A cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is cut off or reduced, preventing the brain tissue from receiving oxygen and nutrients.
It is a serious health problem that according to data from the World Health Organization (WHO),15 million people do it every year around the world. Of this group, 5 million die, and another 5 million suffer a lifelong disability. Thus, stroke represents the fourth cause of death and the first cause of disability on the planet.
“It is estimated that the incidence of cerebrovascular accidents in Argentina is about 126,000 cases a year, this would be a stroke every 9 minutes approximately. The data are conclusive and show a scenario in which one in three people who suffered a stroke will have a recurrence of the disease, that is, another stroke,” explained Dr. Pablo César Spada, a member of the Argentine Federation of Cardiology ( FAC).
“The World Health Organization stipulated October 29 as World Stroke Day or CVA. It is a date that urges us to reflect and thus be able to modify some habits that can help prevent this type of episodes,” Said Spada, who recalled that this terrible disease generates a great psychosocial impact, either in the patient due to the loss of various functions controlled by the brain and that are affected by stroke, as well as in their family environment and friends, due to the disabling condition that it generates in the affected person.
“Loss of speech, difficulty in making movements, problems with the functioning of the organs are just some of the situations that occur in the doctor’s offices. Faced with this reality, it is advisable to request psychological help for both the patient and his environment. Facing this new scenario requires acquiring new habits and routines”, remarked the expert.
Dr. Pablo Bonardo, a neurologist specializing in Cerebrovascular Diseases and Head of the Stroke team at the British Hospital, explained why a stroke occurs. “When we talk about stroke, we are talking about a sudden loss of blood flow to the brain. There are two main types of stroke: due to obstruction of an artery (ischemic, which constitutes almost 85% of cases) or due to its rupture, which causes bleeding (hemorrhagic). Brain tissue stops receiving the oxygen needed for its cells to live. In order to know and confirm what type of stroke it is, highly complex imaging studies of the brain and arterial circulation are required,” said Bonardo.
Some of the symptoms that appear in this pathology in a very acute way are:
– Loss of balance or coordination, feeling dizzy or dizzy.
– Difficulty speaking or understanding; the patient cannot see with one or both eyes.
– Lack of sensation in an arm, leg, or half of the face (something very characteristic is that it is usually on one side).
– Sudden headache of maximum intensity.
“Studies indicate that those centers that have specialized care in Stroke have shown a decrease in mortality and disability of 40%. In our country, there are few High Complexity Centers with the capacity to effectively care for stroke patients: from detection to treatment, including adequate follow-up and subsequent rehabilitation,” he recalled. In this sense, he specified that the British Hospital has been a pioneer in our country in the application of these treatments, having been the first Institution in Argentina to treat with intravenous fibrinolytics and since then leading the specialty and the only private one located in the south of the City of Buenos Aires, which also receives patients from the Buenos Aires suburbs and has safe care circuits in its “Green Areas”, with low COVID risk, due to the strict adapted security protocols.
No time to act
Dr. Mario Boskis, cardiologist and member of the Argentine Society of Cardiology, warned that stroke is a medical emergency. “For every minute that is lost without treatment, 1.9 million neurons die. Unfortunately, it is the leading cause of disability and the third leading cause of death in Argentina, where there is already an increasing number of hospitals that have a stroke unit, where a multidisciplinary team participates that can quickly assess whether we are facing an ischemic or hemorrhagic condition and start appropriate treatment, in order to avoid permanent sequelae in brain function,” said Boskis, coordinator of the SAC scientific councils.
80% of cases are due to an obstruction of an artery in the brain that produces an irrigation deficit called ischemic stroke, the remaining 20% is due to a ruptured blood vessel that causes bleeding.. It is important to recognize early symptoms, such as loss of sensation in the face, or decreased strength in an arm or leg, as well as slurred speech, confusion, vision disturbances, or a severe headache. In our country, it is estimated that 80 cases occur every 100,000 ha/year, and their incidence increases with age. We can prevent it to a great extent if we take care of risk factors such as controlling high blood pressure, not smoking, controlling diabetes and cholesterol, doing physical activity that includes at least 150 minutes of walking a week, and losing weight if we are overdoing it.
