The scariest thing, says Pasqual*, was not knowing what had happened.
On the morning his entire world would be turned upside down, everything had seemed completely normal.
‘It’s strange,’ says the 42-year-old accountant of Jumeirah Lakes Towers in Dubai. ‘I catch the metro to work every day and I remember walking over the bridge that morning, looking out at the blue sky, and I’m not normally one for introspection but my eldest had just started school here and I was thinking how lucky we were, as a family, to be living in this city and really getting on.’
The father-of-two arrived at work that day, spent some time chatting to colleagues who he considered more friends than work associates, and then settled at his desk.
The details of what happened a few hours later remain indelibly etched on his brain even now, four years on.
At 10.30am he made coffee and spent five minutes outside drinking it, chatting to another Spaniard who worked in an adjacent office.
At 10.40am he returned to his desk.
At 10.54am, on the phone now, he felt a sharp pain shoot into his right temple. When he tried to speak a few seconds later, he found his words were not only slurred but incoherent. ‘I couldn’t physically say what I was trying to,’ he recalls.
‘It was like someone had flicked a switch in my brain. I was trying to talk and all that was coming out was this slurred mumble. The guy at the other end was going, “Hello? Are you OK?”’
Pasqual wasn’t. Unable to communicate an explanation and with rising concern, Pasqual attempted to hang up. ‘I was resting the phone between my ear and left shoulder,’ he says. ‘When I moved my right arm to put the phone back, I couldn’t. It felt sluggish. All I could do was drop the phone against the desk.’
A couple of colleagues realised something wasn’t right and came over. ‘They were asking what was wrong,’ he remembers, ‘And I’m sat there, thinking, “I have no idea”.’
Pasqual had suffered a stroke.
A blood clot had stopped the flow to his brain. As he sat in that office unaware of what was happening, some two million of his brain cells were dying every single minute. The neurological systems that control movement and speech were slowly shutting down. Yet, in many ways, he was one of the lucky ones. While he tried, incoherently, to wave away worried colleagues, putting the symptoms down to a momentary turn brought on by standing in the sun earlier, a senior member of staff saw things differently.
She recognised the signs of a stroke; and insisted on getting him to hospital. She knew what many of us don’t: Pasqual was in the golden hour, a 60-minute window when stroke victims, if recognised and treated right, can make an almost full recovery.
‘The reverse of the benefits of such quick action, though,’ says Dr Suhail Al Rukn, consultant neurologist and head of Rashid Hospital’s Stroke Unit, ‘is that if sufferers are not treated as soon as possible, the consequences can be life-altering – from permanent disabilities to even death.’
It is this message – that recognising strokes and acting fast saves lives – that UAE healthcare professionals are promoting as we approach World Stroke Day on October 29.
The annual awareness date is much needed. The condition is on the rise worldwide – some 17 million people are affected every year – but the problem appears particularly acute in the Middle East. In the UAE alone, about 10,000 people suffered a stroke in 2015 – up 25 per cent from just two years.
It is the region’s third-biggest killer after cardiovascular diseases and cancer. For those that survive, meanwhile, life can be inalterably changed: strokes are one of the main causes of adult disability.
The relative youth of victims in the Middle East is a further concern. While globally, the average age of those who suffer is 65, in the UAE it is an astonishing 20 years younger at just 45.
The reasons for this high rate are manifest. Certain non-modifiable factors like age and genetic predisposition mean some people are more vulnerable to the blood clots that cause the vast majority of strokes. But other factors long associated with life in the GCC region – including long working hours, poor diet and lack of exercise – appear to increase the risk. Those who have high blood pressure, high cholesterol and diabetes are more likely to suffer. So are the obese and smokers.
‘If, as a country, we reduce all these things, we will start to see stroke rates reduce,’ says Dr Al Rukn, who is also president of the Emirates Neurology Society as well as founder of the GCC Stroke Group. ‘A few lifestyle changes can go a long way.’
And if those changes aren’t made? It’s not great news. Estimates suggest stroke mortality could triple over the next two decades.
All of which perhaps explains two things.
Firstly, why hospitals here are increasingly improving their stroke procedures. Four major centres across the UAE now have stroke units – that’s Rashid and Saudi German hospitals in Dubai, Cleveland Clinic Abu Dhabi and Al Ain – while doctors in more remote areas use an advanced telemedicine to treat victims quickly. A centralised stroke centre is also currently in the planning.
‘Four units is a good number compared to the region but not as many as we need,’ says Dr Al Rukn. ‘Now, we are working closely with other authorities to build a stroke centre. One is the Ministry of Health. But we also urge all hospitals to continue to work to develop dedicated stroke units.’ Secondly, the increased rate also explains why experts here are so keen to ensure that more and more of us recognise the signs that someone is suffering a stroke.
Loss of speech, blurry vision, sudden weakness, numbness of one side of the face, dizziness and a severe headache are all among symptoms.
One way to determine whether a person might have just suffered is the acronym BE FAST, where Balance, Eyes, Face, Arms and Speech might all offer warning signs that you should act in Time.
‘Research has proven that if a stroke patient is treated very early after the onset of symptoms, full recovery may be possible,’ says Dr Michel Mawad, staff physician and cerebrovascular disease specialist at the Neurological Institute at Cleveland Clinic Abu Dhabi. ‘Even in cases where the stroke does leave some disability, patients who are treated within the time window have been shown to do better than those who aren’t.’
That’s because the most critical step is unblocking that blood clot – responsible for 85 per cent of all strokes – as soon as possible. Allowed to continue too long, the lack of oxygen reaching the brain causes irreversible damage.
So, once a brain scan has confirmed a clot is the cause, the patient will be instantly given tissue plasminogen activator (tPA), a protein that accelerates its breakdown. Receiving this in good time – ideally within a maximum of 90 minutes – is key to a good recovery in future. For the minority of patients whose stroke isn’t caused by a clot, it will be down to a rupture of a blood vessel in the brain. In such cases, immediate surgery may be required to treat brain swelling and reduce the risk of further bleeding in cases. And, again, says Dr Mawad, time is of the essence.
‘Medical advances mean that today, more than ever, strokes and their resulting complications are very treatable,’ he says. ‘But I stress, quick, early intervention is key for the best outcome.’
Pasqual had that quick intervention. By 11.45am that morning, he was at Rashid Hospital and, after scans confirmed and identified the cause of his stroke, doctors set to work removing the blood clot.
The tPA was administered to break it down, followed by a small operation to remove what was remaining. Within 12 hours most of the symptoms were resolved, although he has been left with a slight speech impediment and occasional difficulties using his right arm. Left any longer, he was told, today he may be in a wheelchair.
‘Now I look back, I was working long hours and maybe not eating as well as I should,’ he says. ‘So in a way I guess this speech impediment is a constant reminder to me to live a better life, not just for myself but for my wife and little boys too. This stroke was a warning, and I won’t need another. But all I do say every day is thank goodness someone was there who knew what was happening. If she hadn’t rushed me to hospital so fast, I dread to think how things may have turned out.’
*Name has been changed