Showing posts with label stroke. Show all posts
Showing posts with label stroke. Show all posts

Thursday, June 14, 2018


Mr Parvesh (name changed), a 33-year old, was rushed into emergency department last night with sudden onset of chest pain and breathlessness. He was at his office at 11 PM, when he felt uneasy. He lied down on the sofa outside his office to take some rest. His friends found him unconscious and rushed him to the hospital. On arrival in ER, his pulse and BP were un-recordable. ECG showed features of massive heart attack. He was given the best cardio-pulmonary resuscitation, followed by the best medical care. All in vain, he passed away within four hours. 

Mr Parvesh is not alone. In my practice over the past 25 years, I have seen many young people (mostly men) in their 30s and 40s coming to the hospital with features of heart attack and brain stroke. This is unusual, as during my medical school training in early 90s, we were taught that heart attacks and brain strokes affect only older people in their 60s and 70s or even later. Now, about 40% of people suffering from heart attacks and brain strokes are young people (<50 years of age). 

So, what factors are responsible for this “undesirable” change?
1. Expectations to achieve everything as early as possible: Achievement and success are good things, but not at the cost of health. Young people work long hours. In my interaction with people, I have observed that 13-15 hours work schedules are not uncommon. Add to this, 1-2 hours of commute time, where is the time to unwind? Where is the time to relax with family and friends? Our bodies are not machines (even machines break down, when overused). Heart and brain work best, when working hours are 8-9 hours, with good breaks in weekends.
2. Working from home, working on weekends and even during holidays: Breakthroughs in communication (internet, mobile phones, etc) have their advantages; however, there are drawbacks too. People are in “work-mode” 24X7, 7 days a week, and perpetually. There is no time, when a person totally disconnects from work. Constant work or thought of work takes a heavy toll on the body, especially the heart and brain.
3. Lack of sleep: We need at least 7-8 hours of sleep in order to refresh and recharge. However, younger people are not getting more than 4-5 hours of sleep per night. Demanding work schedules, use of gadgets and late night socializing are some of the reasons for lesser sleep duration. Lack of sleep is strongly associated with higher risk of diabetes, high BP and cholesterol; all of whom are risk factors for stroke and heart attacks.
4. High stress levels: I see many young people in my clinic, belonging to various industries such as IT & software, banking & finance, education, etc. More than 90% of them say they are under stress. Stress is related to jobs as well as personal lives. So, if one felt that not getting a job or not getting married are reasons to be under stress, think twice; those with good jobs and good spouses are also equally stressed, if not more. This cannot be real. Jobs and families need to be cared for and modeled to give joy & happiness.
5. Greed for material things beyond one’s means: Peer pressure is very high. One wants to own a good car and a good house in 30s and even in 20s. As the incomes are low, many end up taking huge loans to fund these dreams. People are also spending more than their means on education of children and vacations. Paying EMIs are no fun! Any unexpected expenditure and reduction in income takes a toll on health and stress levels rise. One must live within their means and avoid taking loans to fulfill the “desires”. We need to be satisfied with what we have and avoid competing with “neighbours or friends” in acquiring materialistic things.
6. Unhealthy diet and habits: Fast foods, irregular food habits and "eating out" have become common. We need to remember, home food is the best and healthiest. “Outside” food is high on taste (due to high amount of salt, sugar and oil) but low on nutrition. 
Most people are not exercising. Moreover, they use vehicles for travelling short distances. Walking as a habit is dying. Most people use lifts and staircases are “hidden” (only to be used in case of emergency or fire)! People sit for long duration (at work, while watching TV, etc). Sitting is as dangerous as smoking, if not more. 
Pollution is increasing- both air and water. Their negative impact on health is well known.
7. Poor financial planning: Younger people do not invest wisely. Either the savings are kept idle in the banks (for a meager interest of 3-4%, which is taxable at the highest slab) or they invest most of their savings in real estate (bought at high prices, with no scope of growth in the near future). The best investment asset class is equity. For someone with less time, investing in equity mutual funds via SIP (systematic investment plans) are the best. You can expect a return of 10-12 % per year (with current tax rate of 10% on the profits, if redeemed after one year).
8. Ignoring health checkups: Our body does give warnings. Any abnormal symptom such as headache, dizziness, tiredness, breathing difficulty, chest pain, etc should be seriously taken and a doctor should be consulted. Even if there are no symptoms, preventive health checkups can help in detecting diseases in early stage, which can be treated well.
So, what can younger people do to live longer and healthier?
1. Find a job that you like (which may not be with the biggest pay cheque).
2. Work for reasonable hours (8-9 hours on average).
3. Cut-off from work when out of office, on weekends and while on vacation (except for occasional emergencies.
4. Take regular vacations with family and friends.
5. Sleep well (on an average 7-8 hours per night). Avoid doing regular night shift duties.
6. Exercise- it can be anything you like, such as walking, jogging, cycling, etc. At least 30 minutes per day and 5 days per week.
7. Prefer home food as much as possible.
8. Keep expenses as per your income. Avoid taking loans as much as possible.
9. Start investing early after analyzing your financial needs and goals.
10. Don’t ignore small warnings about health. Consult a doctor and have preventive health checkups.

