24th October, 2018; Ras Al Khaimah: The window to treat brain strokes with clot busting therapy is just four-and-a-half hours, and any delay in recognizing stroke symptoms could lead to severe repercussions, warns Dr Sweta Adatia, Specialist Neurologist at RAK Hospital, Ras Al Khaimah. Stroke remains the number one killer in the UAE after road deaths with approximately one case predicted every hour in the country. In many incidents, it is the case of patient delaying medical intervention that results in fatality. Earlier considered the disease of the elderly, now an increasing number of people in their 40s are suffering from ischemic strokes. 

 

As per reports, an estimated 10 percent of stroke patients are younger than 50 and 7000 people succumb to it annually.

 

“The need to create public awareness about the deadly attacks from strokes is essential today since early intervention is the key to successful treatment,” advised Dr Sweta on the occasion of World Stroke Day on October 29th.

 

“An apt example is a case we recently treated where the patient was a young 30-year-old doctor who was delayed in recognizing the signs properly leading to severe stroke later. Early in the day, he brushed aside the funny sensation in his right leg which was followed by some slurring of speech. Unfortunately, by evening he had lost the ability to speak and had begun to fumble while giving answers. Moreover, the weakness had reached down to his hand and leg. The patient had been experiencing the onset of the symptoms of stroke for almost eight to 10 hours when he was rushed to RAK Hospital”. 

 

Since it was an emergency case, the RAK Hospital team did not have the option to treat with the clot busting drug. As per brain MRI pattern, the clot, which had increased in size, seemed to be from one of the neck arteries causing fragmentation and leading to stroke. 

 

“It is highly tricky to treat such clots as they can keep fragmenting further and cause progression. We immediately started anticoagulation – a therapy when helps to prevent the clot from progression and assists in dissolving the clot which often happens by body’s own clot dissolving mechanisms”, explained Dr Sweta. It took 48 hours for his symptoms to stabilize and a week later he was discharged with very minimal speech deficit. 

 

Stroke results from damage to brain due to cut off of blood flow and oxygen supply, either due to blockage or rupture of blood vessel. A restriction of blood flowing into the brain or excess bleeding can cause damage of the brain cells, resulting in dysfunction of the area of brain involved. Every minute the brain is deprived of blood and oxygen supply causes damage to around two million neurons (specialized brain cells), 14 billion synapses (connections between different brain cells for communication) and 12 km of myelin fibers (fibers taking information back and forth). 

 

The acronym for spotting a stroke is called FAST, which stands for facial drooping, arm weakness, speech difficulties, and time to call the national ambulance. Usually, one side of the body is affected, making someone’s face on that side sag, and causes problems in raising the arm on that arm. Slurred or confused speech is common as well, since a stroke may be affecting memory and verbal abilities. 

 

However, Dr Sweta warned that not all strokes look like a classic FAST incident. Older adults tend to be affected in larger blood vessels, making them more likely to have the “big stroke symptoms” like facial drooping and incomprehensible speech. But younger people may just feel numbness or having an awkward feeling or having some weakness in arm or face. Young stroke patients experience higher death rate, higher risk of cardiovascular events, and significant limitations in quality of life.

 

Dr Raza Siddiqui, CEO Arabian Healthcare Group, and Executive Director, RAK Hospital added: “In brain stroke cases the decision to remove the clot has to be very quick, and so the setups need to be ready for this therapy, which is currently possible in a few specialized centers in UAE. These centers or hospitals have round the clock facility of a CT scan, MRI scan, 24 x 7 services of an interventional specialist and neurologist available to asses and treat strokes. Fortunately, RAK hospital has an advanced set up in treating strokes.  

 

Dr Raza further stressed on the need for screening, adding that these tests can give physicians a good idea about stroke risk in young adults.