Roll Back Stroke: The Way Forward for Physicians and Patients

ABSTRACT

The 6-lettered word "Stroke" is an ancient disease, likened Biblicallyto "666" in Revelation 13 verse 18. Globally, it is the commonestcause of acquired long-term disability. While its incidence has beendeclining in high-, low/middle-income countries (LMICs) have witnessed an increase. This increase is driven byepidemiologic-transition/modernizatio n-complex, healthcaredisparities, and increasing prevalence of vascular risk-factors. Despitethe disproportionate burden of stroke in LMICs, these countrieshave the lowest rate of access to acute reperfusion-interventions leadingto greater stroke-related morbidity /mortality. Effective primordial,primary, secondary, and quaternary prevention-strategies coordinated at all levels of care are needed to reduce stroke incidenceand poor outcomes. The World Stroke Organization (WSO) hasproposed achieving global primary prevention through 1) Population-wide approach to limiting stroke risk-factors exposure, 2) App-basedmotivational population-wide approach to mitigating stroke risk-fa cto rs, 3 ) u se of lo w-co st co mbi n at io n /po ly- p il l to tre at hypertension/dyslipidemia and 4) addressing behavioural risk-factorsthrough interventions by community health-workers.The need to set-up stroke-units, post-hospitalisation rehabilitation-centres, stroke-registers/registries, stroke-clubs, and encouragecommunity health-education, must be emphasised for optimal care inLMIC.13 Community Health Empowerment (CHE) withthe AcronymBE FAST / STRoke as warning signs of stroke must be emphasised(B Balance-loss; E Eye vision-loss; F Facial Asymmetry; A Armweakness; S Speech difficulties; T Time is brain; Or first 3-lettersof STRoke ­ Can Patient Smile? Talk? Or Raise-arm?). Strokehemorheology/blood-flow and treatment involve 3Ps' of pathogenicprinciples/strategies (Passenger, Passage, Power). Its complicationsinclude the 10D's Death, Disability, Depression, Dementia, Delirium,Dysphagia, Dehydration, Deep-Venous Thrombosis, Decubitus-ulcers, Dysphasia, Seizures.