awareness. All efforts must be made to “roll back stroke.” Stroke is preventable and prevention is certainly better and cheaper than treatment/cure.

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