1) Stroke is a growing global epidemic that threatens lives and quality of life, but much can be done to prevent and treat stroke through increased awareness, prevention efforts, and rehabilitation.
2) Every 6 seconds someone dies from a stroke, but stroke is both preventable and treatable through steps like controlling risk factors such as high blood pressure, diabetes, and smoking, as well as recognizing the signs of stroke and seeking immediate medical help.
3) While the lifetime risk of stroke is 1 in 6 for men and 1 in 5 for women, awareness of risk factors, symptoms, treatment options and rehabilitation can reduce deaths and
5. ‘I was having a great day at work and
nothing seemed unusual.
Suddenly the lights went out.
Seven hours later I woke up in
hospital. I couldn’t move my right side,
and
my speech had gone.’
6. Common believe
It is heart disease
It is not curable
It is not preventable
Etiology (reason ) not known
7. Reality of stroke
It is brain attack
Prevention is better than cure
There is some curative treatment
Outcome good
Pathogenesis is known (reason)
10. 1
in
People world wide
will have a
stroke
6
in their life time
It could be you.
11. 1
in
People world wide
will have a
stroke
6
But
stroke
can be prevented
12. 1
in
People world wide
will have a
stroke
6
Ensure quality care
and support after
stroke
13. 1 Every 2 seconds,
someone in the world suffers a stroke
Every 6 seconds,
in
someone dies
Every 6 seconds,
someone’s quality of life will forever be
6
changed –
they will permanently be physically disabled
14. 1
in
Every 6 seconds,
regardless of age or gender –
6
Someone somewhere will die from
stroke
15. Every 6 seconds,
stroke kills some one
Every other second
stroke attacks a person
15 millions people
experience a stroke each year
6 million of them do not survive
17. About 30 million people
have had a stroke
most have residual disabilities
Behind these
numbers are
real life
18. Second cause of death above 60
5th – people 15- 59
Also attack children
More death each year
than AIDS TB malaria put together
Is indiscriminate &
does not respect borders
26. Sudden confusion, trouble speaking or
understanding
Sudden trouble seeing
Sudden trouble walking, dizziness,
loss of balance or coordination
l fb l di ti
Sudden, severe headache with no known cause
27. Whereas; stroke is a global epidemic
that threatens lives, health and quality of life
Whereas; much can be done to prevent and
treat stroke, and rehabilitate those who suffer
from one
Whereas; professional and public
awareness is the first step to action.
28. Stroke - a non-communicable disease
Attacks 15 million people
worldwide every year
Claims a life every six seconds –
Can be beaten - effectively
29. Regardless of age, stroke can
strike anyone at any time
Stroke can be prevented
Stroke survivors can regain
their quality of life
with appropriate care and
long-term support
30. Reduce the number of people who
are affected by stroke
Reduce the number who die
Increased the number who recover
Increase the QOL of those who became disable
31. The lifetime risk of
stroke is
1 in 5 for women,
1 in 6 for men
The Lancet Neurology 6(12), 1106-14
32. Increase understanding of the
solutions that exist
Knowledge
Healthy environment /
Healthy behavior
Raise awareness
33. Translate knowledge into action
Transdisciplinary team
Evidence > Practice
Establish simple but comprehensive
stroke units
35. 1. Whereas; stroke is a global epidemic
that threatens lives, health and quality of life.
2. Whereas; much can be done to prevent and
treat stroke, and rehabilitate those who suffer
from one.
3. Whereas; professional and public
awareness is the first step to action.
