11 February 2009

Brain attack!

Stroke is the third most common cause of death in South Africa and it is on the increase.

The incidence of stroke is increasing in South Africa. Stroke is the third most common cause of death in South Africa (after only heart disease and cancer), and the leading cause of adult disability. Between 13% and 30% of stroke patients are young adults 15 – 49 years of age. Yet the myth persists that stroke is “just an old person’s disease”.

Prof Vivian Fritz, chair of the Southern African Stroke Foundation (SASF), says that stroke awareness amongst both the public and the medical fraternity is very low, exacerbating the impact of the disease.

“We have a horrendously high death rate from stroke, which is a direct result of the general lack of awareness of the risk factors which can lead to a stroke. In addition, many people are ignorant of the warning signs and symptoms of a stroke, and wait too long before seeking treatment,” said Prof Fritz.

The South African Stroke Guidelines describe stroke as the “Cinderella” of major health issues in South Africa. Historically, the disease was not tackled as an independent health issue despite the fact that it causes:

  • Between 8% and 10% of all reported deaths in this country,
  • 7.5% of deaths in the workforce (25-64 years of age),
  • Age-standardised mortality rate of 125-175 per 100 000 patients.

Stroke defined
A stroke is the result of a bleed or a clot in a blood vessel in the brain. The cause of a stroke is remarkably similar to that of a heart attack, leading neurologists and other medical specialists working in the field to refer to stroke as a “brain attack”.

Up to one third of all strokes are fatal. A previous stroke or TIA is one of the most important stroke risk factors. “It is vitally important that we determine the cause(s) of a TIA or stroke in each individual patient in order to prevent a second stroke. It is obviously easier to target patients who have already had a stroke and recovered (secondary prevention) than to target the whole population (primary prevention),” said Prof Fritz. She added that all risk factors especially embolic sources, e.g. atrial fibrillation or tight carotid artery stenosis, should be identified and treated in patients who have shown good recovery from a stroke.

Risk factors
Some risk factors can be changed, others not.


  • Age
  • Gender
  • Race
  • Familial history of stroke
  • Geographic location


  • Hypertension
  • High cholesterol
  • Cigarette smoking
  • Obesity (Body Mass Index (BMI) >25; BMI = mass (kg) divided by length squared (m2))
  • Diabetes Mellitus
  • Lack of exercise
  • Poor nutrition (a diet high in fat and salt)
  • Drug abuse (alcohol, cocaine, heroin)

Dr Wiebren Duim, a neurologist in private practice in Pretoria, emphasised the devastating impact of stroke when pointing out how important it was for individuals to take control of their health and monitor potential risk factors.

Of those patients who survive a stroke:

  • 12%-18% will be unable to talk properly
  • 22% will not be able to walk
  • 32% will be clinically depressed
  • 48% will be paralysed on one side of their bodies, &
  • 24%-53% will suffer complete or partial dependence on their families and caregivers

Yet, the risk of stroke can be minimised, by paying attention to the risk factors, seeking appropriate medical help, and living a healthy lifestyle.

“Stroke is on the increase because we are living increasingly unhealthy lifestyles. If you want to reduce your risk of having a stroke, monitor your blood pressure to prevent hypertension, stop smoking, lose weight, eat healthy foods, and walk to the corner café rather than drive. It is particularly important if you are over 40 years of age to have your blood pressure checked every six months,” said Dr Duim.

Warning signs
There are five major warning signs that indicate you may be having a stroke:

  • Sudden weakness or numbness of the face, arm, or leg on one or both sides of the body
  • Sudden blurred or decreased vision, especially in one eye, or double vision
  • Sudden difficulty speaking or trouble understanding speech
  • Sudden severe headaches with no known cause
  • Unexplained dizziness, unsteadiness or sudden falls

Time is of the essence
Another myth surrounding stroke is that there is nothing that can be done about it; that once you have had a stroke, there is nothing you can do except suffer the consequences. Not true.

Dr Duim stressed that time is the most critical element in treating a stroke: “Do not ask your mother or your best friend or the guy down the road for their opinions. If you experience any of the warning symptoms, get to a hospital that has a Stroke Unit immediately. Treatment within the first three hours can significantly reduce the area of brain tissue damaged in the attack, which in turn could have a major impact on whether you will learn to walk again, speak properly again. In short, the sooner you are treated, the better your chances of recovery.”

Both Prof Fritz and Dr Duim stressed that proper care and attention made a significant difference to a patient’s chances of survival and recovery. Stroke is best treated in a Stroke Unit, where the medical team is familiar with the symptoms and treatment needs of the disease. “Proper care is dependant on knowledge. For example, blood pressure rises in a stroke patient, but it is important not to try to lower the blood pressure immediately. Hypertension control should only start some three weeks after the stroke,” said Prof Fritz.

Prof Fritz added that it was important for stroke patients and their families to approach rehabilitation positively and do everything that could be done. “One third of all stroke patients recover fully and many more are able to resume normal day-to-day activities. There is hope after a stroke,” she said.

For further information, contact: The Stroke Information Line – 0861 101066

The Heart and Stroke Foundation South Africa


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Stroke Expert

Dr. Ashleigh Bhanjan is a specialist neurologist at the Life Entabeni hospital in Durban. Dr. Bhanjan completed his internship at Johannesburg General hospital and his community service at Ladysmith Provincial hospital before qualifying as a Fellow of the College of Neurologists of South Africa in 2008. Since 2009, he has been practicing at the Life Entabeni hospital as a specialist neurologist with a particular interest in stroke neurology.

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