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Dealing with brain attacks
Dr. Ruwani Gunawardane dispels the myths which surround strokes
By Kumudini Hettiarachchi
Stroke is unpreventable. It cannot be treated and recovery ends six months after a stroke. It strikes only the elderly. It happens to the heart. These are some of the common myths among the public that Dr. Ruwani Gunawardane, Assistant Professor, University of Maryland School of Medicine dealt with on a recent visit to her motherland.

"The reality is that stroke is largely preventable. It requires urgent treatment. Stroke is a 'brain attack' that can happen to anyone but recovery can continue throughout life," stresses Dr. Gunawardane in a bid to change the general perceptions of stroke among people.

In America, stroke is considered to be the third leading cause of death with over 160,000 deaths per year and 750,000 strokes per year. "There are over four million stroke survivors but it is the leading cause of adult disability, as from among those who survive, 90% have a deficit," explains Dr. Gunawardane.

In Sri Lanka, according to Consultant Neurologist Dr. Jagath Wijesekera it is also the third cause of death when considering hospital admissions. The prevalence rate in Sri Lanka is considered high, following a study which indicates that it is .9% or nine per every thousand.

Dr. Gunawardane emphasizes that stroke is a medical emergency. "There is a limited time window for intervention and brain damage is often permanent and irreversible. There is a high morbidity and mortality rate. Therefore, there is an urgent need to act quickly and efficiently."

Dr. Gunawardane, part of the brain attack team of the University of Maryland, says they are using new cutting-edge therapy in the treatment of strokes. "Patients are treated by a multi-disciplinary stroke team and the door-to-needle time for the patient is just 20 minutes."

The university is also linked to many hospitals and rural hospitals via telemedicine. This helps a stroke victim even in a rural hospital to get tertiary level consultation and expertise.

"When the brain attack team hears of someone getting a stroke in a rural community hospital, we can get to our computer and see the patient on it even though the patient maybe far away. We can talk to the patient, check out the CT scans and lab work and make maximum use of the golden opportunity to get the clot-busting medication to the patient," she says.

Another first for America is having telemedicine facilities on ambulances, enabling the process of treatment to start immediately. Detailing the other facilities available, Dr. Gunawardane said rapid assessment for mini-stroke patients is now being done within the first crucial 23 hours. Comprehensive evaluation through CT scans, echocardiograms, Carotid Doppler testing and if necessary MRI scanning are all part of it.

"If they are too late for clot-busting medication, there is a modern technique to open up the blood vessel with the clot, through angioplasty," she says. When giving clot-busters there is symptomatic bleeding - but if you give it within the first two hours it is only 3% while within the first three hours it increases to 6.4%.

While lecturing on new strategies for stroke treatment and prevention, she was also the principal investigator in one of the world's largest secondary stroke prevention trials called PROFESS trials where head to head comparison of two potent anti-platelet medications were tried out.

They also assessed the neuro-protectant properties of a class of high blood pressure medication called ACE-inhibitors. It has been used as treatment for kidney patients, but has also now been found to prevent dementia that is a long-term effect of strokes.

New strategies for migraine prevention and treatment with a new class of drugs called Triptans are also being studied by Dr. Gunawardane. "A favourable side-effect of this drug is weight loss," she laughs.

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