36. The growing epidemic
Growing epidemic >
Preventable
Joint forces to prevent stroke
p
The same few risk factors accounts
for the health problems
Ensure what we know becomes
what is done
37. The growing epidemic
Recognized the uniqueness of stroke
Tx & prevent VCI
Build Transdisciplinary team
38. The growing epidemic
Stroke is
PREVENTABLE
But rising
Globally
Aging, unhealthy diets, tobacco use,
and physical inactivity
fuel a growing epidemic >>
44. o1
Here are 6 steps anyone can take
to reduce the risk and the danger of stroke
g
1. Know your personal risk factors
- BP
- Diabetes
- Cholesterol
45. o1
Here are 6 steps anyone can take
to reduce the risk and the danger of stroke
g
2. Be physically active and exercise regularly
3. Avoid obesity by keeping to a healthy diet
4. Limit alcohol consumption
46. o1
Here are 6 steps anyone can take
to reduce the risk and the danger of stroke
g
5. Avoid cigarette smoke, if you smoke,
seek help to stop now
6. Learn to recognized the warning signs of stroke
47. o2
Time lost
is Brain function
lost
Time window of opportunity to treat stroke short
once symptoms appears
any one having a stroke
immediately
48. o2
Time lost
is Brain function
lost
Call local Emergency phone no.
Go to nearest hospital
Even symptoms disappear
It may the last opportunity to prevent a potentially
forthcoming major stroke
49. o3
Disability in adult worldwide
Physiotherapy
Occupational therapy
Rehab
53. Following are NOT Typical symptoms
Altered consciousness or syncope
Dizziness, wooziness, or giddiness
Impaired vision (“grey out”) with alteration of
I i d i i (“ t”) ith lt ti f
consciousness
Amnesia or confusion alone
Tonic and/or clonic motor activity
Purely sensory symptoms,
54. Following are NOT Typical symptoms
Sensory march
Focal positive neurological symptoms
Bowel or bladder incontinence
B l bl dd i ti
Vertigo, diplopia, dysphagia, or dysarthria
55. PX are not benign
Stroke and TIA are both serious conditions
both are markers of current or impending
disability and a risk of death
10 to 20% of patients have a stroke in the next 90 days,
In 50% stroke within the first 24 to 48 hours
56. PX are not benign
Between 30% and 50% of TIA patients who undergo
brain MRI with diffusion- weighted imaging
57. D/DX
Non-Focal symptoms
Loss of consciousness
Faintness
Generalised weakness
Vertigo only
Drop attacks
Episodes of ‘confusion’
63. MI v Stroke
Extreme pain, fear of death No pain, Sx are
played down
p
Pt screams for help Pt does not ask for Help
Rapid alarm for EMS
Bypass of EMS, primary
care Physician
Good Mx structure & logistic
Structure in development
64. Imaging guideline
Suspected TIA or stroke, urgent cranial CT
(Class I), or
alternatively MRI (Class II), Level A)
If MRI - DWI and T2*-weighted
(Class II, Level A)
TIA, minor stroke, or early spontaneous recovery,
Ultrasound, CTA, or MRA (Class 1I, Level A)
65. ESO | AHA/ASA
guidelines do not separate the management of TIA from
ischaemic stroke.
Loading dose of aspirin (160-325 mg) within 48
hours of ischaemic stroke
(ESO Class I, Level A).
No other antiplatelets or combinations
(Class III, Level C)
Aspirin 50-325 mg/d, aspirin and
extended-release dipyridamole,
and clopidogrel monotherapy
(AHA/ESO Class I, Level A).
66. ESO | AHA/ASA
guidelines do not separate the management of TIA from
ischaemic stroke.
The combination of aspirin and extended-release
dipyridamole over aspirin alone (Class I, Level B)
Clopidogrel is recommended over aspirin alone
Cl id li d d ii l
(Class IIb, Level B),
For patients allergic to aspirin
(Class IIa, Level B)
67. IV rt-PA within 4.5 hours
(Class I, Level A)
BP of 185/110 mmHg or higher
IA rTPA acute MCA occlusion within a 6-hour
IV streptokinase - not recommended
68. Acute Stroke | General
IV - rTPA 3-4.5H
IA - <6 H
Anticoagulation
Antiplatelets
Aspirin should not be considered a substitute for other
acute interventions
79. CardioEmbolic
AF – Anticoagulation
MI with mural thrombus
Anticoagulation ( 9-12 months)
ASA for MI
Cardiomyopathy > anticoagulation / ASA
Valvular heart disease with or without AF
> Anticoagulation without ASA