Professional information website of Professor H. Bakunts

Stroke: how to repulse it.

Sobesednik, Armenia N2, January 2013, pp.18-19

Stroke is the acute dysfunction of brain blood circulation, rupture, spasm, embolism of one of brain vessels. A consequence may be the loss of essential functions- consciousness, movement, speech, swallowing, breathing, heart functioning, etc.

According to WHO, in 2005 stroke has become the cause of nearly 6 million death cases, which is nearly 9,9% from the total number of deaths in the world. More than  85 % of cases are in the developing countries. 50 % increase in number of strokes is supposed till 2050.

About what causes stroke, who involves in the risk-group and are there ways of guarding against this terrible disease, we talk with Henry Bakunts- MD, Professor, the Head of the Clinic of Angioneurology in the Medical Centre “NAIRI”, the Head of the Department of Angioneurology in Yerevan State Medical University after M.Heratsi. In the extensive monograph of H.Bakunts “The endogen factors of cerebral stroke” published in 2011 in Moscow are summarized the results of his research of many years in the area of stroke diagnosis, treatment, mechanisms of formation and prevention. The monograph has had a broad resonance and was positively evaluated by medical community in Russia. Particularly, according to the Head Neurologist of Ministry of Healthcare and Social Development, Academic E.I.Gusyev, the monograph of Professor H.Bakunts should be evaluated as a fundamental work which brings a considerable contribution to the essential problem solving of cerebral stroke and it can by right be included in the number of scientific works which predetermine perspectives of development of contemporary study of stroke”.   

- H. Bakunts, in 29th of October 2004 the World Healthcare Organization announced stroke a global epidemic. How is explained the fact that this ailment is rapidly spreading and growing young?

Every 6 seconds someone dies of stroke, the number of patients with stroke is 15 million in a year, 6 million of them are not to be cured which means that mortality amounts to 30 %. At the moment about 30 million people in the world need rehabilitation. It is really a serious problem and an absolute disaster for the society. After all stroke leaves behind infarction by lethality. In England every 4 minute people have stroke one third of whom die. In Sweden within its population which amounts to 9 million people is registered 30 thousand strokes a year. In the USA with its well-developed medicine, 41% of patients with stroke die, 52% become invalid. Only 7 % of patients are completely rehabilitated. In the case of myocardial infarction lethality is also rather high, but if you come through it you’ll not become an invalid. Thus, stroke is not only a medical but also a social problem connected with an abrupt deterioration of patient’s life who became an invalid at the result of stroke, the change of family relations, government expenses etc. The data is cited that material expenses for treatment and social assistance of these patients in the USA amounts to more than 50 milliard USD a year. The most sorrowful fact is that there is observed a tendency of growth in the number of stroke patients in the whole world. It is connected with the reduction of overall living standard, the fact that it became tougher, tensed, with the growth of social problems, especially in the countries of Eastern Europe, the former USSR republics where the population has undergone the change of formations. Look, in Armenia we have a great number of disjoint families- men have to leave for other countries in search of a job, and this all, for sure, has its negative influence on health state of people. The provoking factors have grown. According to the data of WHO during 1985-2004 Armenia was in the first row in the world by the growth rate of mortality in the result of stroke. 

- Isn’t it possible to somehow prevent the development of this disease?

Healthy life-style is the main preventive measure from all diseases, stroke included. No medicine will replace movement, but movement replaces all diseases. A patient should watch over his/her weight, stop smoking, limit alcohol consumption, stop using fatty and salty foods, put herbal products to ration which are rich in potassium, magnesium and other trace elements. For sure, there may be cases when the young who lead a healthy lifestyle and even the sportsmen have stroke. This is already a congenital pathology of brain vessels, brain aneurism with high lethality. That’s why it’s important to have preventive checkups especially for people with frequent headaches, other subjective complaints that are within the competence of neurologist. People in the risk-group should consult in health facilities and pass a proper checkup especially when the modern medical and diagnostic capabilities give us the opportunity to establish an accurate diagnosis, reveal aneurism and eliminate it.