Dr Sudhir Kumar MD DM
Consultant Neurologist

Monday, November 6, 2017



1. STROKE is a disease that affects:
A. Heart
B. Brain
C. Kidney
D. Lungs
2. Common symptoms of stroke include:
A. severe chest pain
B. Fits or convulsions
C. Paralysis of face, arms, legs, slurred speech
D. Breathing difficulty
3. If someone suffers from stroke at 9 PM,
A. He can go to OPD the next day
B. He should rush to the nearest general physician
C. He should rush to a hospital with 24X7 CT scan and neurologist on call
D. He can try home remedies for the night.
4. Is there a treatment available for patients with stroke, which would minimise disability
A. Yes
B. No
5. Common risk factors for stroke include all the following EXCEPT
A. Diabetes mellitus
B. Hypertension
C. Running on treadmill
D. Smoking
6. Which of the following measures is NOT helpful in preventing a recurrence of stroke in a person who has suffered stroke?
A. Taking Aspirin
B. Controlling BP and sugars,
C. Quitting smoking,
D. Skipping breakfast, if overweight
7. Physiotherapy helps in better and faster recovery of stroke survivors.
A. True
B. False
8. Stroke affects only older people
A. True
B. False
9. Proportion of population that may suffer a stroke in their lifetime
A. 1 in 10
B. 1 in 8
C. 1 in 6
D. 1 in 4
10. Stroke is treated by
A. Neurologist
B. Cardiologist
C. Nephrologist
D. Chest physician
Please go through these questions and answer them. Answers are posted below
Thank you for going through the questions. Here are the answers:
1. B
Stroke affects brain. It most commonly occurs due to blockage of blood supply to a part of the brain. In some cases, it can also occur due to rupture of a blood vessel.
2. C 
Common symptoms of stroke include sudden onset facial weakness, weakness of arm or leg, slurred speech, loss of vision on one side, imbalance while walking or severe headache.
3. C
Stroke is a medical emergency. The brain tissue can suffer irreversible damage, if not treated within the first four hours. Therefore, the patient should be rushed to a hospital with 24X7 CT scan facility. The treatment is administration of clot-buster therapy under the guidance of a neurologist.
4. A
Clot-buster therapy with tissue plasminogen activator or tenecteplase within the first four and a half hours after stroke onset can minimise disability.
5. C
Running on treadmill is a healthy exercise and protects from stroke.
6. C
Skipping breakfast is an unhealthy habit. Moreover, it does not help in reducing weight.
7. A
Physiotherapy is very helpful in faster recovery of stroke survivors. It should be started as early as possible.
8. B
Stroke predominantly affects older people, however, it can affect all ages, including children.
9. C
Stroke is a common cause of death and disability (along with heart attacks and cancer) in the world, and affects i in 6 people in their lifetime.
10. A
Stroke is a disease of brain and is treated by neurologist.
I hope you enjoyed this mini-quiz. I would love to hear your comments or any further queries.

Dr Sudhir Kumar MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad

Sunday, October 29, 2017


On the occasion of World Stroke Day (29th October), an article published in Times of India newspaper, to raise awareness about the diagnosis, treatment options and prevention of stroke. 

The article can be accessed in Times of India (Hyderabad edition), dated 29th October 2017 (Page 31), at the following link:

Dr Sudhir Kumar MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad

Wednesday, September 7, 2016



Brain is, without any argument, the most important organ of our body. We depend on brain to ensure better performance of all useful activities, be it related to our jobs or household chores. Some of the important functions of brain include memory, reasoning, judgment, language, calculation, etc. Having understood the importance of brain and its functions, it is equally important to understand the measures needed to take good care of the brain.

Nutritious diet, regular physical activity, freedom from stress and anxiety, sound & adequate sleep, regular brain “exercises” (solving crossword puzzles, Sudoku, etc), preventing head injury and avoiding smoking, are important measures that ensure good brain health.

The purpose of this article is to emphasize the important role played by silence in the wellbeing of brain. Who has not heard this- “If speech is silver, silence is gold”!

