One in four of us will have a stroke in our lifetime. Sometimes it leaves no escape, those who survive find themselves with more or less disabling outcomes. These cognitive and motor deficits are followed by other long-term complications such as a doubled risk of developing dementia. Stroke, whose world day is celebrated on 29 October, it is the second cause of death globally and the third in Italy, after cardiovascular diseases and tumors. Thanks to advances in medicine, more and more people are surviving it and, therefore, it has also become the first cause of disability and the second cause of dementia. In Italy, almost 100,000 Italians are affected every year and currently there are around 1 million people who have had a stroke and survived. An increase of 26% in the number of people affected is estimated in the near future, with rising costs and organizational difficulties for an aging society.
No one can say they are safe, not even young people. But nine out of ten cases could be prevented by addressing certain risk factors, as he explains the voluntary association representing people affected by stroke and their families ALICe. Italypromoter of the World Day in Italy World stroke day whose slogan is #PiuFortidellIctus (#GreaterThanSktroke) and very active in communicating and raising awareness about this neurological emergency in the belief that the more information citizens have, the greater their ability to prevent and assert the right to treatment.
What is a brain stroke
Cerebral stroke is caused by the sudden obstruction (ischemic stroke) or rupture (hemorrhagic stroke) of a vessel; the damage to brain cells is due respectively to ischemia, i.e. the lack of oxygen and nutrients brought by the blood, or to compression due to hemorrhage. In both cases, the time elapsed from the event to treatment has a decisive role on the prognosis in terms of mortality and motor and cognitive disabilities.
9 out of 10 cases are avoidable
«In the case of ischemic stroke, the most important modifiable risk factors are hypertension, smoking, alcohol, atrial fibrillation, obesity and sedentary lifestyle. In the case of hemorrhagic stroke, they are in order hypertension, smoking, alcohol and substance use” explains Danilo Toni, professor of neurology at Sapienza, director of the neurovascular treatment unit of the Policlinico Umberto I in Rome and president of the technical-scientific committee of ALICe. Italy.
Sedentary lifestyle, diet and smoking
Worldwide, every year one million strokes are attributable to physical inactivity. By moving adequately and regularly the risk decreases considerably: 30 minutes of activity five days a week reduces the risk by 25%. A person who smokes a pack of cigarettes a day is six times more likely to have a stroke than a non-smoker. If you are a smoker, remember the world organization, Quitting gives a reduction in risk to you but also to those who, although non-smokers, live with you. Furthermore, the literature confirms the main role of nutrition in the primary prevention of stroke: you need a balanced diet and pay attention to the consumption of processed red meat, refined foods, sugars and saturated fats, alcohol and sugary drinks.
Beware of hypertension
About half of strokes are associated with high blood pressure, a silent killer. «Systolic blood pressure levels constantly above 145-150 mmHg and diastolic blood pressure levels constantly above 90 mmHg oland two conditions together may not cause symptoms but” explains Toni “in the long run they damage the vesselsfirst compromising the smaller ones and then, often in conjunction with hypercholesterolemia, smoking and alcohol, damaging the carotid and vertebral arteries.”
Young people are not safe
A recent appeal was launched by the Italian cardiologists of Sic, concerned about the too many hypertensive young people in our country (14% of under 35s already have blood pressure above 120/80 mmHg, up to 4% of children aged 6 to 11 have altered values). Attention to this aspect e the need to be rigorous in respecting blood pressure values is shared by vascular neurologists who also attribute the numerous youth strokes they treat to this situation. «In the age group between 18 and 50 years, approximately 4,500 new cases are recorded in our country every year, almost double those relating to multiple sclerosis, a neurological pathology that exclusively affects the young age group” explains Toni. «This is also attributable to that silent because asymptomatic killer that is hypertension, in addition to the spread of traditional incorrect lifestyles already mentioned, but also to the consumption of drugs, which contribute to an increase in cardiovascular risk». Furthermore, in young people, the events are more serious, often haemorrhagic in nature, the outcomes are very disabling, as are the damages for the individual in terms of personal and working future and for society. It is important to make the size of the risk we run when talking about bad lifestyles clearly perceived and to teach prevention.
Stroke Units and rehabilitation
Finally, it should not be forgotten that, alongside the acute problems, stroke has medium and long term consequences. «The improvement of the clinical outcome, both in ischemic and haemorrhagic cases, is associated with the patient’s referral to a highly specialized center» explains Toni. On the one hand, there is the reality of the uneven distribution of neurovascular units (stroke units) on Italian territory: only 22% are located in Southern Italy, with 45 structures, while the Center of the country hosts 26%. In the North, however, 52% is concentrated, with 108 units, as shown by a survey by the Italian stroke association Isa-Aii on 208 centers in the country. On the other hand there is also the problem of beds here. Yet, following acute surgery, only 20-30% of patients are discharged. The others require more or less complex rehabilitation depending on the case: «We manage to take care of a significant number of ischemic strokes, many fewer haemorrhagic ones, to which we should pay more attention, for timely and appropriate management by the emergency room , to the stroke unit, to the subacute phase”.
Life after stroke
Professor Toni also intervenes in the docu-film Facing Challengesand, Life after Stroke (Rising to Challenge, Life After Stroke) promoted by Ipsen on the importance of post-stroke rehabilitation, where it is recalled that the greatest economic and social burden is due to the development of post-stroke complications, including of which the spasticity that occurs a few months after the event and, unfortunately, as the professor confirms, “is often not diagnosed and this prevents many patients from accessing the necessary care”.
The opening photo is by Isi Parente from Unsplash.
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