- What are the risk factors of having stroke?

Nowadays we know more than 20 risk factors of rise and development of stroke. We should note that the risk factors can be modified and unmodified. There are 4 unmodified risk factors: age, gender, ethnicity and compromised heredity. Medicine can not influence on these factors but we should take them into consideration when evaluating the overall risk. The modified factors are: arterial hypertension (the main factor), atherosclerosis, myocardial infarction, fibrillation, pancreatic diabetes, adiposity, hyperlipidemia (increase of cholesterol level in blood), smoking, chronic inflammatory diseases, drug addiction, adynamy etc. In general the modern directions of stroke preventive methods are based on the fact that a patient with a variety of risk factors can run the risk of disease development in more cases than in the case of one but pronounced risk factor.   

- You have mentioned gender among the risk factors. What can this mean?

The risk of stroke development is higher in men than in women, but the data of modern studies testifies to the leveling of these factors. To the point, in cases of “female” stroke Armenia ranks second in the world. This is connected with the fact that the main load (especially psychological) in our families falls on women.          

- Is there a chance of full recovery after stroke?

Stroke is an acute brain blood circulation disturbance. The earlier we start the therapy the less irreversible changes will be. The concept “time-brain” means that the help in stroke cases should be urgent to bring to the minimum the delay of patient transportation. Stroke like myocardial infarction and injury is an urgent condition. The chances of recovery of a patient rise sharply in the case if s/he is taken to hospital during first three hours after stroke. Nowadays we have medications, the so called endogenous thrombolitics, that help to dissolve fresh thrombus, but they can be used intravenously only during first 3-4 hours after stroke. Unfortunately, in Armenia cases when patients with stroke are quickly taken to hospital are rather rare, usually they are tried to be treated at home. As a rule patients also come to hospital on the 3-4th day after having stroke because of worsening of state. Often it is conditioned by the fact that medical care of stroke patient requires payment and the treatment is rather expensive. Medical insurance can solve this problem, but it involves only 30% of Armenian population. Stroke treatment is expensive in all countries including the developed countries and it is in general paid by insurance companies and a part of costs of poor or elder patients compensates the government.        

- I found that in European countries more significance is gaining the development of branch networks of specialized stroke help, the so called stroke-units. Do we have something like that?  

I have been working with the problem of stroke in Armenia since 1977. We are among the first in the USSR who opened a specialized department for stroke patients in the Emergency Hospital in Yerevan. It was in 1977- this is in the case that only now the world is coming to the point that stroke should be cured in specialized centers. Indeed, if a patient is cured in a specialized centre the results are higher. Mortality from stroke is 30-40% in the world, but we achieved the result of 4-5% lethality in our clinic. The same results have the leading centers in Europe, the USA, Canada, where treatment is lead in high qualified departments. Based on our experience of stroke treatment I think that in the case of properly organized treatment process all kinds of stroke are curable. In this case turning-points are very important from the very first moments of patient’s stay in the clinic. To highlight the importance of observance of this principle, I often cite the well known saying from China philosophy: “If you wrongly  button the first button, then the others will be wrongly buttoned too”. Unfortunately nowadays there are no unified methods of stroke treatment and it is lead with different not well grounded methods in common neurological and often in therapeutic departments that are not fitted for these patients. In my opinion stroke therapy should be lead only in high-qualified “Stroke” centres with advanced technology that are opened worldwide according to the decision of World Stroke Organization (WSO). In Russia in the context of governmental target program a large amount of financial resources are marked out for opening 40-50 “Stroke” centres throughout the country. I would like to mention that qualification of medical staff working in these institutions should be corresponding. It is not the fault of many neurologists that they cannot effectively treat stroke but their trouble. They should be trained in corresponding centres including abroad. Non-professionalism in general is a scourge for society in every work, and in our case non-observance of this principle leads to sorrowful outcomes and general worsening of epidemiological indexes of lethality and invalidization of population from stroke.                

