“The faster a stroke case is treated, the better the prognosis”

Specialists agree that a stroke it is just the tip of an iceberg of other health problems the person may have. That is why it is important that patients receive timely and adequate care after suffering this kind of episodes.

The cerebrovascular accidents (CVA) They are the second most common cause of death in the world. In Peru, up to 19.6% of premature deaths are associated with this disease. El Comercio spoke with Manuel Moquillaza, interventional neurologist and coordinator of the Neurology Service of the Ricardo Palma clinic, to learn more about this health problem.

— Is a cerebrovascular accident (CVA) the same as a stroke?

There are two kinds of stroke: ischemic, when the artery is clogged; and hemorrhagic, when the artery ruptures and the brain is flooded with blood. The latter is popularly known as a stroke. We doctors prefer to call them brain hemorrhages.

— Are hemorrhagic strokes more common?

These cerebral hemorrhages only account for 15% of all stroke. In the remaining 85%, the artery is clogged and this is what has become increasingly prevalent associated with COVID-19. For example, COVID-19 has been shown to increase the prevalence of stroke not only by producing an inflammatory response in the lungs, but also in the brain. Brain hemorrhages also increased.

— What factors increase the risk of suffering a stroke?

The lifestyles. We have become very sedentary, we gain weight, we stop exercising. Our diet has become less and less selective.

“In Peru there are only three certified centers for the care of cases of cerebrovascular accidents.”

— What are the most common signs to identify that someone is suffering from a stroke?

There are three symptoms that are the most frequent in a stroke, whether it is ischemic or hemorrhagic. First, dysarthria or difficulty articulating words. The second is facial asymmetry, also known as palsy. This must be evaluated yes or yes in an emergency center. A patient with facial paralysis should not think that it was because he gave him air or “had anger”. Just as in cardiology all chest pain should be considered a heart attack until proven otherwise, here too that paralysis is due to a stroke until proven otherwise. The third symptom is hemiparesis, or decreased strength in one half of the body. These three symptoms represent between 81% and 83% of the symptoms that a patient with stroke presents. In the US, these have been widely disseminated, forming the Cincinnati scale. At the Ricardo Palma clinic we use it to inform our patients.

— It’s because in ACV cases time is very valuable…

It is estimated that, in a patient suffering from a stroke, two million neurons die every minute. It is not the same to treat someone who suffered it an hour later than someone who had it 10 or 14 hours later. The good news is that we can now treat an ischemic stroke for up to 24 hours after it occurs. In 1996, for example, they could only be treated, at most, up to three hours after the event. However, having this extended window of care does not mean that we must wait 24 hours to treat a patient. The sooner you receive care, the better the results, prognosis, and functional independence will be.

— After identifying these signs, go to the nearest hospital…

Yes, but it is much better to take it to a specialized center and it is better to have them identified. In Peru there are only three centers with the Essential Stroke Center certification –granted by the World Stroke Organization– for having adequate training, quality treatment and good practices in the care of patients with stroke. These are the National Institute of Neurological Sciences, of the Minsa; the Rebagliati hospital, from Essalud; and the Ricardo Palma clinic, in the private sector.

— What other types of sequelae can a stroke leave behind?

Vascular epilepsy, when there is a brain lesion, generally in the temporal lobes, which can produce epileptic discharges. Also vascular dementia. Between 7% and 8% of patients who have suffered a stroke develop dementia or, at least, a more frequent cognitive deterioration.