It is also important in periodic medical check-ups to assess the presence or absence of plaques in the carotid arteries, cardiac arrhythmias such as atrial fibrillation, or problems with the heart valves or their walls. All these pathologies significantly increase the possibility of stroke, especially ischemic, since they can form clots that travel through the bloodstream to lodge in the arteries of the brain.
Detecting the symptoms and recognizing that a patient is suffering a stroke, requesting immediate medical assistance, identifying the type by performing a Brain Tomography, will allow us if it is ischemic to use a medication (thrombolytic) with the ability to dissolve the clot that obstructs blood circulation and/or perform a more advanced endovascular procedure, and if hemorrhagic, take steps to control the bleeding and its effects.
“Time is brain. For this reason, the first 3 hours from the onset of symptoms are crucial and by acting early, a partial or total reversal of this potentially devastating neurological condition can be achieved”, says Dr. Valeria El Haj, National Medical Director of OSPEDYC.
How do you know if someone is having a stroke?
It is necessary to inform and know what the symptoms are – which usually appear suddenly – and how to act in a situation where a person is suffering a stroke, since the sooner the treatment begins, the greater the chances of recovery.
For this reason, you must act quickly and seek immediate medical assistance in the presence of any of the following:
– Face – Does the person’s face look crooked or lowered to one side?
– Arm – Does the person feel weak or numb in one or both arms? Will one of the arms fall off if the person tries to hold both arms up?
– Speaks – Does the person have trouble speaking? Does your way of speaking sound strange?
– Balance – Does the person have difficulty standing or walking?
– Eyes – Is the person having sudden vision problems?
In these situations it is necessary :
– Request immediate assistance.
– Lay the person on their left side.
– Do not administer any medication.
– If possible, remember the time the symptoms started.
“Thanks to early recognition of symptoms and prompt seeking medical attention, the chances of death and disability can be greatly reduced, in other words, acute brain injury can be minimized and the patient’s chances of recovery can be maximized,” said El Haj.
“A stroke is an emergency and therefore it needs extremely fast medical help since the response time will limit the severity of the sequelae or even save the life of the patient. The time, resources, and protocols to attend to this emergency are key throughout the patient’s process, from symptoms to treatment and follow-up”, commented Sergio Domínguez, Manager of Cardiovascular Care and Interventional Radiology for Latin America at Siemens Healthineers.
“ About 90% of stroke cases are preventable since the main risk factors can be controlled and treated. Factors like high blood pressure, heart problems, and high cholesterol increase the odds, while diabetes and smoking can increase the risk of developing a stroke by two to four times. As it is a preventable disease, for the most part, it is essential to implement efficient strategies focused on both prevention and care of stroke patients”, Domínguez completed.
How to prevent it
“High blood pressure is one of the main risk factors and is present in almost 80% of patients who suffer a stroke in the country. In addition, 22% of those who have a stroke are diabetic, ” Dr. Paola Caro, Vittal’s Medical Director, told pointing out that the danger increases between 50% and 70% in smokers and that the impact is greater in women. women. “Other risk factors are high cholesterol and alcoholism,” he stresses.
About how to recognize a stroke, Dr. Caro emphasizes that it is very important to be aware of the moment when symptoms begin and their duration. “Every second is vital to helping someone who has a stroke. Knowing the warning signs of a possible stroke can help save your life since receiving treatment soon can improve the chances of survival and recovery more quickly,” added the specialist.
“Before any of these symptoms, it is necessary to check if the person has difficulties understanding or speaking. Simple questions should be asked to see if he understands and responds to orders, ”emphasized Dr. Caro and listed that the person should not be left alone, that they must be reassured, remain calm and call the emergency system or take them quickly to a guard medical if you are close. “The faster they receive medical care, the chances that the person will recover and/or only have minor sequelae,” said Caro.