In our daily lives, we are surrounded by different kinds of noise and sounds most of the time. These include sound of vehicles, loud music, ringing of smartphones, and so on. This “noise pollution” has a detrimental effect on our brain and body. Various research studies have shown that exposure to noise leads to higher incidence of elevated blood pressure, which is an important risk factor for heart attacks and brain strokes. Noise pollution also causes impairment of hearing; sleep disturbances, and problems with memory and concentration. Studies have concluded that children exposed to households or classrooms near airplane flight paths, railways or highways have lower reading scores and are slower in their development of cognitive and language skills.  

If noise has so much of adverse effects on brain, silence should have just the opposite effect- and it is indeed so.
1. Silence leads to lowering of heart rate and blood pressure. This effect on BP lowering is seen with as little as two minutes of silence. Lowering the BP would lead to a lesser incidence of brain strokes.
2. Silence is relaxing and rejuvenating. In this 24X7 work environment with exposure to various sounds, our brain gets muddled and then, we cannot focus and concentrate. Therefore, we need periods of quiet and calm to allow our brains to recharge. Some people use music to relax. While music does relax the brain, it is interesting to note that silence has far greater effects on brain relaxation than music.
3. Silence promotes better sleep. We have all experienced the difficulties in falling or maintaining good sleep, when exposed to sounds or noise. In silent environment, on the other hand, sleep is sound and relaxing. Better sleep translates into better functioning of brain. Growth hormone is secreted in brain during sleep. Consolidation of memory and learning also occurs during sleep. Good sleep is also a stress buster and lowers BP.
4. Silence may improve memory. In an interesting experiment conducted on mice, it was found that exposing them to two hours of silence per day led to development of new neurons in the hippocampus area of the brain. Hippocampus is mainly involved in memory, emotion and learning. So, there is a high possibility that these brain functions would improve, if one is exposed to even short periods of silence on daily basis.
5. Silence is a stress buster. When a person is stressed and anxious, one of the best and easiest quick fixes is to take rest (sit or lie down) in complete silence. While it may be tempting to get a counseling done by a family member or a psychologist for stress, it is equally important to have periods of silence to overcome stress.
6. Silence improves our ability to concentrate and focus. In our daily lives, we are constantly exposed to stimuli- sounds as well as sights. This makes our brains foggy and inattentive, leading to difficulty in concentrating. In this situation, the ability to solve problems or to come up with new ideas is greatly hampered. Silence, even for short periods, comes to our rescue in this condition. Silence makes the brain fresh and energetic. One can solve complex problems and come up with bright new ideas after a brief period of silence.
7. Silence helps us tap the hidden talents and strengths in our own brain. Brain has immense capacity and resources, which largely remain untapped. This is because one cannot look deep inside his brain, when exposed to distractions of sounds/noise. On the other hand, in a silent environment, one can daydream, fantasise or think and be more creative. As Herman Melville once wrote, "All profound things and emotions of things are preceded and attended by silence."
8. Silence reduces the risk of heart attacks and brain strokes by reducing plaque formation in the arteries. 
All these beneficial effects of silence on brain should prompt us to seek silence everyday in our busy lives, even if it is for a brief period. Moreover, sitting in silence is free, easily accessible, and has no side effects.

This article was modified and published in September 2016  issue of B POSITIVE magazine, a heath and wellness magazine.


