Early intervention and quick action key to reversing stroke symptoms, UAE specialists say

Dubai: One person is suffering from stroke every hour in the UAE. On an average, there are 10,000 to 12,000 strokes occurring annually. This calls for an urgent need to create better awareness, say leading stroke specialists in the country.

Ahead of World Stroke Day on October 29, Dr Sohail Al Rukn, president of Middle East and North Africa (Mena) Stroke Organisation and the president of Emirates Neurology Society, told Gulf News: “While stroke remains the second leading cause of death worldwide, it is important to note that in the UAE, the incidence of stroke occurs in people ten years younger. While the world average is between 55 and 60 years, in the UAE, people as young as 45-50 years or even younger experience stroke episodes. That is owing to several causes such as obesity, high incidence of lifestyle-related conditions such as cardiovascular diseases (CVD), diabetes, hypertension and high cholesterol levels.

In addition, smoking and stress too are major contributors in accelerating strokes. It is possible to prevent strokes with early screening and in the eventuality of a stroke episode, quick action can help.”

Quick intervention can reverse symptoms Take the case of 31-year-old Ritzy Madrid Ungson, a Filipina expatriate working as a secretary in a logistic company in Dubai. Ungson, the mother of an eight-year old daughter, had a history of hypertension, diabetes and stroke. Ungson recounted: “This happened in the second week of September 2021. In the morning, I had experienced some palpitation and had gone to a local hospital for a check-up. The doctors there stabilised me and I was back home in the late afternoon, resting on the living room sofa. My daughter was playing in the next room, when I suddenly felt a debilitating weakness on the left side of my body. So much so, that I was totally immobilised. I was unable to call out to my daughter or dial a number. I barely managed to send my sister, who lives in the neighbourhood, a picture of mine.”

Ungson’s sister, who rushed home, somehow got the daughter to open the door. She had already called the ambulance and within eight-ten minutes, the paramedics arrived. They recognised the classic stroke symptoms while checking her vital parameters and rushed her to the emergency section of City Hospital, Dubai, where Ungson underwent a CT scan within 20 minutes of the stroke episode.

Dr Al Rukn and Dr Pappa Rosario, consultant neuro radiologist who conducts interventional neuro endovascular procedures, ascertained that the patient had suffered acute right cerebral Artery occlusion. Further brain scan and contrast CT scan confirmed that there was no major bleeding, but acute occlusion on the right side of the brain. Dr Al Rukn added that the patient was administered a blood thinner and Dr Rosario carried out the mechanical interventional thrombectomy at the CATH lab. Since the procedure was carried out within a few hours of the episode, it helped and as soon as the occlusion was cleared, the patient regained her movement and speech on the procedure table itself.

After the procedure, Ungson underwent a comprehensive rehabilitation programme for physical, speech and occupational therapy and was able to report to the hospital after three weeks, walking on her own and showing minimal neurological deficits.

Time is of the essence in stroke management and if a patient’s symptoms are to be reversed, the shorter the time to treatment from the episode the better. Dr Naseem Palakkuzhiyil, Neurology (specialist), Aster Hospital, Al Qusais, Dubai, explained: “Every second counts. Almost 85 per cent of stroke cases are caused by blocked blood vessels and for every minute the vessel remains blocked, 1.9 million neurons die. The golden hour of 60 minutes, from occurrence to treatment, is essential to avoid brain damage, disability and fatal outcome. By being aware of the different signs and symptoms of occurrence of stroke, one can call for emergency medical help in time."

Dr Chelladurai Pandian Hariharan, Neurosurgery Specialist at Aster Hospital, Qusais, added: “If not treated in time within the golden hour, it can cause disabilities like paralysis, sensory impairment, speech problems among others and death. The good news is that, if we are following good health habits such as regular exercise, healthy food habits and if we avoid stress, then serious complications can be avoided — if treated within the golden hour.”

