Today's Edition
TALAH TURK (ABU DHABI)
Strokes are the second leading cause of death globally and one of the top leading causes of adult disability. The UAE records between 9,000 to 12,000 strokes every year, both new and recurring, with more than half of those affected being under 45 years old — 20 years younger than the global average of 65, according to figures from the Sheikh Khalifa Stroke Institute (SKSI).
“The reasons behind these figures are not entirely known but it is multifactorial,” Dr. Victor Urrutia, Professor of Clinical Neurology, Director at the Johns Hopkins Hospital’s Comprehensive Stroke Centre, and Director at SKSI, told Aletihad in a recent interview.
He explained that uncontrolled risk factors like high blood pressure, diabetes, obesity, lack of activity, and smoking cause strokes. It could also be affected by other local factors.
“Different populations could have a greater risk of strokes. If you look at the US, for example, and divide the population along racial lines, there are differences in stroke incidences among people of different races. However, research shows that most of those differences are due to the distribution of risk factors. So, it’s less about genetic differences and more about the presence of risk factors,” he said.
Stress as a Contributing Factor
According to Dr. Urrutia, stress is one of the most popular topics that people bring up in conversations about strokes. He said that individuals respond to stress in different ways, urging people to make smart choices and opt for healthy outlets for stress. “Some people find that exercise helps them de-stress, which is a healthy response. While others start eating more, sleeping less, and exercising less, which is the unhealthy response.”
Dr. Urrutia noted that the effect of stress is accumulative and builds up over time. “So, if you struggle with stress over a long time and turn to unhealthy responses, that can eventually lead to a higher risk of a stroke,” he added.
Stroke Prevention
There are three types of stroke prevention, primordial prevention, “which is when somebody is healthy and wants to stay healthy”, primary prevention, “when the patient has some of the risk factors and wants to keep them in check”, and secondary prevention, “when you already had a stroke but want to prevent another one from happening”.
One of the methods shared between all kinds of prevention is the need for a healthy amount of physical activity. “What is being recommended right now is mild to moderate exercise at least 150 minutes a week. So, if you take a brisk 30-minute walk five days a week that would already have a positive impact on your health,” he explained
Another shared preventative measure is having a healthy diet. “A diet that is higher in fish. Ideally, three times a week… Three daily servings of fruit and two servings of vegetables. Go for vegetable oils instead of animal fats and limit your red meat intake to less than once a week. Generally speaking, incorporating more plant-based foods and avoiding processed ingredients will help you achieve the goal of reducing risk factors.”
In addition to cutting out unhealthy habits like smoking, vaping, and excessive drinking, Dr. Urrutia noted that there are several healthy habits worth taking on. “You must check your blood pressure regularly. Checking it once a year is fine for a young, healthy individual. Blood sugar should be regularly monitored as well.”
Finally, sleep is an important factor, which he noted is a weak point for a lot of people nowadays. While the amount of sleep needed differs from person to person, everyone should prioritise healthy sleeping habits.
Stroke Detection and Importance of Early Intervention
Symptoms of all types of strokes are the same, Dr. Urrutia said, noting that the patient would feel “sudden onset of weakness or numbness in the face, arm, or leg… on one side of the body. Speech problems are another sign. It could be slurred speech or issues speaking or understanding speech. Also, dizziness, difficulty walking, or a severe sudden headache.”
As soon as the symptoms are detected, the patient should be taken to the emergency room, ideally a hospital with a certified stroke centre, where there are protocols for stroke care.
The patient would either receive clot-busting medication to restore blood flow to the brain or undergo a surgical procedure to open the blood vessel.
Both treatment options are time-sensitive because early intervention for blocked blood vessels could significantly reduce the chances of having a disability. It is important to note that all stroke patients require some degree of rehabilitation afterwards, but if the intervention was quick, the rehabilitation process would be faster and more effective, Dr. Urrutia said.
Stroke Care in the UAE
Reflecting on his experience working in the UAE, Dr. Urrutia said: “The UAE, Abu Dhabi specifically, is very well-equipped for great stroke care. You have excellent doctors, excellent facilities, and excellent hospitals.”
He spoke about the start of SKSI, describing it as a “very generous gift” from the UAE government through the embassy in DC. “The gift was to create this institute for research to advance stroke treatment, care, and rehabilitation, as well as to implement research results in the UAE.”
The endeavour started in 2018, when Dr. Urrutia and his team came to the UAE, met the local leaders of stroke care, and started establishing the metrics and certifications for a stroke system of care. The ultimate goal is to have “certified hospitals at different levels across the country so that everybody has close access to a stroke centre”.
Aspirations for Stroke Care in Abu Dhabi
So far, there are three certified stroke centres in the UAE’s capital: Cleveland Clinic Abu Dhabi, Sheikh Shakhbout Medical City (SSMC), and Sheikh Tahnoun Medical City (STMC) in Al Ain. The plan is to develop other hospitals in Al Dhafra, Abu Dhabi, and Al Ain as acute stroke-ready hospitals, and align the emergency medical systems to follow the necessary protocols.
“Nowadays, the treatment of the stroke starts in the ambulance by the paramedics determining how severe the stroke is. If the patient had a big stroke, it would be better to transport him to a comprehensive stroke centre rather than the closest acute stroke-ready centre,” Dr. Urrutia explained. “Therefore, we need to work with the emergency medical services to refine protocols and have a better working system throughout the whole of the UAE.”