Wednesday, July 27, 2016



1. Increased risk of road traffic accidents: Road traffic injuries account for 1.25 million deaths per year. They are the leading causes of death in young age group (15-29 years). Drink driving is a major risk factor for road traffic accidents. Driving under the influence of alcohol accounts for about one-third of all deaths in road accidents. It should be noted that the victims are most often the passengers, pedestrians or children, who have not consumed alcohol.
2. Increased risk of cancer: Alcohol drinking is significantly associated with cancer of seven sites in body. These are throat, larynx (voice box), esophagus (food pipe), liver, colon, bowel and breast. Drinking just 50 grams of alcohol per day can increase the risk of mouth cancer by seven times (as compared to non-drinkers). About 6% of all deaths due to cancer can be attributed to alcohol intake. This study was recently published in the Journal Addiction. The full test of the article can be accessed at the following link:
3.  Increased risk of stroke: Alcohol consumption increases the risk of high blood pressure, diabetes, obesity, atrial fibrillation and liver disease; all of these increase the risk of stroke. Alcohol consumption also leads to higher death rates in patients with stroke. People drinking alcohol more than twice a week (irrespective of the amount) have a 3-fold higher risk of death due to stroke as compared to non-drinkers.
4. Memory impairment: Consuming too much alcohol leads to severe memory impairment and dementia in later life. Alcohol causes brain shrinkage (atrophy), malnutrition, deficiency of thiamine and vitamin B12; all of which contribute to memory loss.
5. Damage to peripheral nerves: Alcohol use, if regular and heavy, can lead to damage of nerves in arms and legs, leading to numbness, weakness, burning, pain, etc.
6. Seizures (fits or convulsions): Heavy alcohol drinking can lead to seizures. Sudden withdrawal in a person dependent on alcohol can also lead to seizures.
7. Headache: Alcohol consumption can lead to hangover (with a prominent symptom of headache); worsening of migraine; or headache as a direct effect of alcohol (due to vasodilation and dehydration).
8. Liver disease: Alcohol is a leading cause of liver disease. This includes fatty liver, alcoholic hepatitis and cirrhosis.
9. Pancreatitis: Inflammation and damage of pancreas occurs in about 5% of alcoholics after 5-10 years of alcohol drinking.
10. Sexual dysfunction: Heavy alcohol drinking can lead to sexual dysfunction in about 75% of people. The most common symptoms are premature ejaculation, low sexual desire and erectile dysfunction.
11. Marital discord and divorce: Alcoholism adversely affects relationships and marriage. Alcoholics are two times more likely to have a divorce as compared to non-alcoholics. In addition, suspicion, infidelity and arguments are more common with if one or both spouses consume alcohol. People consuming alcohol also have delayed marriage.
12. Increased crime rate: Alcohol consumption leads to increase in crime rate. Most states report that alcoholism is involved in 70-85% of crimes, especially against women. These include violence, sexual exploitation, rape, kidnapping, murder, robbery, etc.
13. Increased death rate: 15 people in India die everyday due to alcohol related effects, which means every 96 minutes, one person dies due to alcohol use.

I have enumerated the harmful effects above. I am sure there are many people (especially the ones who drink), who are eager to know the beneficial effects. There are some benefits of alcohol too.
1. Feeling of euphoria and elation: Alcohol has a depressant effect on brain. So, drinking makes one carefree, elated and free from all worries. However, these effects are for short term and are seen with small amounts of alcohol. Heavy alcohol intake leads to sleepiness and confusion.
2. Reduced rate of heart attack: Moderate alcohol consumption may reduce the risk of heart attack by increasing the amount of good cholesterol (HDL). However, exercise can also have the same effect. At present, American Heart Association does NOT advise people to start drinking, if they do not already drink alcohol.
3. Increased sexual desire: Alcohol intake may reduce the inhibition and increase the sexual desire; however, it reduces the testosterone level and hence, the performance. So, the overall effect of alcohol on sex is negative. In addition, alcohol may promote the risk-taking behavior such as not using condoms.

1. Alcohol has several harmful effects on health.
2. Alcohol leads to increased risk of heart disease, brain stroke, dementia, peripheral neuropathy, liver disease and cancers.
3. Alcohol is directly responsible for increased road traffic accidents and deaths.
4. Alcohol is involved in most of the crimes, especially against women.
5. Alcohol use in moderation may have protective effect on heart attacks.
6. Those who do not drink should NOT start drinking alcohol.
7. Those who drink should drink in moderation.

(Disclaimer: I do not drink alcohol)

Dr SUDHIR KUMAR MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad

Phone: 0091-40-23607777/60601066

Tuesday, April 19, 2016

Frequent Coffee Breaks Keep You Healthy Too!

Coffee Breaks Make You Healthier

Coffee drinking is quite popular all across the world. There are many, who have coffee first thing in morning, referred to as bed coffee. Bed coffee is supposed to energize people and get them out of sleepiness. Many others take “coffee breaks” while at work, which relaxes them. Who would have forgotten the student days, when numerous coffee cups kept them awake until late nights just before examinations? Coffee drinking is supposed to increase alertness and concentration. The effects are mainly related to caffeine contained in the coffee.

