Stroke: act quickly to limit the damage

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Extract from the article: Troisième cause de mortalité, après les cancers et les cardiopathies ischémiques, et première cause d’incapacité motrice, les accidents vasculaires cérébraux (AVC) sont aujourd’hui un réel problème de santé publique au Togo. Des études menées récem

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The third leading cause of death after cancer and ischaemic heart disease, and the leading cause of motor disability, strokes are now a real public health problem in Togo.   Recent studies carried out at the Sylvanus Olympio and Campus teaching hospitals in Lomé have shown that more than 50% of patients admitted to hospital are affected, and the number of strokes is rising all the time. What is so special about strokes?  What can be done to prevent and combat this disease? Professor Mofou Bélo, a specialist in neurology and neurophysiology at the Sylvanus Olympio University Hospital in Lomé, and Head of the Non-Communicable Diseases Surveillance Division at the Ministry of Health, offers some valuable insights.

The national stroke situation is alarming. According to Pr Mofou Bélo, "in 2022, around 3,850 people went to hospital with a stroke. In Lome alone, 2,500 people suffered a stroke. Around 1,000 people died from it", he stressed on 21 October 2023, during an awareness-raising campaign on stroke, organised by the 3A association (Ananias, Azarias Misaël).

What is a cerebrovascular accident?

This is a sudden neurological deficit resulting in a motor or sensory deficit due to obstruction or rupture of a cerebral artery. A stroke occurs when, for example, a healthy person suddenly develops hemiplegia, loss of vision or loss of language.

What factors favour the onset of a stroke?

There are two types of factors that contribute to stroke.Firstly, there are factors that can be modified: these are factors that can be acted upon to prevent the occurrence of a stroke.

These are: high blood pressure, identified as a silent killer. It is the leading factor in stroke.In Togo, over 80% of stroke victims are hypertensive; diabetes, defined as high blood sugar levels. Diabetes creates a vicious circle, as it is the cause of high blood pressure; obesity, as a person who is obese is bound to have high blood pressure and diabetes. We have physical inactivity, a person who is physically inactive will be obese, diabetic and will have a high level of fat in the blood.He will end up with high blood pressure; high blood fat levels are a very important factor in our country. The low-fat diet is not respected.The consumer oils frequently found on our markets are not controlled and are sometimes animal oils; taking the pill to avoid unwanted pregnancies.

There's also poverty: when you're poor, you can't buy your anti-hypertensive medication; you can't go to the doctor. Poverty also means that health facilities are under-equipped to deal with strokes.Raising the population's standard of living can help prevent strokes; ignorance, because you can be rich and have all the means, but when you're ignorant, it's like having nothing.We need to fight illiteracy and step up awareness-raising too.

Other factors include alcohol consumption, which leads to obesity, a sedentary lifestyle, high cholesterol levels, fragile arteries and high blood pressure; smoking, which creates atheromatous plaques that can lead to heart attacks and strokes; and stress, which is considered a significant risk factor.

Then there are the non-modifiable factors.  The older you are, the greater your risk of stroke.In our country, from the age of 40 onwards, the factors seem to come into play and this is where we need to be very careful. There's gender: worldwide, men are more at risk. But in our country, housewives are the main victims because they are often sedentary, obese and don't necessarily have information about the disease. And race: studies carried out in South Africa and in the black American population have shown that black subjects are more at risk, and it seems that there are genetic factors involved.

What are the causes of stroke?

Hypertension and arteriovenous malformations are the cause of haemorrhagic strokes, characterised by rupture of the arteries.

Ischaemic strokes, characterised by the formation of a clot that blocks an artery in the brain, are caused by high blood pressure, heart defects and myocardial infarction.

What are the warning signs of a stroke?

Apart from sudden death, there are the following: sudden loss of language, sudden loss of vision, loss of motor skills in half the body, balance problems, vertigo, loss of feeling in half the body.

What should you do if you see these signs?

The first thing to do in the event of a stroke is to call a doctor immediately or transfer the patient directly to a hospital or clinic staffed by a neurologist.You must avoid wasting time by keeping the patient at home or going to clinics that are not equipped.

Ideally, there should be a call centre for regulating stroke patients. But failing that, patients can be taken to the university hospitals in Lomé or to certain local clinics for better treatment.Why is it so urgent to take action in the event of a stroke?The Anglo-Saxons say "time is brain" in the same way that a shopkeeper says "time is money". We mustn't waste a single minute, because after 6 hours without being fed, the brain cells die. We need to understand that when there is a stroke, the blood no longer flows to the brain, so the cells die.

Is there any chance of recovery after a stroke?

Yes, there is a chance of recovery, and recovery depends on how quickly the patient is admitted and treated. But in our country, where we don't have the resources to act quickly, it's very difficult for us. Ideally, we would have molecules known as "anti-thrombotics", which can recanalise the brain tubes that are blocked by blood clots.

However, when patients are referred to a neurologist, risk factors are taken into account and regular monitoring ensures rapid recovery. Since the establishment of neurology facilities in Togo, mortality among stroke patients has fallen from 50% to 17%.

Who should you turn to after a stroke?Stroke management is multidisciplinary. It involves the neurologist, radiologist, cardiologist, diabetologist, physiotherapist, speech therapist and occupational therapist.Psychological support from psychologists is also important.But once back at home, the patient should be referred to the family doctor, preferably a GP.

How can recurrence be prevented?

The risk of recurrence after a stroke is high.Theoretically, 24 months after a stroke, you are at risk of having another attack.To avoid a recurrence, you need to control your risk factors by taking your medication regularly, exercising, avoiding high-fat and high-sugar meals and, above all, going back to see your doctor or neurologist regularly.

How can I prevent a stroke?

When it comes to stroke prevention, I usually quote the philosopher Socrates: "Know thyself".This means that you need to be screened for risk factors at an early stage.If you don't have high blood pressure, you should have your blood pressure checked at least 2 or 3 times a year. If you do have high blood pressure, you should see your cardiologist regularly and take your medication as prescribed, taking it exactly as prescribed.As a general rule, you should: exercise as recommended by the WHO, i.e. 30 minutes of physical exercise such as jogging or walking; eat meals low in fat, salt and sugar, with more emphasis on vegetables and fruit; avoid smoking tobacco and drinking alcohol. In addition to complying with these rules, you should see your doctor regularly.

Advice

Don't panic when you or a relative shows signs of a stroke.You need to be brave enough to go to a health facility, particularly a university hospital, to get treatment. When the accident occurs at night, you mustn't waste time thinking that it's night and you're going to wait until the next day before going to hospital, or that you're going to take some kind of medicine until daybreak. You have to act quickly, because the more time you waste, the more serious the complications.

Abel OZIH