Unveiling the Enigma of Stroke

Stroke is an enormous burden in most countries around the world and is the leading cause of death and mortality. Approximately sixteen million cases of first-ever stroke occur globally every year, resulting in five to seven million deaths annually. Findings from the US Centers for Disease Control and Prevention (CDC) reveal that stroke is the leading cause of death in the United States, with more than 795,000 people experiencing strokes.

Turning our attention to sub-Saharan Africa, two-thirds of stroke cases worldwide occur in this region, where poverty, poor health infrastructure, malnutrition, and communicable diseases coexist, exerting their greatest toll. Nonetheless, Africa is considered the epicenter of stroke, with an annual incidence rate of up to 316 per 100,000 population. In Nigeria, it is estimated that about one million people in the country suffer from a stroke every year, with an alarming fatality rate as high as 40 percent.

Stroke, also known as cerebrovascular stroke, is a disease that manifests from damaged blood vessels called arteries, which occur within and leading to the brain. A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is either blocked by a clot (thrombus or embolus) or when the vessel bursts open. In these instances, the affected part of the brain cannot receive the necessary blood, oxygen, and nutrients, leading to damage and eventual death of brain cells and tissues within minutes. This can result in disability and possibly death for the victim.

There are two main types of stroke: ischemic and hemorrhagic stroke. Ischemic stroke is the most common type, accounting for 85-87 percent of all stroke cases. It occurs when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). This is often due to the accumulation of fats, blood clots, or other debris in the blood vessels, which typically travel through the bloodstream from the heart and become lodged in the brain's blood vessels.

On the other hand, hemorrhagic stroke occurs when an artery in the brain ruptures or leaks blood (hemorrhage). The blood from the artery exerts excess pressure on the skull, causing brain cells and tissues to swell and become damaged. Hemorrhagic stroke accounts for 13 percent of all stroke cases and is usually caused by weakened blood vessels such as aneurysms and arteriovenous malformations (AVMs), often stemming from uncontrolled hypertension.

A temporary stroke, known as a transient ischemic attack (TIA) or ministroke, occurs when blood flow to the brain is temporarily blocked. While its symptoms resemble those of a full stroke, they are transient and disappear after a few minutes or hours as the blockage moves and blood flow is restored. Although TIA is not categorized as a full stroke, it serves as a warning sign that an actual stroke is imminent. Therefore, it is crucial not to ignore it and to seek the same treatment one would for a full stroke, including emergency medical care. The US Centers for Disease Control and Prevention (CDC) has pointed out that up to 10-15 percent of people who experience a TIA have a major stroke within three months if they do not receive the necessary medical care.

Recently, two new types of stroke have been identified: cryptogenic and brainstem stroke. Cryptogenic stroke is a stroke of unknown cause, while brainstem stroke occurs within the parts of the brainstem and cerebellum. According to the American Stroke Association (ASA), diagnosing these newest types can be challenging. However, with proper and timely treatment, recovery can be achieved.

Certain conditions increase the risk of experiencing a stroke. Medical factors include high blood pressure, high blood cholesterol, irregular heartbeats, other cardiovascular malfunctions, diabetes, obstructive sleep apnea (OSA), and the use of birth control pills or hormone therapies containing estrogen. Lifestyle factors contributing to stroke risk include overweight/obesity, physical inactivity/sedentary lifestyle, heavy alcohol use, cigarette smoking, and the use of illegal or hard drugs such as cocaine and methamphetamine (mkpuru miri - Igbo) etc.

Certain personal background factors have also been identified as stroke risks, including old age (55 years and above), race (African, Hispanic), and sex - men are at a higher risk than women, but women are more likely to die from a stroke than men.

The loss of blood flow to the brain damages brain tissue. Stroke symptoms manifest in body parts controlled by the damaged areas of the brain. Stroke symptoms include paralysis, numbness or weakness of one side of the body (arm, face, and leg), distorted or slurred speech, confusion and disorientation, vision problems such as blurred or double vision, loss of gait balance and coordination, severe headaches of unknown cause, seizures, dizziness, nausea, and vomiting, among others. Certain diagnostic tests, when conducted by trained medical personnel in addition to clinical examination, help confirm stroke diagnosis. These tests determine whether a stroke has occurred, the brain regions involved, the cause, and the presence of bleeding. Such tests include magnetic resonance imaging (MRI) and computed tomography (CT) scans, as well as cerebral angiograms, carotid ultrasounds, electrocardiograms, and echocardiograms.

