HIGH STRAIN JOBS LEAD TO A HIGHER RISK OF STROKE

HIGH STRAIN JOBS LEAD TO A HIGHER RISK OF STROKE

Today's job requires working long hours, often stretching into late nights. Several jobs also require doing night shift duties. With increased internet connectivity, there is a boon to communication. However, it has also blurred the boundaries of "work time" and "leisure time". It is common to see people bringing work to home. At home, instead of relaxing, they remain busy on "business calls" on their smartphones, or work on "projects" on their laptops. While all these long and unearthly hours of work have increased their productivity making these employees "valuable assets" to the company; it has also taken a big toll on their health.

A recent study, published in NEUROLOGY Journal (Nov 2015) has shown a significantly higher risk of brain stroke in people with high strain jobs. The risk was higher for ischemic stroke (where the blood supply to a part of brain gets blocked), resulting in paralysis, impaired speech, blindness, and so on. The risk of brain stroke due to high strain jobs was found to be higher in women as compared to men.

Several reasons may be involved in increasing the risk of brain stroke in high strain jobs:

1. Work strain may lead to unhealthy lifestyles such as increased smoking, reduced physical activity, unhealthy eating habits, untimely meals, reduced sleep, lack of health check ups, etc. All of them are risk factors for stroke.

2. Work stress is often associated with certain cardiovascular risk factors, such as metabolic syndrome, high body mass index (obesity), impaired glucose metabolism (diabetes), and dyslipidemia (high cholesterol), which are also known to be risk factors for stroke.

3. Work stress can also lead to neuro-endocrine disturbances, leading to increased inflammation and plaque destabilization, leading to ischemic brain stroke.

Therefore, one needs to maintain a good work-leisure balance. Maintaining good work out put and efficiency are important, however, it should not be at the cost of strain and stress.

1. Working hours should be restricted to 8-10 hours per day.

2. Work should not be brought home.

3. There should be adequate time left (after work) to spend with family; and exercise on a regular basis.

4. Smartphones and laptops should be in silent mode during sleep, so that sleep is not disturbed.

5. Avoid night shift duties as much as possible.

6. Avoid excess travel, as it leads to disturbed sleep rhythm, as well as increased strain.

7. Periodic breaks and vacations with family are advisable, to get relaxed and recharged.

DR SUDHIR KUMAR MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad
Email: drsudhirkumar@yahoo.com
Phone: 040-23607777/60601066

Online Consultation: http://bit.ly/Dr-Sudhir-kumar

SUMMER HEAT AND NEUROLOGICAL PROBLEMS

SUMMER HEAT AND NEUROLOGICAL PROBLEMS

Summer is here and temperatures are starting to rise. Summer has its share of fun, with lots of delicious mangoes and frequent trips to ice cream joints. However, it also brings with it, its share of problems. Here, I would discuss the neurological problems that may get worse with summer heat.

1. Migraine- Migraine is a condition characterized by frequent episodes of headaches, associated with nausea or vomiting. Headaches in migraine patients are triggered or exacerbated with a number of factors, heat being one of them. It is common to have severe headache with every outing in the scorching sun. So, it is better to avoid going out during the hottest parts of day- 12 noon to 3 pm. Also, one can use umbrella to avoid direct sunlight.

2. Multiple sclerosis (MS)- MS is a disease that affects central nervous system (brain, spinal cord and optic nerves). In this disease, there is damage to the myelin sheath, the covering of the nerves. The symptoms in MS patients get worse with increased heat, as after exposure to summer heat, hot water baths, strenuous exercises, etc. The symptoms noted are blurred vision, fatigue, weakness and cognitive dysfunction. So, patients with MS should avoid heat exposure.

3. Heat stroke- Heat stroke occurs if body temperature rises to abnormally high levels on exposure to heat for prolonged duration. Generally, our body tries to regulate temperature with sweating, increased thirst, etc when exposed to heat. However, these mechanisms may fail when exposed to high temperatures for prolonged periods. Symptoms of heat stroke include high temperature, headache, nausea, weakness, muscle cramps, confusion, and in severe cases, unconsciousness and coma may also occur.

4. Brain stroke- Exposure to heat can lead to dehydration, thereby, increasing the chances of a brain stroke. Brain stroke may lead to paralysis due to blockage of blood supply to a part of brain.

5. Epilepsy- Heat can be a trigger for seizures. Some people experience an increase in seizure frequency during summer months. In children below the age of six, febrile seizures are common, where they get seizures during an episode of high fever. Also in adults, high fever can trigger an episode of seizure. There is a special type of epilepsy, where the person gets a seizure after taking hot water bath; this type of epilepsy is referred to as “hot water epilepsy”.  The increase in seizure frequency may be due to loss of anti-epileptic medications through too much sweating or perspiration in hot weather.

