The silent killer

When a prominent person, and especially one who has earned general respect, is affected by a severe life-threatening disease, public awareness of the condition is raised. Such is the sad case of Karl Chircop, a beloved father, family doctor and politician, and also a personal friend and colleague, who at the age of 43 is still seriously ill as a result of a haemorrhagic stroke.

Most of us were shocked not only because he is such a well known and beloved personality, but also because we were reminded that we are all prone to all sorts of unexpected diseases that suddenly crop up threatening to end or permanently change our lives. Cynthia Busuttil (The Sunday Times, August 10) has very rightly alerted the public to the causes, consequences, possible outcomes and prevention of stroke.

There is a crucial point that I wish to add. At the very beginning of a stroke, there are warning signs, which, if recognised in time and treated with utmost urgency, can prevent or diminish many of the consequences, and increase prospects of recovery. The critical time available for effective emergency treatment is only about three hours, and people should be aware of the warning signs and the importance of requesting emergency help from the accident and emergency services.

There might not be enough time to call the family doctor first.

The first signs of an impending stroke are sudden difficulty in, walking, use of the hands, speech or vision. Numbness, confusion, and loss of balance are often accompanying signs. The sudden change is the most important aspect.

Indicative signs may be that the person cannot say or repeat a simple sentence coherently, walking becomes suddenly clumsy, there is difficulty in raising one arm, or there is sudden blurring of vision or double vision. The symptoms may occur together or separately, and vary with the region of the brain that is affected.

Emergency investigation will determine whether there is blockage of or bleeding from an artery. Emergency treatment with medicines that break down obstructing blood clots (e.g. tissue plasminogen activator) instituted within three hours of the first symptoms has been shown to be effective in reducing subsequent disability and mortality. Surgical treatment to stop bleeding from an artery may also be possible and could also prevent more extensive damage.

Of course, early recognition and intervention are not always possible, because the blockage or haemorrhage may be very sudden and extensive.

In many cases, however, the silent killer is not so silent and if one heeds the early warning signs, there are good prospects of saving lives and preventing lifelong disabilities.

Together with increasing public awareness, it is essential to ensure that the health service is adequately prepared to deal with such emergency situations.

It is possible to decrease the mortality and disability outcomes of cerebro-vascular accidents by an educated public and emergency intervention.