Early intervention for ischemic and hemorrhagic stroke minimizes brain damage, reduces impairment (including disability and secondary complications), and thereby reduces the risk of death. It is crucial to note that stroke is a medical emergency, and the sooner an affected person receives treatment, the less damage will occur. This is why the American Heart Association emphasizes, 'Time lost is brain lost.' Generally, treatment plans for stroke management may involve clot-breaking drugs such as recombinant tissue plasminogen activator (rtPA), antiplatelets, anticoagulants, statins, mechanical thrombectomy, the use of stents, surgery, and craniotomy. During stroke recovery, a hospital care team stabilizes the patient's condition, assesses the effects of the stroke, identifies underlying factors, and initiates therapy to help the patient regain affected skills. Recovery typically focuses on four areas: speech therapy, cognitive therapy, relearning sensory skills, and physical therapy, all of which are conducted by trained experts.

Stroke recovery and prevention have witnessed significant advancements in traditional medicine. However, an integrated and comprehensive approach utilizing natural methods holds the key to alleviating the burden of strokes. A groundbreaking avenue for stroke treatment emerges through the potential of turmeric, renowned for its role in protecting and regenerating brain cells. Researchers have harnessed a compound within turmeric, a staple in curries, which exhibits promising capabilities in shielding and revitalizing brain cells following a stroke.

This pioneering endeavor involves creating a novel molecule derived from curcumin, the essential chemical constituent of turmeric. Although human trials are pending, laboratory experiments indicate its potential to mend molecular-level damage while fostering the survival of neuronal cells within the brain. The research was presented by Paul Lapchak, the director of translational research at Cedars-Sinai Medical Centre in Los Angeles, during the American Heart Association International Stroke Conference.

The newfound drug, CNB-001, showcases rapid distribution within the brain and modulation of pivotal mechanisms crucial for neuronal preservation. Notably, laboratory assessments have shown its capacity to mitigate issues related to muscle control and movement when administered within an hour after a stroke.

Turmeric, recognized for its vibrant hue and culinary presence in Indian, South-east Asian, and Middle Eastern cuisines, emanates from a ginger-related plant. Beyond its gastronomic appeal, turmeric has long been associated with numerous health advantages. In particular, curcumin, an active component of turmeric, boasts a historical legacy in Ayurvedic medicine, where it has been employed for centuries to address various gastrointestinal ailments. Prior investigations have also hinted at its anti-inflammatory attributes and potent antioxidant properties.

Scientists insist that prevention is better than cure, and making modest changes in lifestyle and incorporating healthy habits can help stave off strokes. Generally, preventing cerebrovascular strokes involves adopting a healthy lifestyle and managing risk factors. Regular physical activity, a balanced diet rich in fruits, vegetables, and whole grains, and maintaining a healthy weight are key. Managing conditions like high blood pressure, diabetes, and cholesterol through medications, if necessary, can significantly reduce stroke risk. Avoiding smoking and limiting alcohol intake are crucial steps.

Regular medical check-ups help monitor and control risk factors. Learning to manage stress and ensuring adequate sleep contribute to stroke prevention. Stay hydrated and manage chronic conditions to maintain overall health. Recognizing warning signs like sudden weakness, speech difficulties, and severe headaches can lead to timely medical intervention. Education and awareness play a vital role; knowing stroke symptoms and seeking prompt medical attention can save lives. Obviously, a comprehensive approach, combining healthy habits and proactive healthcare, is essential to preventing cerebrovascular strokes. By prioritizing these measures, you can reduce the risk of cerebrovascular strokes and promote overall brain health.

REFERENCES

American Stroke Association. (2022). About Stroke. https.//www.stroke.org/en/about-stroke. (Accessed on August 15, 2022).

Brown, R. (2022). Stroke. https://www.mayoclinic.org/diseases-conditions/stroke/symptoms -causes/syc-20350113. (Accessed on August 15, 2022).

Kohli, P. (2022). Everything You need to Know About Stroke. https://www.healthline.com/health/stroke#diagnosis. (Accessed on August 15, 2022).

Muanya C. (2022). Natural cures for stroke validated. https://guardian.ng/features/health/natural-cures-for-stroke-validated/ (Accessed on August 15, 2022).

Okoro FO, Nwoha CO, Ogoko NC, Nwoha EC, Amadi CC et al. (2021l). Stroke Survivors' Preference of Herbal Centre to Hospital. International Journal of Complementary Medivine, vol. 1(1): 29-41.