Stressful life may increase the risk of stroke

Maria Endah Hulupi, The Jakarta Post, Jakarta

Hendra, 35, was a very energetic, hard-working businessman. He was a good tennis player and often played tennis with his friends on Sunday mornings, a weekend activity which he said soothed his stress.

Earlier this year, his parents and friends were shocked to hear the news that Hendra had passed away after a sudden collapse on the tennis court. A family doctor said that he died of a stroke.

"A stressful lifestyle which includes heavy responsibility, debts and targets one cannot cope with would increase one's risk of stroke," said the chairman of the Indonesian Neurologists Association (Perdossi), Samino.

"This situation would induce stress, increase the adrenaline level, make one's heart beat faster and in turn would eventually contribute to cardiovascular problems. This condition can increase a person's risk of stroke or cardiac diseases," Samino added.

A few decades ago, he claims, strokes generally occurred to people aged 50 and older but now the disease also increasingly attacks people in their mid-30s.

Samino explained that a stroke is a vascular problem, which hinders blood flow to the brain depriving it of essential oxygen and nutrients. "It happens spontaneously and persists for 24 hours," he said during a seminar on endovascular surgery at Siloam Gleneagles Hospital recently.

He said strokes are a result of clogging and hemorrhaging in the brain. "Usually a hemorrhage stroke occurs during an activity, but the stroke due to clogging usually occur at night or in the morning," while people are resting.

Clogging occurs when plaque builds up in blood vessels in or leading to the brain that have already been damaged by arteriosclerosis. However, a blood clot can also form in the heart and travel along the vessel and finally, nest in the brain.

This clogging would block blood flow, carrying oxygen to the brain, and leading to brain cell death within minutes. "When an area of the brain doesn't function, body parts related to it cannot function either," he said.

Hemorrhage stroke can be caused by several factors, including head trauma, ruptured Arterio-Venous Malformation (AVM) or defective arteries in the brain which leads to a ruptured aneurysm. An aneurysm is a bulging blood vessel formed due to a weak artery wall. Aneurysms generally are difficult to detect and usually have no symptoms until it ruptures, and at that point it is usually fatal in a very short time.

People at high risk for stroke are those with high blood pressure (hypertension), cardiovascular diseases, diabetes mellitus, dislipidemia, and infections such as syphilis. Prior research indicates that 70 percent of stroke sufferers have hypertension, 20 percent have cardiovascular problems and 20 percent diabetes.

"However, normal people with bad habits like smokers, alcoholics, drug users and overweight people are also very high risk," he said, adding that all these conditions can lead to vascular problems.

Samino added that age also plays a role in the onset mainly because the aging process can lead to arteriosclerosis.

He said common symptoms of a stroke can include coordination problems, partial memory loss and some sensory loss. It may also hinder the patient's ability to talk and swallow, depending on the part of the brain damaged by the stroke.

The American Heart Association indicates that warning signs of a stroke may be a sudden numbness or weakness in the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination and sudden severe headaches with no known cause.

Among other neuro related diseases, Samino said, stroke is a major cause for disability and once a person experiences a stroke, he has a 30 percent chance to get the second attack within the next 12 months.

Treatment for an acute stroke, he said, was aimed at preventing death, minimizing brain defects and preventing the onset of other illnesses due to prolonged immobilization, such as pneumonia, bed sores and falling down.

Stroke can be treated by micro surgery, open surgery or both.

Micro or endovascular surgery -- a procedure that requires inserting a micro catheter from the vessels on the femur or thigh and directing it to the lesion area in the brain -- can be done to release a coil and/or a small balloon to protect the aneurysms against rupture and to insert stents to create space for the artery. While, the open surgery can be performed for decompression, hematome evacuation and to insert a metal clip around the base of aneurysms to prevent it from bursting.

As for prevention, treating or managing hypertension, diabetes mellitus and cardiovascular diseases with related internists are very important.

It is also necessary to change bad habits and eat a healthy, high-fiber, low-fat diet to reduce cholesterol and to become or remain physically active.