I am Dr. Sahil Kohli, consultant neurologist and stroke specialist in hospital in Gurgaon. I will be talking about stroke and women today. Stroke in women is a very very important topic because one in five females are going to have a stroke in their lifetime and 60% of all stroke deaths are in females. Stroke is the third leading cause of death in women and fifth in men and stroke kills twice as more women as compared to breast cancer. Still, the thought and the question of stoke in women is less represented. It is very important for women to identify and know about the risk factors for stroke and how they can prevent it. The traditional risk factors for stroke in women are the same as in men which are hypertension, diabetes, cigarette smoking, obesity and high cholesterol levels. Other than that there are specific risk factors in women which needs mention, these include the women in childbearing age group, in this period females who are on oral contraceptive pills especially who are on ethinyl estradiol pills they have a high incidence of strokes and these strokes are especially more common if the females are smoking and have other traditional risk factors.
The second point is pregnancy. The pregnancy is also a procoagulant state where there is a tendency of the blood to coagulate specially in the peripartum and the postpartum period where there is a special type of stroke called as a cerebral venous thrombosis which is very very common and any female who has new onset of headache or seizures during this period has to be evaluated for a CVT. And the third important thing is in the young age group is the female with migraine with aura. Migraine with Aura has a special connection with brain stroke. Females who have a migraine with aura and those who continue to smoke and have oral contraceptives have an additional risk factor and they should be counseled for taking care of their risk factors so that stroke can be prevented. The second stage is the period in the postmenopausal age group. In the postmenopausal age group, females especially who are on hormonal replacement therapy and the hormonal replacement therapy which has higher estradiol content, they have a higher tendency for stroke.
The third important thing is females who are more than 80 years, it has been seen that females who are more than 80 years of age they are less likely to receive good medical care especially in terms of treatment of hypertension, diabetes and anticoagulation for atrial fibrillation thus putting these females at a higher risk. It is important that stroke should be considered as a treatable emergency and it should be identified and correctly treated. For the identification of stroke, a powerful 4 letter word has been given by AIG which is F-A-S-T FAST. ‘F’ means the sudden onset of facial dropping, ‘A’ means sudden onset of arm weakness, ‘S’ is sudden onset of speech problems or slurring and ‘T’ is time. So time is very important which is 4.5 hours. So all the patients who develop certain these symptoms should be identified correctly and reach a hospital where the treatment can be given in the first 4.5 hours.
I am Dr. Sahil Kohli and main consultant neurologist aur sports specialist, Narayana hospital Gurgaon mein kaam Karta hoon. Meri training DM ki CMC Vellore se huyi hai. Uske bad maine 1 sal ki sub-specialty stroke ki training All India Institute of Medical Sciences se ki hai. To mai aaj aapko stroke ke bare mein kuch important cheeze batana chahta hoon kyunki bahut hi important hai kyunki stroke jo hai vo leading cause of morbidity aur mortality bann raha hai aur pehle to mana jaata tha ki stroke sirf 60 saal se jyada umar ke logo mein hota hai but ab stroke jo hai vo young age mein bhi dekha jaa raha hai. To pehle to ye hai ki stroke hai kya? Stroke ek aisi bimari hai jisme hamari jo blood vessels brain mein jaa rahi hai unme block hone ki vajah se brain mein oxygen ki kami ho jati hai aur brain mein jo cells hai vo death ho jati hai unki. To brain jo aisa vital structure hai jisme hume agar ek second bhi oxygen ki kami hoti hai to 32,000 neurons jo hai vo destroy ho jate hai aur millions of neurons minutes aur ghanto ke period mein lost ho jate hain.
