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BRAIN ATTACK ! |
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Heart
attack as a word is very well understood by the lay man.
People rush to their doctors even with minor aches and
pains in the chest, the latter are but signs of life.
However, the same concern is not there when one gets a
stroke. In fact, strokes need as much emergency care as
heart attacks. In our country patients with strokes are
usually given oil massage and are left with residual
disability to fend for themselves, till they meet their
maker. This gloomy picture has to change and there are
now studies to show the good benefits of early diagnosis
and treatment of strokes and their causes.All strokes are
not completely curable. Many people with advanced
longstanding neurologic deficits following a stroke,
therefore, should not expect magical cure from their
doctors.
Brain attack as a word, a close cousin of heart attack,
might just do the trick of awakening the lay public to
the need to be on the alert when pain in the
head comes like a bolt from the blue with the intensity
never felt before. Headaches are so common
that if one did not get any headache at all he is either
lying or has probably no head at all! Very severe
headache coming on very suddenly is sure to be the
beginning of a major problem and may be the harbinger of
a future stroke.
Any stroke needs urgent medical attention to minimise, if
not totally rectify, the neurologic deficit. One of the
early symptoms of a stroke is severe headache, in
addition to the other symptoms. I must hasten to add that
minor headaches, or headaches one is accustomed to over a
long period, are of no consequence in this context. Your
doctor should be the best person to either treat you or
refer you to the neurologist when the need arises. So
always consult your doctor without losing precious time,
when in doubt. Going directly to a specialist with minor
aches and pains may, at times, land you in trouble; as
the great medical teacher of yore, William Harvey, wrote
in the early part of this century: " Specialists
have an inevitable tendency to a narrow and perverted
vision in which the life of the ant-hill is mistaken for
the world at large."
One of the causes of brain attack is what the doctors
call sub-arachnoid leak or haemorrhage. Here the
diagnosis in the early curable phase depends only on the
correct history of the attack got from the patient. This
was recently proved in a study in England where a team of
neurologists and surgeons reviewed prospectively the
efficacy of this early approach to management of
subarachnoid haemorrhage. It is very important to note
from this study that the proper history from the patient
is the best way to make a diagnosis of the first leak,
which even a CT scan may not pick up in the early stages.
The only sign of this malady is a sudden severe headache
like a bolt from the blue, the like of which the sufferer
never had in the past. This may or may not be accompanied
by vomiting. Every living human being has had headache
sometime or the other, and many of us have headaches
almost daily and a few of us are a headache to others.
But the headache of a stroke is very severe and can never
be missed. It is mandatory that one sees his own doctor
forthwith lest he should miss the best opportunity for an
early diagnosis and correct management.
A good history, coupled with a thorough clinical
examination of the patient with, may be a simple
examination of the spinal fluid got after lumbar
puncture, should yield the diagnosis. The first bleed is
rarely ever fatal; if not diagnosed and treated properly,
the second bleed is almost always dangerous and many
times fatal. The usual cause of the bleed is a congenital
malformation of the blood vessel inside the cranial
cavity, called by doctors as congenital berry aneurysms.
In this situation the question of prevention does not
arise as no one knows who has the malformation as also
the risk of the first bleed. The second bleed is a
certainty and so requires surgical correction of the
abnormality: the latter is a very simple procedure these
days.
There is a lot of talk about preventing strokes by
treating mildly elevated blood pressures in the
population these days. In this area the largest study has
been the MRC ( Medical Research Council of UK) study
published in 1985 after studying a very large number of
people. This study has the largest patient-years of
experience of any study to date, of 85,000 patient-years
of experience! Do not get shocked! These are all
statistical terms and it does not mean that the study
observed patients for 85,000 years. The study, however,
did show that to save one man from stroke we need to
treat 850 apparently healthy people with marginally
elevated blood pressures with drugs that do not help them
might harm. It is also true that the largest stroke
centre in the UK in Glasgow kept its records of the
stroke patient admitted in an year, of which around 18%
were high blood pressure patients untreated, another 12%
were well controlled hypertensives, and the remaining 70%
were normotensives.
Strokes could be due to many causes, but all of them need
emergency medical attention as many of them could benefit
from modern medical advances. It is high time that we, in
this part of the world, stopped thinking that strokes do
not have treatment in modern medicine and our best bet is
to give the patient oil massage and folk medicines. Far
from it. Even some of the haemorrhagic strokes could be
very well treated with surgical methods and many of the
thrombotic strokes, where blood clots inside the blood
vessels of the brain, could be helped with the present
drug regimen. Newer clot busters are also being tried
with fair degree of success. The future holds lot of
promise in the area.
It is always a good dictum to live well and eat healthy
diet and take regular exercise for the well being and
comfortable living. To think that by doing all that and
having regular check-ups ( Executive Check-ups sold these
days) will prevent one from getting diseases and postpone
death is only a myth. In this area we have opinions and
very few facts. It is time for doctors to shed their
dogmatic attachment and work with compassionate
pragmatism for the good of their patients and society at
large. The idea that healthy long life results from
regular check ups to detect diseases in their
pre-symptomatic stage has also not stood the test of
time. Our best bet is to see our doctor with the least
deviation in our otherwise healthy living. There are two
situations where this dictum will fail. Alcohol and
tobacco will blunt our body signals. It may not be a bad
idea for alcoholics and smokers to have regular check
ups, lest they should miss the early warning signals from
their bodies.
There was a recent symposium on this last issue in memory
of Petr Skrabanek, who along with McCormick had done a
lot of work in this field, at the Trinity College Dublin,
wherein the speakers brought out many interesting data
which will have relevance here.
- The gains of a life
time spent in the pursuit of health care are not
large where longevity is concerned in
people with average risk.
- By computer modeling
it was determined that a life long cholesterol
awareness and correction might lead to an average
of three weeks of extra life.
- In all screening
programmes most individuals never
contract the disease of interest.
- Disciplined subjects
who comply with life long ingestion or
non-ingestion of certain substances "forever"
will seldom live to reap the benefit of their
compliance.
- Instead they die of
something unrelated.
The moral of the story is
to live well only to enjoy healthy life: to avoid
premature death do see your doctor immediately when in
trouble or in doubt, and only when in trouble and not
before!
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