Stroke is a medical term which literally means a certain part of one’s brain dies because it goes without blood for too long. This can happen when the blood supply to a part of the brain is interfered with, commonly caused by either; a clot forming and blocking the blood vessel carrying blood to that affected part of the brain, or bursting and bleeding of a blood vessel supplying the affected brain portion. This leads to cutting off the supply of oxygen and nutrients, causing damage to the brain tissue. A modern CT (Computed Tomography) scan machine at Rwanda Military Hospital. / Photo by Lydia Atieno. According World Health Organization, stroke is the second leading cause of disability. 15 million people worldwide suffer a stroke every year and nearly six million die and another five million are left permanently disabled. There is a general increase in stroke incidence rates in low income countries and in fact over the last four decades, the stroke incidence in low- and middle-income countries has more than doubled, and on average occurs 15 years earlier in these low and middle income countries, whereas the stroke incidence has declined by 42% in high-income countries in this same time period. The damage from a stroke may be temporary or permanent. A person’s long term outcome depends upon how much of the brain is damaged, how quickly treatment begins, and several other factors. There is no single known condition that will cause one to suffer from a stroke, but certain situations have been identified to increase one’s risk of suffering from a stroke in life, and include; age older than 40 years, having a heart disease, poorly controlled high blood pressure, smoking, poorly controlled diabetes, high blood cholesterol levels, recent childbirth, inactive lifestyle and lack of exercise, obesity, current or past history of blood clots and certain medicines such as warfarin (usually prescribed to treat clots in legs, heart and lungs). Signs and symptoms of stroke often develop suddenly and then may temporarily improve or slowly worsen, depending upon the type of stroke and area of the brain affected. Sudden occurrence of symptoms like; weakness of the face, arm or leg, especially on one side of the body, confusion, trouble speaking or understanding, trouble seeing in one or both eyes, trouble walking, dizziness, loss of balance or coordination, severe headache with no known cause are highly suspicious of a stroke. These symptoms should never be taken lightly once experienced as they could signal a potential life threatening stroke. Early proper medical diagnosis and intervention is the cornerstone of recovery from a stroke. Previously, the proper diagnosis of certain forms of strokes and ability to distinguish it from other conditions with similar symptoms was a burden to medical personal in low income settings. Medical equipment such as CT SCAN, which is a main investigation required for detecting the presence of the stroke and whether the stroke is due to a bleed or a clot in the brain weren’t easily accessible due to their less availability and high costs to the patients and this had a negative impact on stroke management because the type of treatment highly depends on the specific cause of the stroke and in fact if someone whose stroke is due to a bleed in the brain is given the same treatment as the one for a stroke due to a clot, the patient’s condition usually worsens. However, currently these equipment are more available to us, and coupled with the availability of many medical health insurances policies in Rwanda such as Mutuelles de Sante, Military Medical Insurance (MMI), RAMA and many other health insurance providers country-wide which greatly cover these which would be costly investigations to low income earners, thus, the current timely diagnosis and proper intervention for patients with stroke has come with a lot of better patient outcome, with great to full recovery from stroke episodes to many. The CT scan of the head helps to identify the exact location of the stroke in the brain, presence of any brain abnormalities such as brain tumors, infections and is highly covered by many medical insurances available country-wide. Patients can get the scan for not less than Rwf5,000 with Mutuelles de Sante, and about Rwf10,000 with MMI or RAMA insurance policies and full cost coverage with some private health insurance, which is a great reduction from more than Rwf80,000 without any health insurance coverage. At MMI, CT scan services are available 24 hours since they are normally needed in emergency medical situations. Once the diagnosis of stroke has been made and the exact cause identified, there are medicines which can be given to dissolve the clot and prevent formation of new clots if the stroke is due to a clot in the brain, and medicines to reduce bleeding in the brain if the stroke is due to ruptured blood vessel in the brain. In severe cases, surgery can be performed to minimize the effect of the bleeding into the brain. Physiotherapy is always done to help in gradual recovery and return to normal body functioning. Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospitaliangashugi@gmail.com