Toh stroke ke treatment mein sabse important cheez ye hai ki aapko sabse pehle stroke jab bhi ho raha hai usko identify kaise kare, chahe aap metro mein jaa rahe hain, chahe aap gadi mein drive kar rahe hain, chahe aap kisi function mein hai; to aapko yeh pata hona chahiye ki stroke ho kaise raha hai, agar ho raha hai to usko identify kaise karna hai aur iske liye aap ko koi special training ki zaroorat nahi hai. Ek four letter word hai FAST: F-A-S-T, agar aap vo word samajh le toh aaram se stroke ko identify kar sakte hain. To FAST fast mein hai F se agar aap kisi ko dekhein sudden onset facial dropping, toh agar aapse koi baat kar raha hai toh uska jo muh hai vo ek side pe suddenly teda ho gaya, A- arm weakness, agar koi hath jo hai aise pakad ke khada hai aur dekha uske hath se aise choot gaya aur S is speech difficulty; agar koi baat kar raha hai to suddenly uski awaz jo hai ladkhadana shuru ho gayi hai ya fir uski jo vo bol ni paa rahe aapki baat samajh nahi paa rahe aur T hai time; time sabse important hai jo ki 4.5 ghante hai, uski importance ye hai ki agar apne kisi admi ko ye symptoms identify kiye, suppose aap kisi function mein hai aapne dekha ki haan kisi ka face drop ho raha hai ya speech difficulty ho rahi hai to aap usko identify karke 4.5 ghante ke andar vo hospital mein pahuchna zaroori hai.
Toh yeh jo FAST word hai ye same word hindi mein bhi hai. Isko hindi ka word hai BACHAV. B se means bol na pana, A means awaz thartharana aur CH means chehre ka teda hona aur V means vaqt ab na gavana. To aapko 4.5 ghante ke andar hospital mein aana hain. To aisa hai ki pehla jo step tha stroke hota kya hai, vo hume bata dia. Ab doosra hai ki stroke identify kar lia to next best step kya karna hai. Common perception ye hai ki jaise heart attack ke patient ko agar kisi ko chest pain hoti hai to aap uski aspirin de sakte hai but brain attack mein aisa nahi kar sakte kyunki hume pata nahi hai ki vo jo stroke hua hai vo blood vessel fatne ki vajah se hua hai ya blood vessel band hone ki vajah se hua hai. Upto 80%, 88% jo strokes hai vo ischemic strokes hote hai lekin jo 12% hai vo hemorrhagic stroke hai but kyunki koi bhi tareeka clinical aise bata nahi sakta ki vo bleeding stroke hai ya vo clotting stoke hai to hum jo common perception hai ki heart attack mein Aspirin de dijiye hospital pahunchne se pehle, vo hum recommend nahi karte.
To agar aapne kisi ko ye symptoms dekhe ki kisi ko ye symptoms ho rahe hain to aapka second step rahega ki aap kisi patient ko aisi jagah refer kijiye jo stroke ready centre hai. Stroke ready centre ek aisi jagah hai jahan par 24 ghanta CT scan ki facility available hai. Jab kisi patient ko stroke hota hai aur vo CT kiya jata hai aur CT mein bleed rule out kar di jati hai to fir hum uss patient ko blood thinners ya fir jo humare pass EPA medications hain vo hum de sakte hain. To stroke ek aisi cheez hai jiska jo treatment hai vo sirf tabhi possible hai agar vo 4.5 ghante ke andar hospital mein aata hai. Uske baad jo bhi hota hai vo aisa treatment hai jisme vo sirf secondary prevention ke liye hai jo stroke hogaya hai vo dubara na ho.
To stroke ko theek karne ke liye hume sabse pehle ye symptoms identify karna hai, uske bad stroke ko stroke ready centre mein bhejna hai aur agar CT normal hai aur usme bleed nahi hai to hum ek drug de sakte hai jisko hum bolte hai tic plasminogen activator ya fir thrombolytic agent chemical thrombolysis jisse jo clot hai usko time pe pighlaya jaa sakta hai aur teen mahine ke baad studies ye kehti hai ki jin patients ko ye treatment milta hai unme se upto 65-70% jo patients hai stroke ke vo bilkul normal hoke chal sakte hai. Aur kyunki ye blood thinner hai to 2% risk bleeding ka bhi rehta hai to 100 mein se 2 patients aise rahenge jinko bleeding ka risk hai. Lekin jo improvement hai vo that is seen in almost 65-70% cases. So it is highly recommended ki agar aap kisi patient ko ye symptoms hote huye dekhe aur aap unko identify kare correctly unko ek stroke ready center mein bheje taki unko jo chemical thrombolysis therapy ka faida mil sake aur ye jo word maine aapko aaj bataye FAST aur BACHAV inko yaad rakhein.