Roll Back Stroke: The Way Forward for Physicians and Patients.

The 6-lettered word "Stroke" is an ancient disease, likened Biblically to "666" in Revelation 13 verse 18. Globally, it is the commonest cause of acquired long-term disability. While its incidence has been declining in high-income countries, low/middle-income countries (LMICs) have witnessed an increase. This increase is driven by epidemiologic-transition/modernization-complex, healthcare disparities, and increasing prevalence of vascular risk-factors. Despite the disproportionate burden of stroke in LMICs, these countries have the lowest rate of access to acute reperfusion-interventions leading to greater stroke-related morbidity/mortality. Effective primordial, primary, secondary, tertiary, and quaternary prevention-strategies coordinated at all levels of care are needed to reduce stroke incidence and poor outcomes. The World Stroke Organization (WSO) has proposed achieving global primary prevention through 1) Populationwide approach to limiting stroke risk-factors exposure, 2) App-based motivational population-wide approach to mitigating stroke riskfactors, 3) use of low-cost combination/poly-pill to treat hypertension/dyslipidemia and 4) addressing behavioural risk-factors through interventions by community health-workers. The need to set-up stroke-units, post-hospitalisation rehabilitationcentres, stroke-registers/registries, stroke-clubs, and encourage community health-education, must be emphasised for optimal care in LMIC.13 Community Health Empowerment (CHE) with the Acronym BE FAST / STRoke as warning signs of stroke must be emphasised (B: Balance-loss; E: Eye vision-loss; F: Facial Asymmetry; A: Arm weakness; S: Speech difficulties; T: Time is brain; Or first 3-letters of STRoke - Can Patient Smile? Talk? Or Raise-arm?). Stroke hemorheology/blood-flow and treatment involve 3Ps' of pathogenic principles/strategies (Passenger, Passage, Power). Its complications include the 10D's: Death, Disability, Depression, Dementia, Delirium, Dysphagia, Dehydration, Deep-Venous Thrombosis, Decubitusulcers, Dysphasia, Seizures.