Outdoor Leadership & Wilderness Medicine
Updated on 26 July 2020
Our brain needs a constant supply of oxygen and nutrients. Disrupted supply of oxygen rich blood can lead to irreversible damage to the brain leading to complications called a stroke. Stroke is the second leading cause of deaths worldwide as per WHO (2020).
Types of stroke
Ischemic stroke –
Ischemic stroke is the leading cause of deaths in stroke patients. It accounts for more than 85% of deaths. It is tissue death due to blockage in the blood vessels, affecting perfusion*.
Ischemia can be caused by either a) Thrombosis, or b) Embolism
Thrombosis – In simple terms it means clotting of a blood vessel. As we age our vessels develop plaque deposits in the inner walls, thereby narrowing vessels and resulting in reduced blood flow. This blockage can be partial or complete.
Hypertension can also cause damage to the vessels leaving rough surfaces. Plaque moving in the bloodstream can attach to these rough surfaces and occlude or block the vessels.
Embolism – Simply put, it means occlusion due to a clot or air bubble which moves in a blood vessel. This can originate in the heart or carotid artery in a patient with a stroke. The embolism may contain fat particles, air bubbles or clotted blood. This embolus can get stuck in the artery supplying blood to the brain and damaging the part where blood flow has been compromised.
Hemorrhagic stroke –
Hemorrhagic stroke happens due to leakage of the blood caused in the cranial cavity as a result of a rupture in the artery that is supplying blood to the brain. Hypertension patients are prone to a hemorrhagic stroke due to a rupture in the artery. The constant high pressure within the arteries results in weakening of their inner structure eventually causing arteries to rupture and hemorrhage.
Because this is an internal bleed we can do very little to stop it. Immediate medical intervention is required for controlling blood loss and reducing damage to the brain.
Apart from being a lifestyle disease, stroke may also be because of a congenital defect therefore it is also seen occurring in children and healthy adults.
Who is at risk?
People with the following ailments are at a higher risk of developing a stroke :
Diabetics
Obese
Heavy drinkers
Smokers
Hypertension (High blood pressure)
Atrial fibrillation (irregularly irregular heart rhythm)
If you suspect that the patient is having any form of stroke, don’t waste time on being sure about the type of stroke, this is a critical situation which demands immediate medical intervention.
At present there is no dedicated number for stroke care, although most hospitals in cities are equipped to respond to such situations.
Medical facilities use mnemonics like F.A.S.T. , F.A.S.T.E.R. , B.E.F.A.S.T. among others to identify a stroke. Here is one of them to help you assess :
B- Balance
Having trouble walking
Feeling dizzy, lack of coordination
E- Eyes
Change in vision in one or both eyes
F- Facial droop
Partial facial droop
A- Arms
Ask the patient to raise both hands up, see if one arm drops down.
S- Speech
Patients usually have slurred speech
Ask them to repeat a simple statement after you
Avoid asking questions
T- Time
Time to call emergency services
Contact your nearest stroke care centre
If you are caring or living with a possible stroke patient, having the contact number of your nearest stroke facility is a good idea. Stroke patient will be taken to the emergency department. Based on CT scans, MRI’s, glucose level and other various tests, the line of treatment is decided.
* Gas exchange
Author- Amit Arora, Outdoor Leadership & Wilderness Medicine Educator
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