Stroke strikes more young people

By Rebecca Kwei Many more young people are suffering from stroke, an illness that occurs when blood supply to a part of the brain is interrupted or severely reduced, depriving the brain tissue of oxygen and nutrients. According to a neurologist at the Korle-Bu Teaching Hospital (KBTH), Dr Albert K. Akpalu, stroke is becoming more common in young people between 25 and 45, a situation he described as alarming. He attributed the situation to unhealthy lifestyles, including excessive alcohol intake and poor control of blood pressure. Additionally, he said stroke formed 30 per cent of all admissions at the Department of Medicine of Korle-Bu and was the biggest cause of death in the department, accounting for more than 25 per cent of mortality there. Stroke has also been identified as a leading cause of adult disability in Ghana. Interestingly, a BBC report on October 11, 2012 indicated that strokes are becoming more common at a younger age, with about one in five victims now below the age of 55, according to a research in the American Academy of Neurology Journal. The report said the study followed 1.3 million people in a US region and found that 19 per cent of those experiencing a stroke in 2005 were in that age group, up from 13 per cent in 1993. This is despite a trend of overall falling rates of the condition. The Stroke Association said the findings were alarming. Report author Dr Brett Kissela said: "The reasons for this trend could be a rise in risk factors such as diabetes, obesity and high cholesterol." The study looked at all people over the age of 20 in greater Cincinnati and North Kentucky over three periods in 1993, 1999 and 2005. Looking at the UK parallels, the study said as well as a rise in the occurrence of stroke in the under-55s over this time from 109 per 100,000 people in 1993 to 176 per 100,000 in 2005, the study also found the average age of those experiencing the condition fell from 71 years in 1993 to 69 years in 2005. Dr David Werring, a neurologist from the University College, London, said: "Stroke is usually considered a disease of older people, but this study reminds us that young people are also affected.” Dr Akpalu said many factors can increase one’s risk of a stroke. These include one’s family history, explaining that “your risk of stroke is slightly greater if one of your parents or a brother or sister has had a stroke or a temporary interruption of blood flow to a part of the brain known as transient ischemic attack (TIA)”. Age is also another factor, as the risk of stroke increases as you get older. He said stroke affects men and women about equally but women are more likely to die of stroke than men, and in the case of race blacks are at greater risk of stroke than people of other races. This is partly due to a higher prevalence of high blood pressure and diabetes. Other risk factors are high blood pressure (hypertension), undesirable levels of blood cholesterol, high levels of low-density lipoprotein (LDL) cholesterol, cigarette smoking, diabetes, obesity and cardiovascular disease. In order to improve the care of people suffering from the illness, a Stroke Unit has been established at the KBTH and work has commenced on the building of the unit, although a multi-disciplinary team is already in place. The aim of the project, among others, is to work in partnership with the multi-disciplinary stroke team at the hospital and scale up training of staff at all entry points involved in stroke admissions. Dr Akpalu said stroke survivors who could go home to a spouse or other companion were more likely to become independent and productive again and that encouragement and early treatment were important. He said recovery and rehabilitation depended on the area of the brain involved and the amount of tissue damaged. “Harm to the right side of the brain may impair movement and sensation on the left side of the body. Damage to brain tissue on the left side may affect movement on the right side. This damage may also cause speech and language disorders. In addition, people who've had a stroke may have problems with breathing, swallowing, balancing and hearing, and loss of vision and bladder or bowel function,” he said. In view of this, rehabilitation, which is facilitated by a diverse team, focuses on giving education on four areas: swallowing, where patient may choke because he/she is unable to swallow; positioning, frequent turning to prevent bed sores and improve mobility, information on stroke to patients and carers and continence management which has to do with bladder and bowel care. Kwame Asare Boadu reports from Kumasi that stroke has consistently remained the leading cause of mortality at the Komfo Anokye Teaching Hospital (KATH) for the past 10 years. At KATH, it has been established that 43 per cent of patients with stroke die on admission, while up to 60 per cent has severe functional limitation, making them heavily dependent on relatives. A study conducted by Dr Fred Stephen Sarfo, a clinic neurologist at KATH, revealed that the most important risk factor for stroke in Ghana was high blood pressure (or hypertension). “The most affected age group are patients in their mid-50s, with a slight female predilection,” the study said. A good number of younger persons in their 30s are also being affected these days as a result of factors including lifestyles. According to Dr Sarfo, 85 per cent of all stroke patients had hypertension. “By far, the most important risk factor for stroke among Ghanaians is high blood pressure (or hypertension),” he said. He said nearly 70 per cent of the patients with hypertension were not aware they had hypertension. “That is why hypertension is seen as a silent killer because it is often without any striking symptoms,” he said. Giving further details on the situation at KATH, the clinical neurologist indicated in his study, “Among those who were known hypertensives, only 20 per cent reported taking their pressure medications (anti-hypertensives) consistently. “In the same study, 73 per cent were physically inactive, 65 per cent were obese or overweight, 50 per cent had high blood cholesterol (fat in the blood) and 38 per cent were diabetics (high blood sugar).” Dr Sarfo emphasised that that was an indication that the control of stroke in Ghana could be tackled head-on through intensive public education on lifestyle modification. He described stroke as a growing public threat in the country and, indeed, most developing countries. This is against the fact that the incidence of stroke is gradually declining in the developed world, Dr Sarfo pointed out that stroke is a preventable disease because the risk factors for its predisposition are largely remediable. He disclosed that in Ghana, there were no community-based studies conducted to date to assess the prevalence of stroke in Ghana. It has been estimated that one-third of patients die after their first stroke, one-third will have severe functional limitation (or incapacitation) and one-third will recover fully. Additionally, Dr Sarfo noted, “there is a paucity of trained personnel, namely, neurologists, neurosurgeons, neurophysiologists, specialist nurses, physiotherapists and speech and occupational therapists to manage patients who present to our health institutions with stroke”.