Smoking, a sure shot trigger

A case in point is that of Gerardo Cordero, a 57-year-old Filipino expatriate and Abu Dhabi resident. On September, 26, 2021, Cordero, a habitual smoker, collapsed to the ground at 7.10am while brushing his teeth one morning. His son heard him fall and noticed that his father’s left side was paralysed and he was unable to speak. An ambulance was summoned and Cordeiro was rushed to the Stroke Centre at Cleveland Hospital, Abu Dhabi.

Recounting his case, Dr Syed Irteza Hussain, chair of Neurology at the hospital, said: “Upon arrival, our in-house stroke neurologist quickly recognised the symptoms and facilitated a rapid sequence evaluation of his brain with a CT scan. Doctors discovered a very large clot blocking his carotid artery that supplies blood flow to the right side of the brain. The patient was given a clot-busting medicine within 37 minutes of his arrival, to dissolve the clot immediately and was rushed to the operating room to remove the clot within a couple of hours.

” This prompt action not only reopened the blocked vessel within 90 minutes of arrival at the hospital, but restored normal movements in the patient, said Dr Hussain. The stroke was triggered by a plaque build-up in the patient’s carotid artery, owing to his smoking habits. Cordeiro underwent a stent placement in the right carotid artery during hospitalisation and has recovered from the functional deficits caused by his stroke very quickly.

Dr Hussain added that the patient is actively engaged in rehabilitation programme right now and has undergone rigorous physical and occupational therapy, which helped him resume work.

Reversing symptoms at an advanced age

The Abu Dhabi Health Services Company (Seha) has also been very actively treating stroke patients and the speed and alertness has made a qualitative difference to the life of stroke patients even at an advanced age. Take the case of 68-year-old Haris Babic, a Bosnian expatriate who arrived at Tawam Hospital with classic stroke symptoms. A CT scan confirmed there was no internal bleeding and the patient underwent a CT angiography, which detected the blockage in the left middle cerebral artery of the patient.

The patient underwent a catheterisation procedure at the hospital’s interventional radiology department to remove the clot. Dr Jamal Aldeen AlKoteesh, head of Radiology and Consultant of Interventional Radiology at Tawam Hospital, remarked: “The cerebral catheterisation procedure through interventional radiology has become necessary to deliver the best outcomes for patients. This is because traditional medication does not work in all cases, particularly if a patient arrives three or more hours after having symptoms or if he or she has experienced a stroke while asleep.” Babic was discharged days after the procedure in stable condition.

Speaking about the recovery for stroke patients, Dr Hala Abuzeid, Critical Care consultant and head of the Intensive Care department at Tawam Hospital, had a word of caution for all: “One in four people will suffer from stroke, but most cases can be prevented by following a few simple steps. To reduce the risk factor, it is highly recommended to exercise five times a week, eat a healthy balanced diet, reduce blood cholesterol, maintain a healthy body weight, quit smoking and control stress and depression levels.”

Dos and Don’ts to avoid strokes

Dr Robert Pineiro-Bolano, consultant neurologist at the Fakeeh University Hospital, Dubai listed out the essentials:

• Take steps to control obesity.

• Give up smoking. This is a major risk factor when arteries and veins narrow and trigger blood clots.

• Adopt a strict control of cardiovascular risk factors (blood pressure, blood sugar, etc) under medical supervision, especially if there is a genetic history of stroke in the family.

• Follow an active lifestyle by including at least 45 minutes of physical exercise daily. • Adopt a healthy diet, which balances the micro and macronutrients and is rich in dense and complex carbohydrates.

• Avoid processed and tinned food high in salts, trans fats and added sugars.

• Sign up for regular health check-ups where stroke inducing factors such as cholesterol, hypertension are regularly screened. If there is any need of medication to control the factors, the doctor can prescribe it sooner than later.

• If you experience a stroke episode, early intervention is crucial. Report to the emergency of an acute stroke management hospital where doctors can screen and take quick decision for reperfusion with thrombolysis and/or thrombectomy (mechanical removal of the clot). This is crucial to reduce the disability impact of stroke, followed by long-term treatment with anti-platelets or anticoagulation medication.