Prevention also plays a fundamental role: 8 out of 10 strokes can be prevented and almost 80% can be prevented through healthy lifestyle habits. It is important to carry out regular check-ups with the family doctor, adopt healthy habits, and, above all, control hypertension for which the doctor can prescribe medications.
“Exercising, managing stress, maintaining a healthy weight, reducing the amount of salt and saturated fat you eat in your food, limiting the amount of alcohol you consume, quitting smoking, and managing diabetes are all ways to maintain your high blood pressure under control,” Caro recalled. In addition, it is advisable to eat fish at least twice a week to obtain healthy omega-3 fatty acids, to bake foods instead of frying them, and to choose lean meats and poultry without skin.
Delays due to the pandemic
Grupo Medihome specialists told that the pandemic produced an interpersonal and intrapersonal disconnection and that it further evidenced the link between the environment and health. “The pandemic that we are going through has generated an interpersonal and intrapersonal disconnection. In this sense, Gabriela Ferretti, neurologist, and Scientific Divulgadora affirmed: “There have been changes in our routine that had a negative physical and mental impact: the change to telework or even the loss of the job itself, physical distancing, sedentary lifestyle, disruption of time patterns, increased calories consumed and decreased medical consultations for control of prevalent chronic pathologies. This generated anxiety, depression, anguish and irritability and, on the other hand, increased body weight and poor control of diseases such as high blood pressure and diabetes, among many others.”
“Every year we emphasize healthy habits to avoid stroke. And in this edition, we add as essential to promote the bond with our own body and with other people, who have been weakened by the pandemic. In addition, we must be increasingly aware of the relationship with the environment, which has been shown to impact our health”, said Valeria Muda, Director of Grupo Medihome, who invited on Saturday, October 30, from 10 a.m. to 12 p.m., to a talk about healthy habits and plogging – walking or jogging that is done along with collecting waste-.
It is an activity that combines physical exercise with caring for the environment. Born in Sweden, plogging is an activity that combines physical exercise with caring for the environment. It is a trend that has more and more followers around the world. From a cause or premise that unites them, people go out for a run or jog with a bag while collecting waste as it passes. Its objective is to spread social awareness about caring for the environment while exercising.
Study in Argentina
For several years, Fleni has been carrying out the SIFHON program through which surveys are carried out on knowledge and behaviors in the face of stroke in the general population. After the worrying results of the SIPHON-Covid study”, an “ online ”survey carried out in the Metropolitan Area of Buenos Aires (AMBA) in which more than 10,000 people participated during the mandatory isolation period of 2020, which showed that 76 % of the population did not carry out their usual health check-ups, Fleni began to develop several awareness campaigns to strengthen the importance of continuing regular medical check-ups.
Sebastián Ameriso, Head of the Vascular Neurology Service of Fleni, explained that “We want to reach the population with information about this pathology to raise awareness about risk factors and, above all, the importance of not neglecting early controls and symptoms, because we have observed a high prevalence of vascular risk factors, stroke and myocardial infarction in the AMBA”.
The data mentioned by the specialist refers to the study “SIPHON-2”, a digital survey to assess the degree of knowledge of the population about cerebrovascular disease, the prevalence of the main risk factors and healthy habits, carried out in the Metropolitan Area Buenos Aires (AMBA) in which more than 3000 people participated.
Soledad Rodriguez Perez, coordinator of the “SIPHON-2” study explained that a third of those surveyed had hypertension and/or dyslipidemia, 14% were smokers and 12% had diabetes. Additionally, more than half of those surveyed were overweight, but only 24% exercised. Likewise, he remarked that “approximately 30% do not carry out medical controls despite the high prevalence of risk factors for health that they themselves acknowledged having”.
Stroke is one of the most terrible events that a person can suffer, so taking care of physical and mental well-being is key to avoiding it.