Why diabetics suffer more stroke and attacks of paralysis ?

Dr KK Pandey *

Quite frequently you would have overheard people talking about either their fathers or elder brothers who had suffered from strokes and had been confined to bed since then. They did have diabetes and blood pressure problems, even though without any difficulty they would walk and undertake daily morning rounds of park, but after an attack of stroke, they not only stopped their daily morning walk, but were even unable to reach bathroom without a physical help.

You must have heard your friends or relatives using the word “stroke” in their conversations. You would have also heard, that the victim after the episode of stroke developed weakness in hand or leg and would stumble while walking, and he needed somebody’s help for walking.

You would also have noticed that your acquaintance who had stroke, would frequently become emotional and his eyes would get filled with tears. Some people, after an attack of stroke start losing temper and get angry on small provocations. Some people feel loss of memory after an episode of stroke.

What is this stroke all about?

The direct meaning of stroke in a simple language is sudden attack of unconsciousness or paralysis or both simultaneously at the same time. Later on, the unconsciousness although might disappear but paralysis persists and affects hand or foot.

Previously stroke used to attack generally elderly people, but now due to rapid rise in number of diabetic patients, middle–aged persons are falling victim to stroke. These days even a 50 year old may suffer from stroke.

Stroke means knocking at the door of death?

According to one analysis, stroke has emerged as a biggest merchant of death all over the world. Out of all deaths, stroke becomes the third largest cause of death in general, but among deaths occurring in diabetics and heart patients, the stroke stands out as the second important cause. Men are ones and the half time more at risk of developing stroke than women.

It has been seen among diabetics who suffer from stroke for the first time, forty out of hundred patients meet an fatal end. The survivors of first stroke if they get a second attack of stroke, thirty five out of hundred die but if they get the third attack, 65% of survivors embrace death. One can imagine the enormity of loss of human lives caused due to stroke among diabetics.

What is this TIA ?

Quite frequently, people would have heard a word “TIA” from doctors’ mouth. This T.I.A or “Transient Ischemic Attacks” means mini or a small stroke. In TIA, a person has momentary loss of consciousness and development of weakness, but this condition does not last for more than twenty four hours, and the person who had TIA. becomes normal outwardly.

About one third of TIA patients suffer a real fatal stroke within five years, if preventive strategy is not adopted. Therefore a patient who had TIA must take full precautions and keep consulting a vascular surgeon frequently besides neurologist (Neuro Physician) so that possibility of a major stroke can be prevented by all means.

The major cause of this TIA or momentary fall in consciousness level and power is the narrowing or blockade of blood pipes in the neck which carry pure blood to brain. That is why, the investigation of blood pipes of neck in a patient suffering from TIA is very essential and such patients in this regard should take the help of a vascular surgeon.

Which diabetic population is more prone to develop major stroke?

1.) Advancing age or elderly people.
2.) TIA patients.
3.) High blood pressure patients.
4.) Patients suffering from heart disease.

If an elderly person is suffering from high blood pressure and having had an heart attack previously, believe me, he will sooner or later is bound to have an attack of T.I.A. or major stroke. Therefore such patients must observe certain precautions. Other than these people, any diabetic patient who is obese and smoker will fall victims to stroke very soon.

Cholesterol or Atherosclerosis is a major cause of stroke.

In about 90% of stroke victims, it has been observed that the major reason of stroke was deposition of fat and calcium in the wall of blood pipes of the neck. This is called in medical terms the process of “Atherosclerosis”, which results into two things.

Firstly, there occurs a decrease in supply of pure blood to brain, secondly the pieces or debris of fat, slip upwards and block the blood pipes in the brain resulting into a permanent damage of a part of brain. In about 10% cases of stroke victims, there are other reasons of stroke, for example an outside pressure on the blood pipe or a birth defect in the structural anatomy of blood pipe or an excessive swelling of the wall of the blood pipe in the neck.

Secondly, there happens an another important reason that is a clot lying in the heart. A part of this clot can dislodge from the heart, and then pass through blood pipes in the neck and finally reaches the brain where it is finally lodged in the blood pipe and thus gives rise to a stroke.