Health-Related Benefits of Drinking Coffee

1. Lower risk of diabetes: In a Dutch study done on 40,000 people, it was found that drinking at least 3 cups of coffee or tea per day reduced the risk of developing diabetes by 42%. (Diabetologia 2009). The anti-diabetic effects are related to polyphenols found in coffee.
2. Lower risk of coronary heart disease: Moderate habitual coffee consumption (3-4 cups per day) lowers the risk of coronary heart disease, especially in women. (International Journal of Cardiology)
3. Coffee improves headaches and migraine, if taken alone or along with other painkillers.
4. Lower risk of brain stroke: Middle aged people in Japan, who drank 3 or more cups of coffee per day had lower rates of silent brain infarctions (strokes without symptoms, picked up on MRI scan of brain). Lesser brain infarctions would also lead to lesser incidence of dementia. (Journal of Stroke and Cerebrovascular Diseases, 2016)
3 or more cups of coffee intake per day reduced the risk of brain stroke (despite smoking tendency in coffee drinkers). A lower incidence of heart failure, diabetes and hypertension was also observed. (Nutritional Neuroscience, 2015)
5. Reduced risk of Alzheimer’s disease: Alzheimer’s disease is the commonest cause of dementia (memory loss and loss of other higher mental functions) in the world. Based on the meta-analysis of 11 research studies, it was found that higher coffee consumption reduced the risk of Alzheimer’s disease. (Nutrition, 2015)
6. Reduced risk of Parkinson’s disease: Parkinson’s disease is the commonest cause of movement disorder, characterized by tremors, rigidity and slowness of movements. Based on meta-analysis of 26 studies, increased caffeine/coffee consumption was associated with reduced risk of Parkinson’s disease. (Journal of Alzheimer’s Disease, 2010)
7. Reduced risk of multiple sclerosis: Researchers in USA and Sweden have found that drinking at least 900 ml (six cups) of coffee per day has protective effects against multiple sclerosis. Caffeine has neuroprotective properties and suppresses inflammation. (JNNP, 2016)
8. Reduced risk of depression and suicide: A meta-analysis of 11 studies showed a protective effect of coffee against depression. The relationship between coffee intake and depression was linear; for each cup/day increase in coffee intake, the risk of depression reduced by 8%. (Australia NZ Journal of Psychiatry 2016)
In addition, increased coffee consumption was also associated with reduction in incidence of completed suicides. (World Journal of Biol Psychiatry, 2014)
9. Reduced risk of cancer: Various studies have shown that regular coffee consumption is associated with lower risk of cancers. 5 or more cups per day reduced the risk of colorectal cancer (Oncotarget, 2016). Other studies have shown reduced risk of cancers of oral cavity, pancreas, urinary bladder, breast, uterus, and liver among regular coffee drinkers.
10. Lesser incidence of erectile dysfunction: Coffee can provide a boost to sexual health too. Men with coffee intakes of 2-3 cups of coffee/ day reported significantly lesser incidence of erectile dysfunction, as compared to those with no coffee intake or only 1 cup/day. (PLos One, 2015)
11. Lower death rates: Regular intake of coffee can increase longevity and prevent deaths too. Recent research has shown that people drinking 2-5 cups of coffee/day had significantly lower deaths from heart disease, chronic lung diseases, diabetes, pneumonia and influenza, and intentional self-harm. Coffee may reduce mortality risk by favorably affecting inflammation, lung function, insulin sensitivity, and depression. (American Journal of Epidemiology,

Possible Health Hazards of Coffee Drinking
1. Poor control of BP in patients with hypertension:  A recent study showed that older people with hypertension, who consumed 3 or more cups of coffee per day, had higher BP (systolic and diastolic). Coffee drinking, however, does not lead to an increased risk of developing hypertension (in people with normal BP).
2. Increased cholesterol levels: Drinking unfiltered or boiled coffee may cause an increase in the levels of LDL cholesterol and triglycerides.
3. Increased risk of coronary heart disease: Drinking 3 or more cups of Italian-style coffee (espresso or mocha) is associated with increased risk of coronary heart disease. (PLoS One, 2015). This effect was independent of cholesterol levels, as the cholesterol levels did not increase in this study.
4. Sleep problems: Caffeine is a brain stimulant and after consuming it, people feel alert. People sensitive to the stimulant effects of caffeine may not get proper sleep, if they drink coffee close to bedtime. Since, the effect of coffee may last for 5-6 hours, people sensitive to it should avoid coffee after 6 PM.
5. Not recommended for children: Coffee suppresses appetite, and may cause children to eat less. Also, after having coffee, children feel full, and avoid nutritious foods such as milk.
6. Pregnant and nursing women should have coffee in moderation: There is no restriction of coffee in pregnant or nursing mothers. However, they should restrict the coffee intake to 2-3 cups per day.

So, what is the final take home message?
1. Coffee is good for health, and can be safely consumed by adults.
2. For optimum benefits, it should be restricted to 2-5 cups per day.
3. The maximum safe limits for caffeine/coffee intake is 200 mg in one sitting (around 2½ cups of coffee) or 400 mg daily (around 5 cups of coffee). 
4. Coffee (without sugar and milk) has zero calories; and hence, people on strict diet too can freely have coffee.

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Jubilee Hills, Hyderabad
Phone: 040-23607777/60601066
Online Consultation: