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)

8. 1
in
6

9. 1
in
i
6

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

16. Preventable
and
Treatable
Catastrophe

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

19. F
A
S
T

20. F
A
S
T

22. F
A
S
T

23. F
A
S
T

24. F
A
S
T

25. F
A
S
T

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

34. Generate a movement
that stimulates collective responsibility
and action

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 >>

39. 1
in
i
6

40. 1
in
i
6

41. 1
in
i
6

42. The growing epidemic
High BP
High Cholesterol
of >> Obesity
Diabetes
stroke
Heart disease
VCI

43. A treatable and preventable catastrophe

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

51. Transient ischaemic attacks (TIAs) offer a great
opportunity to initiate
treatments that prevent strokes

52. Typical symptoms
Hemiparesis
Hemisensory loss
Dysarthria
D th i
Diplopia
Monocular blindness
Ataxia

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’

58. Risk score
ABCD2
Age ≥ 60 years (1 point)
BP≥ 140/90 mmHg (1 point)
g( p )
Unilateral weakness (2 points)
Speech impairment (1 point)
Duration ≥ 60 minutes (2 points)
or 10–59 minutes (1 point)
Diabetes mellitus (1 point)

59. Risk score
ABCD2
Low risk (0–3 points)
Moderate risk (4–5 points)
( p )
High risk (6–7 points

60. Back to the
B k – t - th - wall
ll
emergency

62. Australia

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

69. In acute setting
Secondary prevention
Drug Tx

70. Acute setting 140 – 180mg
Secondary prevention
HbA1C < 7

72. Anti lipid
Statin / Niacin

74. X

75. BMI 18.5 – 25.4
Waist : <35 F and < 40 M

76. physical activity,
at least 30 minutes

77. Interventional approach
Stroke > 6 month with 70-90% stenosis
> CEA
Recent stroke with 50-69% stenosis
> CEA
<50% Med Tx

78. Interventional approach
ICAS with symptoms
Stent / angioplasty unceretain

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

80. CardioEmbolic
MAC with regurgiation with or without AF
> Antiplatelet or Anticoagulation
Prosthetic valves
> anticoagulation

81. NonCardioEmbolic
> Antiplatelet
Arterial dissection
Anticoagulation – 3-6 m or Antiplatelet
Beyond 6 m > Antiplatelet
PFO
Antiplatelet

82. NonCardioEmbolic
> CVT with or without Hg
Anticoagulation for 3-6 months followed
by
Antiplatelet only

83. NonCardioEmbolic
> Hyperhomocysteinemia
B6 B12 & Folate
Hypercoagulable state
Inherited Thrombophilias
CVT > Antiplatelet
Recurrent > Anticoagulation

84. NonCardioEmbolic
> APL Ab > Antiplatelet
> APL syndrome > Anticoagulation

85. lower-risk > UFH / LMWH
1st trimester > ASA low dose
High risk PG
UFH throughout

86. After ICH SAH Sub Hg > All
anticoagulant – stopped for 1-2 wk
Resume 3-4 wk
Hemorrhagic transformation of Infarct
Anticoagulation may be >>

87. CAM
No current recommendation of
neuroprotective
substances (Class I, Level A)

89. Q&A

90. Drop your QUERY >
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