- How do you see the ways of solving this problem in Armenia?

In this connection we have worked out a united program of preventive, treatment and rehabilitation help organization for stroke patients that foresees the foundation of medical “Stroke” centre in Armenia equipped with modern medical equipments for diagnosis, treatment and prevention of cardiovascular diseases using modern technologies that give the opportunity to improve the quality of curative help of patients. The centre is planning to cooperate with the leading medical institutions of Europe, the Commonwealth of Independent States with active involvement of leading specialists and experts of different countries (there is an agreement). This kind of centre is extremely essential in Armenia. In my monograph is expanded the role and importance of this centre for the Republic, the main directions of its activity and foreseeable results. No doubt, the main problem is to find the needed financial assets which is practicable taking into consideration the fact that big foreign firms, specialized in designing and building of medical institutions of international level, want to participate in realization of this project. What is also important is that in the structure of centre it is provided to work out the “register of stroke” subdivision which aims to hold a population screening for revealing people with stroke predisposition and taking the appropriate preventive measures. Unfortunately, the stated in Armenia fact of discrepancy between low morbidity index and hospitalization of stroke patients and its high mortality witnesses insufficient disease detectability, absence of unified diagnostic criteria and principles of step-wise treatment.

- Turning to your monograph, in its reviews published in medical and scientific publications and also in preface of the book that wrote the present Minister of Healthcare and Social Development of RR, correspondent-member of РАМН of RR, professor V.I.Skvortsova, are mentioned new concepts, progress, principles, developed by you and that are for the first time presented in modern neurological literature. May they help in struggling with this pressing medical and social problem - stroke?   

  You have touched a very important question, as in the final analysis any scientific discovery, research, elaboration should have practical application and promote to solve problems of clinical medicine and in our case- the problem of stroke. In this regard our researches have been made based on a large clinical material (including abroad) in well-known research-and-development centers, schools headed by academics E.I.Gusev, R.V.Petrov, U.M.Lopukhin, correspondent-member of РАМН A.Y.Kulberg, who are leaders in the field of neurology, immunology, physico-chemical medicine, immunochemistry. We think that dominant in work is to present in it new concept of evaluation of homeostasis disturbance (inner balance) of organism in stroke connected with accumulation of decay products of end-organs in blood. We succeeded to prove that abnormality of cell reception is the very mechanism that around which are expanded difficult pathophysiological processes that finally lead to the formation and development of different stroke forms. This fact gives the explanation of ineffectiveness, in some cases absence of effect of the given therapy for this pathology, and it calls forth such a big lethality for stroke. Another important aspect of work which is practically not aware of medical literature- this is the description of acute stroke dysfunctions of immune, endocrine systems, data about integral role and importance of neuroimmunoendocrine system for this pathology which is presented as a unified, integral, general regulatory system connecting all active components of homeostasis. Thus, we succeeded to present the clinical confirmation of theoretical notions about existence of neuroimmunoendocrine system, which is generally presented in modern literature by immunologists, neurochemists, biologists, and, in particular, thanks to bright work of outstanding scientist, academic A.A. Galoyan. Thereby, are created real perspectives and opportunities for elimination of ascertained dysfunctions of various systems of organism and bringing in corrections in therapy. Finally, in the “Stroke” programs, that we have worked out and presented in the monograph, we are going to use cluster-oriented regional politics in organization and management of all services of diagnostics, treatment and stroke prevention in Armenia. This kind of cluster principle of work-organization in some developed countries is in the conceptual stage of realization. I hope that we will manage to realize this cluster project also in medicine, as we have the needed potential in Armenia. Thus, I see the strategical course of stroke complexity management in realization of the above said programs and projects. 

Genofiya Martirosyan