Brain attacks or strokes are sudden neurological deficits characterized by sudden weakness or numbness on one side of the body, difficulty with speech/language function, sudden blindness, or sudden imbalance while walking. This happens when an artery supplying blood to an area of the brain gets blocked and the resulting symptoms pertain to that particular area of the brain. An acronym called FAST has been coined to create more awareness among the general public and help identify symptoms of stroke better in the community. Stroke-related disability is an immense health care burden on society and scores adversely on the quality of life indices of patients as well as caregivers. The larger question here is, “Isn’t it better to prevent strokes from occurring in the first place?” More awareness and efforts should be made in educating the people on how to prevent strokes. It was believed that Kumbhakarna, the brother of the evil Ravana was cursed by the Gods and the curse was that he would sleep excessively and then wake up and eat excessively. In medical terms, it could mean obesity as a result of problems in a gland called the hypothalamus which controls sleep, appetite, and diurnal rhythm. Some stories state that he would snore excessively while sleeping. These are some of the symptoms which even today are alarming and a cause for concern. Obesity is a major risk factor for both cardiovascular and cerebrovascular disease, so is the condition which involves excessive snoring, frequent night arousals associated with a fall in oxygen saturation, and as a result, increased daytime sleepiness (OSA) and in the long run, causing high blood pressure. This continues to be one of the most under-recognized causes of brain attacks or strokes. Hence it wouldn’t be inappropriate to say that obesity and OSA are serious health hazards of the modern era and continue to be a curse in the Kaliyuga. One of the best ways to prevent OSA is to reduce weight, have a healthy and balanced diet, and regular exercise. If the sleep study shows a significant abnormality, a CPAP machine is sometimes recommended by sleep specialists to improve oxygenation during these episodes of snoring. Hence, awareness about this condition is crucial in getting timely advice from sleep specialists/pulmonologists and preventing complications such as high blood pressure and stroke.

Other Causes Of Strokes Are:

1. High Blood Pressure

High blood pressure continues to be amongst the leading causes of cardiovascular, cerebrovascular disease and mortality. Hence timely identification and prompt treatment go a long way in preventing complications. Several dietary modifications including reduction of sodium intake, cutting down on alcohol, a diet rich in fruits, vegetables, and legumes, low-fat dairy products and low in meat, sweets, and saturated fats. Cessation of smoking and institution of a regular aerobic exercise regimen and leading a stress free lifestyle goes a long way in controlling blood pressure and preventing its complications.

2. Diabetes

Diabetes continues to be a leading killer and is also a leading cause of stroke, cardiovascular and peripheral artery disease. Adherence to a diet high in fruits, vegetables, nuts, wholegrains, and olive oil reduces the risk of developing diabetes. It is crucial to identify patients with pre-diabetes, in other words called IFG and IGT. Patients with a positive family history with other risk factors should frequently undergo testing so that they can be medicated early to prevent complications. It is important to take medications (tablets or insulin) on time and follow a healthy diet pattern, avoidance of direct sugar containing preparations. Regular exercise helps reduce insulin resistance and improves the sensitivity of the available insulin and makes it work better. Again, identification and prompt treatment are key to prevent complications due to diabetes.

3. Smoking

Smoking is not only the leading cause of heart attacks, bronchitis, lung cancers, but also one of the leading causes of stroke. The air that we inhale with its dangerous levels of SPM is a serious health hazard. Add to it the ill effects of smoking- and we have a double whammy. Studies are currently underway to analyze the effects of air pollutants on the brain arteries and also on cognitive functions, it will not be surprising if these studies prove a serious adverse impact on these parameters.

4. High Cholesterol Level

High cholesterol is one of the important risk factors for a brain attack. Early identification and prompt treatment certainly helps in preventing complications related to high blood cholesterol. Avoiding a high-fat diet, and regular exercise is crucial in preventing complications. One of the easy ways to identify cholesterol blockages in the neck vessels (atheromatous plaque) and narrowing of the brain arteries is by neurovascular sonography which includes a simple bedside duplex ultrasound monitoring of the neck vessels and transcranial doppler (TCD) monitoring of real-time flow in the arteries of the brain. This is not only easy to perform but is also cheap and does not involve any contrast exposure, is safe and non-toxic and can be repeated any number of times. It is recommended as a screening modality for those patients who have risk factors for stroke along with any symptoms like sudden onset transient numbness, weakness, speech problems, visual deficits, or giddiness. It is also a very convenient bedside test to follow-up patients with cholesterol plaques to ascertain whether the plaques are regressing, in which case, best medical therapy is sufficient. In case of any progression on serial testing (once every 3-6 months) despite best medical treatment and control of risk factors, interventional management (stenting) or surgical removal of atheroma (endarterectomy) is recommended.

5. Atrial Fibrillation

Atrial fibrillation is one of the most common under-recognised cause of stroke. It is a very common rhythm abnormality of the heart which increases in frequency after 70 years of age and also with underlying cardiac problems. Holter monitoring and loop recorder are important in identifying this condition. It is very important to identify this condition as this needs a stronger blood thinner (anticoagulants) to prevent strokes and other medications to ensure heart rate is under optimal control.

6. Sedentary Lifestyle

Finally, of-course the modern-day Ravana, which is none other than a sedentary lifestyle. A sedentary lifestyle is now among the top 5 risk factors for a heart attack as well as a brain attack. Hence the proverb, “Sitting is the new smoking.” Exercising for 30-45 minutes everyday, leading a healthy and active lifestyle prevents atherogenesis and hence cholesterol deposition and also clot formation. Our resolve should be to have a healthy diet, avoid junk food, exercise regularly, keep fit and maintain an active and healthy lifestyle. Also, quit smoking, cut down on alcohol, and routinely check blood pressure, cholesterol, and blood glucose and control them optimally to have a stroke-free life. Don’t bring the demons home – preventing a stroke is certainly better than treating it.