Brain bleed: A dreadful nightmare

It is welcome news that man’s life expectancy is improving with the availability of modern life-saving and life-extending drugs in the medical armamentarium. However, a big threat which can lead to permanent disability or may even cause sudden premature death is the increasing prevalence of strokes, also known as brain attacks.

It is estimated that 22 percent of our adult population has high blood pressure (BP) defined as a BP of 140/90 or higher. When seen by a physician, more than half of these hypertensives already have complications in the brain, heart and kidneys, referred to as target-organ involvement. Less than 15 percent of these hypertensives are adequately controlled. Many are walking around with markedly elevated BPs without any symptom, until such time when they develop serious complications. They are what some would call as "walking time bombs" because anytime, they could figuratively succumb to a brain or heart attack. In many instances, stroke victims are not given a second lease in life. The first attack may be fatal. If not so, it may render one permanently disabled at the prime of his life.

Intracerebral hemorrhage or bleeding into the brain needs special attention because of its generally more serious outcome compared to other types of strokes. A massive bleed in the brain may cause severe swelling of the brain which can cause the patient to rapidly deteriorate and die, within 24 hours. Strong and active one day, comatose or dead the following day due to a massive brain bleed. Such is a not too infrequent sad story we come across in our neurology wards.

Better Understanding

Hence, we must try to conquer this medical menace both by preventive and modern therapeutic methods. A better understanding of this problem can put us in a better position to prevent and control it.

"Declare War against Brain Hemorrhage!" Such is the SONA-like call of the Stroke Society of the Philippines (SSP), composed of the country’s top specialists in the field of stroke. The SSP issued this call on the occasion of the forthcoming Brain Attack Awareness Week. Its highlight is the SSP’s Third National Congress, to be held at the Manila Midtown Hotel on Aug. 22-23, with the theme "Guidelines in the Diagnosis and Management of Hemorrhagic Stroke."

Why all the excitement about strokes in general, and brain hemorrhage in particular? Stroke is the No. 2 killer worldwide (with a total of five million deaths out of a total of 20 million annual strokes), and is actually the No. 1 killer here in Asia. In the Philippines, stroke occurs at the rate of 500 per 100,000 of the population, with about 25-30 percent of patients dying within one year, leaving the survivors with various disabilities and complications.

2 Types Of Strokes

There are two major types of strokes. The first (called ischemic stroke) results from blockages of the blood vessels supplying oxygen and nutrients to the brain, and the second (called hemorrhagic stroke) is caused by the rupture or "blowout" of a blood vessel, either within the brain itself (intracerebral hemorrhage), or near the thin, delicate membrane surrounding the brain (subarachnoid hemorrhage). While both types of stroke are quite dangerous, hemorrhagic stroke has double to triple the mortality of ischemic stroke, and thus, is the more lethal variety of the two. Clearly, an entire national congress dedicated to hemorrhagic stroke alone is a most welcome development for all health professionals.

The two-day congress will feature lectures on brain structure and function, as well as the pathophysiology, epidemiology, clinical presentation, and of course, the latest diagnostic and therapeutic, and rehabilitation modalities for hemorrhagic stroke. An important congress feature will be the afternoon workshops, which will attempt to set common Philippine standards for the diagnosis and management of this disease.

Short of attending the congress, the average Filipino can still do a lot in the field of prevention of both first and recurrent strokes. Preventive strategies include blood pressure and cholesterol reduction, smoking cessation, reduction in alcohol intake, weight reduction, treatment of diabetes, and of course, a healthy diet and exercise, all of which require the patient’s active participation and cooperation.

A healthy lifestyle is still the best preventive strategy. Unfortunately, getting the message across seems to be met with some cold attention and having it faithfully implemented is an even bigger challenge. The SSP and the CHARTER Foundation, as well as many professional organizations, join hands in ceaselessly promoting a healthy lifestyle.

Hemorrhagic strokes offer a particularly difficult challenge with regards to secondary prevention, because prior to 2001, there were absolutely no treatments that had been proven to prevent their recurrence.

Fortunately for stroke specialists and their patients, the recent PROGRESS study, announced in June 2001, indicated that the blood pressure lowering Perindopril-based treatment successfully reduced recurrent hemorrhagic stroke by up to 70 percent. Stroke survivors no longer have to live in fear of another brain attack, as new prevention and treatment strategies are constantly emerging, and organizations like the SSP do battle against this dangerous enemy.

For more details on the Stroke Congress, interested parties may call 723-0301 local 5143. Hopefully, with a better understanding and increased awareness of stroke and the risk factors that cause it, we can successfully implement lifestyle and other preventive measures to make sure that many high-risk patients will not end up with the sad fate of many victims of brain attacks.

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(CHARTER is the acronym for Clinical Hypertension and Atherosclerosis Research on Therapies, Epidemiology and Risk-management, a non-stock, non-profit research foundation which promotes healthy lifestyle practices in the prevention of many common medical problems. It joins hands with the Stroke Society of the Philippines in increasing awareness to prevent brain attacks and other cardiovascular complications. The author is a senior consultant on neurology at the Santo Tomas University Hospital.)