How does this fat or cholesterol spell doom?

When deposition of fat and cholesterol occur inside the wall of blood pipe of neck, swelling and redness appears in the wall leading to accumulation of calcium. This results into unusual thickening of wall of blood pipe. This precipitates two outcomes.

Firstly, at the site of swelling, bleeding starts inside the wall, with the result swelling increases further and blocks the blood pipe completely and this reduces considerably the amount of pure blood going to brain.

Secondly, the swollen part of the wall may burst open and fragments (pieces) of fat get mixed with blood and reach the brain along with blood and disturb the blood supply of the brain. One more development occurs, that is appearance of ulcer after swollen wall of the artery has given way.

Because of ulcer formation, recurrent formation of blood clots does occur at the ulcer site and blood particles keep on collecting there. Quite frequently, these clots and blood particles (platelets) slip upwards and block the blood pipes of brain and this results into repeated attacks of strokes.

“Carotid” Artery in the neck is the mother of all strokes.

Although all the blood pipes of neck and brain are responsible for stroke, but the blood pipes situated inside the neck which carry pure blood, are solely responsible for stroke in two-third cases and in one third of stroke patients, the blood pipes of brain are the culprit. By now you would have understood, poor health, or disease of blood pipes of neck is the main reason of stroke.

Out of all these blood pipes of the neck, a blood pipe named “carotid artery” plays an important role in stroke. If this carotid blood pipe is kept healthy and fat-free, an episode of stroke can be possibly prevented in approximately eighty five percent patients.

This very fact illustrates the importance of carotid artery in the development of stroke. The other important blood pipe of the neck called “verteleral artery “is responsible for stroke in fifteen percent of stroke patients.

What is this Carotid blood pipe?

The carotid artery is a main blood pipe emerging from heart which carry pure blood to brain. There are two carotid arteries situated on either side of the neck. One branch of carotid artery supplies blood to face and organs of neck and other branch called an “Internal Carotid Artery” supplies pure blood and nutrients to brain. If blood flow in internal carotid artery reduces, the possibility of stroke increases.

What causes reduced blood supply in Carotid pipe

There are several reasons of reduced blood supply, for example excessive length of carotid artery since birth. Because of unusual long length, carotid pipe cannot remain straight and thus gets kinked. This results in partial obstruction of blood flow. The second reason is the external pressure on the carotid pipe, for example by a tumor or cancer in the neck.

These days radiotherapy of neck cancer causes pressure on the carotid pipe from outside due to process of fibrosis and secondly it trigers the process of deposition of fat in the pipe. Both the processes disturb the blood flow to the brain..

It is well known fact that in diabetics due to continuous process of fat deposition in carotid pipe, flow of pure blood is jeopardized but sometime due to disease of inflammation & swelling of wall, carotid blood flow is reduced, for example in “TAKAYASU” disease that is disease of blood pipe which affects blood pipes of neck as well as other organs of body.

Sometimes in a road traffic accident if a victim sustains neck injury, the inner wall of carotid artery gets damaged. This results into accumulation of blood clots in the blood pipe and this blood flow to brain through carotid artery completely stops.

What a diabetic should do?

If a diabetic patient complains of any episode of sudden giddiness or weakness, consult immediately a vascular surgeon and get your carotid blood pipes in neck checked up for correct assessment of health status of carotid arteries and amount of blood flowing through them, otherwise it would be difficult to prevent an attack of stroke.

If you already had stroke in the past and you are under treatment of a neurologist or (Neuro Physician), you request him to seek consultation with a vascular surgeon, so that the possibility of a second attack of stroke in future could be minimized.

* Dr KK Pandey wrote this article for The Sangai Express
The writer is with the Dept. of Vascular & Cardiothoracic Surgery,
Indraparasth Apollo Hospital, New Delhi-110076
and can be contacted at drpandeykk(AT)gmail(DOT)com
This article was webcasted on December 06 2023.

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