Brain attack (Stroke)

An elderly person’s worst nightmare is suffering a stroke. It conjures up visions of being confined to bed with the inability to move or speak and, worst of all, loss of bowel and bladder control. A cerebral stroke occurs when blood supply to a part of the brain stops for any reason. Though strokes can occur at any age, they are more common after 65 years. With the increase in life expectancy in India, the incidence of stroke has doubled from 175 to 350 per 1,00,000.

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Although it is uncommon for strokes to occur in young people, it can happen in youngsters born with a malformed blood vessel in the brain, brain tumours or those who suffer severe dehydration. Also, at any age, irregular heartbeats can lead to small clots in the brain called emboli, which can block vessels. The chances of having a stroke increase in those above 65 years if they have diabetes, hypertension, obesity, elevated blood lipids (cholesterol and triglycerides), are smokers, take more than 60ml of alcohol a day and do not have an active life.

Pregnant women can also suffer a stroke because of an increase in clotting tendency . In fact, the number of such women having a stroke has increased internationally. This upsurge has been blamed on older age at first pregnancy, an inactive life prior to and during pregnancy and obesity.

The manifestations of a stroke are giddiness, weakness or paralysis of muscle groups, blurring of vision, inability to speak or loss of consciousness. This is followed by paralysis of a limb, or a side of the body. A stroke occurs when blood supply to an area of the brain is cut off, either as a result of a block or a bleed.
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Usually, there are a few warning TIA (transient ischaemic attacks) before a stroke or cerebral attack. There can be sudden blurring of vision, inability to speak or weakness of a limb. These signs are due to spasm of a diseased vessel in the brain or to small amounts of blood leaking. Many people do not take these symptoms seriously since recovery is spontaneous and complete. But appropriate preventive treatment at this point can prevent a full-blown stroke.

In the absence of treatment, TIAs are soon followed by the real thing — a stroke. The devastation caused by it depends on the extent of damage to the brain. This in turn depends on the site and size of the block or leak. Thirty three percent of stroke victims recover, 33 per cent have permanent disability and another 33 per cent die. Cerebral stroke is responsible for 1.2 per cent of the recorded deaths in India.

The most common effect is paralysis of a part of the face or one side of the body. Muscles in the throat and mouth lose co-ordination, making it difficult for the person to swallow and talk. Speech may become slurred and distorted. If the speech centre in the brain is affected the person may understand everything that is said but be unable to reply. Memory loss may make recollection of present events a blur. Quite often though past memories are intact. A person may also lose the ability to make judgements, reason and understand concepts. This makes them appear unnecessarily stubborn. A strange numbness or pricking sensations may occur in the paralysed limb. Since all these effects are because of damage to the brain, they are difficult to treat with medication.

All injuries heal given time and treatment, the brain is no exception. It is capable of rewiring itself so that lost skills are regained to an extent. A person who is predominantly right handed can learn to write with his left hand. Physiotherapy makes the paralysed muscles flexible and stronger. Since a few muscle spindles may be still active, they can be retrained to enlarge and take over the function of the paralysed muscles. The bladder can be trained to empty itself every 3-4 hours. By speaking slowly and using simple sentences, it is often possible to be understood. The brain can be stimulated with puzzles and poetry to enable faster healing.

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Better still, try to prevent a stroke. :-

• Keep diabetes and hypertension in control.

• Take medications to reduce lipid levels.

• Take aspirin and clopidogrel, usually prescribed to diabetics and those with high pressure, regularly to prevent a stroke.

Walk, swim or cycle for at least 30 minutes a day.

• Stimulate yourself intellectually by learning new skills and doing puzzles.

When it comes to brain circuits, the correct mantra is “use it or lose it!”

Source : The Telegraph ( Kolkata, India)

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