Altnagelvin stroke consultant reveals 'disturbing phenomenon' staff are encountering at their clinic

Dr Anirudda Deshpande, a stroke consultant at Altnagelvin, says staff at the hospital are encountering a 'disturbing phenomenon' where people have suffered stroke damage even though they have never reported symptoms.

Dr Deshpande has spoken out to raise more awareness around the burning problem, which he has labelled 'silent strokes'.

Speaking to Derry Now, he said: “As we review brain scans in our Altnagelvin TIA clinic, we frequently encounter a disturbing phenomenon – patients with clear evidence of stroke damage who never reported symptoms. 

“These 'silent strokes' account for 1 in 3 strokes in Northern Ireland, yet remain dangerously overlooked. Unlike dramatic strokes with paralysis or speech loss, silent strokes manifest as subtle memory lapses or balance issues, often dismissed as 'normal aging'.”

The latest Northern Ireland Stroke Registry data reveals that 12,000+ undiagnosed silent strokes occur annually - 3-fold higher dementia risk in affected individuals - 40% occur in adults under 65.

Silent strokes cause brain damage detectable only on MRI. They occur when small blood vessels become blocked, typically in: - Deep brain regions basal ganglia, thalamus) - White matter pathways critical for cognition.

Dr Deshpande says the local population faces specific vulnerabilities, including:

Demographic Timebomb: - Rural isolation: 62% of silent stroke cases in Tyrone/Fermanagh present late due to: - Limited access to MRI (only 3 scanners west of the Bann) - "Stiff upper lip" culture dismissing subtle symptoms.

Comorbidity Clusters Data from Western Trust shows strong links to: - Atrial fibrillation (25% undiagnosed in over-65s) - Hypertension( 34% uncontrolled in stroke-prone areas) - Diabetes (Derry has NI's highest prevalence at 8.4%) 

Economic Impact: Queen's University Belfast estimates silent strokes cost our health service £28 million/year through: - Undetected cognitive decline → earlier care home admissions - Increased falls (42% higher in silent stroke patients).

Spotting the warning signs through their clinic at Altnagelvin, Dr Deshpande and staff have identified key red flags:

The 5 S's" Screening Tool

1. Stumbling: Unexplained balance issues 

2. Slowing: Mild cognitive dips at work/school 

3. Slipping: Small handwriting changes 

4. Snoozing: Excessive daytime fatigue 

5. Souring: Personality/mood shifts 

A 58-year-old Derry teacher presented with 'burnout' and an MRI revealed four silent strokes– her "forgetfulness" was vascular cognitive impairment. 

Early intervention prevented dementia progression. 

 Breaking the Diagnostic Logjam Northern Ireland needs a three-pronged approach, according to Dr Deshpande.

These include; Community Neuro-Vigilance - Pharmacist-led screening: Pilot in 20 Boots stores (measuring BP + 5-minute cognitive tests) - Farmers' Union initiative: Mobile stroke checks at livestock markets.

Targeted Imaging Proposed Western Trust Protocol: - Fast-track MRI for: - Unexplained falls (≥2 in 6 months) - Diabetes + hypertension "dual diagnoses" - Coronary artery disease patients. 

Prevention Campaigns Lessons from the successful "FAST" campaign: - “SLOW" mnemonic for silent strokes (Stumbles, Lapses, Odd moods, Weariness) - GP toolkit with 1-page assessment guide.

NI research is leading the way Altnagelvin contributes to groundbreaking studies: 

The GlenSHANE trial is Derry-led: - Statins + blood pressure control reduce silent stroke risk by 61% - Recruiting at Altnagelvin, however participants are needed.

The Foyle Food Fortification Project: - Adding B vitamins to local bread lowered homocysteine levels (silent stroke marker).

The neurologist has urged members of the public who are over 50 to request a 10-minute stroke check at their next GP visit 

Know your numbers: BP <130/80mmHg, LDL <2.0 mmol/L 

Report subtle changes – your "senior moment" could be brain damage. 

He has also called on policymakers to fund five new mobile screening units for rural areas, mandate silent stroke screening in NHS Health Checks and establish a cross-border stroke prevention task force.

“No stroke should go unseen, every silent stroke is a missed opportunity to prevent dementia and disability. Through community awareness and targeted healthcare strategies, Northern Ireland can become a global leader in combating this stealthy brain threat,” said Dr Deshpande.

“As I tell my patients: 'Your brain's whispers today could become shouts tomorrow – let's listen carefully'."