Strategies to beat the summer heat:

• Stay indoors as much as possible, especially during the hotter parts of day,
• Use umbrella to avoid direct sunlight exposure,
• Stand in shade,
• Use AC or fan, when indoors,
• Drink plenty of water and juices to keep yourself well hydrated.

DR.  SUDHIR KUMAR MD (Medicine) DM (Neurology)

Senior Consultant Neurologist,

Apollo Hospitals, Hyderabad, India.

Email: drsudhirkumar@yahoo.com

Appointments: 0091-40-23607777/60601066

VERTIGO or DIZZINESS or GIDDINESS

VERTIGO

What is vertigo?

Vertigo is a common symptom in patients presenting to neurology outpatient department. It is described as a sense of rotation (rotation of self or of the surroundings). Other terms to describe the same sensation are dizziness, giddiness, chakkar (in Hindi), tala tiragadam (in Telugu), etc.

What are the common symptoms in a patient with vertigo?

The most common feeling is a sense of rotation or imbalance. This feeling becomes more prominent while walking or moving. In some cases, even head or neck movements (such as getting up from lying down position or bending down to pick something) can aggravate the symptoms of dizziness. Other symptoms may include:

·      Nausea,

·      Vomiting,

·      Imbalance while walking,

·      Blurred vision,

·      Poor concentration.

What are the common causes of vertigo?

Vertigo can be caused by a variety of reasons. The more important of them include:

BPPV- benign paroxysmal positional vertigo

·      In this condition, there is a problem in the inner ear. Calcium crystals get deposited in one of the semicircular canals.

·      It can occur in all ages, and is common in adults and in older people. It affects 2.4% of population sometime in their lifetime.

·      It is a benign condition, which means it is not life-threatening and it does not get worse over time,

·      Symptoms are made worse with head or neck movements (positional symptoms),

·      Symptoms occur intermittently,

·      People may get better in 1-2 days, however, in some, it may last for a few months also,

·      Head injury, concussion, migraine, etc may bring on the symptoms of BPPV

·      Diagnosis is made on the basis of history and clinical examination. Hearing and vestibular tests may be helpful.

·      Treatment consists of symptomatic treatment with antihistaminic medications such as betahistine tablets.

·      Canal repositioning procedures done in office are helpful and can cure the condition, however, these procedures should be done by trained doctors,

·      Vestibular adaptation exercises help in prevention of recurrent episodes of vertigo.

·      In refractory cases, there may be a role for ear surgery. 

2

Posterior circulation stroke (Brain stroke)

·      This refers to reduction in blood supply to the back of brain, mainly cerebellum and brain stem.

·      This is more common in people with risk factors for stroke, such as high blood pressure, diabetes, high cholesterol, smoking, etc.

·      Patients often have additional symptoms such as double vision, slurred speech, difficulty in swallowing, imbalance while walking, etc. Isolated symptoms of vertigo without any additional symptoms, seldom/rarely occur due to brain stroke.

·      The diagnosis can be confirmed by doing an MRI scan of brain.

·      Treatment is done as for brain stroke (refer to my earlier blog articles on brain stroke management).

 Cervical vertigo

·      This is an uncommon cause of vertigo,

·      Occurs in the setting of severe cervical spondylosis and disc disease in the cervical (neck) region,

·      Cervical vertigo is also more common in older people.

·      Treatment is as for disc disease (refer to my earlier article on disc disease)

 Miscellaneous causes of vertigo

In addition to the above listed main causes of vertigo, we should also look for other causes. These include low blood pressure, anemia (low haemoglobin), general weakness, low blood sugars, etc. 

Who should we consult for vertigo?

Initially, a primary care physician may be consulted. If there is a doubt in exact diagnosis, the patient should be evaluated by a neurologist. 

An ENT opinion may be taken if an ear-related cause is suspected.

What is the outcome in cases of vertigo?

Most people with vertigo recover well and they do so in a few days. However, a minority of patients continue to suffer for several months. It is uncommon for the symptoms to last for more than three months.

Vertigo may be disabling in the first few days of illness, however, after that period, most people are able to normally function.

Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)

Senior Consultant Neurologist

Apollo Hospitals, Jubilee Hills, Hyderabad

Email: drsudhirkumar@yahoo.com

Phone (for appointment): 0091-40-23607777, extension 6634/3011

Online consultation: http://bit.ly/Dr-Sudhir-kumar