World Stroke Awareness Day is marked annually on October 29. This day was established by the World Stroke Organization (WSO) to raise public awareness about the causes, consequences, prevention, and treatment of strokes.

A stroke is an acute life-threatening condition that occurs due to disrupted blood supply to the brain. It is a state of acute ischemia in the central nervous system caused by the interruption or reduction of intracerebral circulation. This is usually due to thrombosis, embolism, spasm, or hemorrhage in an arterial blood vessel, ultimately leading to reduced blood circulation in a specific region of the brain and damage to brain tissue.

There are two types of stroke: hemorrhagic stroke (brain bleeding) and ischemic stroke (brain infarction). Hemorrhagic stroke occurs due to the rupture of a cerebral blood vessel, often due to sudden and excessive increases in blood pressure.

In some patients, brain hemorrhages can also occur due to the rupture of an aneurysm (dilation) of a cerebral blood vessel, causing blood to leak into brain tissue and resulting in sudden damage to brain functions. Ischemic stroke occurs due to the blockage (occlusion) of a blood vessel in the brain, leading to what is known as a brain infarction. Occlusion stops the blood circulation in part of the brain, causing permanent damage to brain tissue – a stroke.

The lack of blood supply reduces oxygen and other nutrients to the brain, leading to the death of brain cells. Some people may experience only temporary ischemia of the brain circulation, a condition known as a transient ischemic attack (TIA), which fortunately does not lead to permanent neurological damage.

Ninety percent (90%) of strokes occur due to blood clots, i.e., ischemic strokes, caused by the presence of a thrombus in a specific part of the brain, leading to the death of brain tissue that cannot survive without oxygen.

Signs and symptoms of a stroke include:

·         Difficulty speaking and trouble perceiving the surroundings, confusion, or sensory aphasia.

·         Paralysis or weakness of the face, arms, or legs. This often occurs on only one side of the body and can cause asymmetry in the lips.

·         Problems with vision in one or both eyes, reduced vision, dark spots in one or both eyes, or double vision.

·         Headache – a sudden severe headache often accompanied by vomiting, dizziness, or altered consciousness.

·         Difficulty walking – ataxia, loss of coordination, or sudden weakness.

Stroke symptoms can develop gradually, sometimes over days. If you experience a “mini-stroke,” the symptoms may be temporary and usually resolve within a few hours. In this case, people might mistakenly attribute the warning signs of a stroke to stress, migraines, or other nervous system issues.

Any symptoms that might indicate a stroke require urgent consultation with a medical professional. If treated promptly, usually within a few hours of the stroke (with medications to dissolve the blood clot), blood can be restored to the brain quickly. Fast intervention significantly increases the chances of full recovery and reduces the level of disability that often follows a stroke. Not only does this save lives, but it also improves the chances of a better quality of life after a stroke.

Recognize the symptoms of a stroke and act FAST!

·         Face – Does one side of the face droop?

·         Arms – Can the person raise both arms?

·         Speech – Is the person speaking unclearly?

·         Call 194 immediately!

Risk factors for stroke include:

·         Certain diseases or conditions (heart diseases, certain blood disorders, high cholesterol, etc.)

·         High blood pressure (hypertension) – a major risk factor for stroke

·         Diabetes – associated with an increased risk of stroke, especially when uncontrolled

·         Poor lifestyle (unhealthy diet, obesity, smoking, physical inactivity, excessive alcohol consumption)

·         Smoking – significantly increases the risk of stroke

·         Excess weight and an unhealthy lifestyle – related to atherosclerosis, leading to strokes

·         Other risk factors (genetic predisposition, age over 55, female gender, certain nationalities). Migraines can also be a precursor to TIA or stroke, and they are associated with PFO or intracranial aneurysms – the most common cause of hemorrhagic stroke in young people. Anyone can have a stroke, but some individuals are at significantly higher risk. Knowing that you belong to a high-risk group can help you stay cautious and undergo regular preventive check-ups for parameters like lipid profile, blood pressure, and blood sugar.

The diagnosis is made based on the clinical picture, neurological status, neuroimaging techniques like CT scans and MRIs, and Doppler ultrasound of the major brain arteries (carotid and vertebrobasilar arteries). Treatment can be either conservative or surgical, supplemented by physical therapy for quicker rehabilitation.

Conservative treatment involves medications to normalize blood viscosity. For hemorrhagic strokes, surgical intervention may be required.

Cardiovascular diseases (CVD) are the leading cause of death globally, claiming around 17.9 million lives each year. CVDs include coronary heart disease, cerebrovascular diseases, rheumatic heart disease, and other conditions. In our country, research shows that nearly one in two deaths is caused by some form of heart disease, including strokes.

According to a 2014 study by the U.S. Centers for Disease Control and Prevention, 80% of cardiovascular diseases, including heart attacks and strokes, could have been prevented or avoided!

Stroke is one of the most common causes of death and disability worldwide. According to the American Stroke Association, one person suffers a stroke every four seconds, and one person dies from it every 40 minutes. More than 15 million people worldwide experience a stroke each year. Around 5 million die from stroke-related causes, and another 5 million survivors suffer from disability due to strokes.

Strokes are more common in low-income countries and those with limited access to healthcare. In developed countries, stroke mortality rates are much lower due to advanced prevention, early detection, and treatment methods.

Stroke is more common in men, while women tend to experience strokes at older ages, often related to hormonal changes during menopause. At the same time, men are at higher risk at younger ages, especially if they have factors like high blood pressure, smoking, and alcohol abuse.

According to the Institute for public health, the mortality rate for cerebrovascular diseases in 2024 was 121.6%, with 122.7% for men and 120.5% for women. The mortality rate for cerebral infarction in 2024 was 110.2%, with 110.2% for men and 110.1% for women. On average, 3,000 people experience a stroke each year in Macedonia, with 30-40% of stroke patients suffering from consequences like paralysis, speech impairment, memory problems, or physical disability.

Prevention of key risk factors has been shown to reduce the risk of cardiovascular diseases. Health policies that make preventive check-ups and education accessible are essential for motivating people to adopt and maintain healthy habits.

Prevention is key in the fight against stroke:

·         Control your blood pressure

·         Stay physically active

·         Eat a healthy diet

·         Quit smoking

·         Check your blood sugar and cholesterol levels

Identifying those at high risk for cardiovascular diseases and providing appropriate treatment can prevent premature death. Access to non-communicable disease medications and basic health technologies in primary health facilities is essential to ensure that those in need receive treatment and advice.

Special attention should be given to physical therapy, which plays a significant role in rehabilitation and reducing disability.

Prevention is crucial in minimizing the impact of stroke. Timely recognition of symptoms (TIA – Transient Ischemic Attack, which can be a precursor to a stroke or mini-stroke), proper treatment of chronic conditions, regular and timely use of prescribed medications, lifestyle changes, and abstinence from alcohol, smoking, and drug use are crucial in preventing the recurrence of strokes.

Stroke is one of the top five causes of death and disability worldwide. Early recognition and treatment are critical for reducing morbidity and mortality from strokes. Stroke is a global health challenge that does not discriminate by age or gender. However, with early detection, education, prevention, and access to medical care, we can significantly reduce its mortality and disability rates.

Anyone can influence their health – start today with healthy habits!