Stroke

Stroke is a medical emergency that kills at least one person every five seconds. Stroke cuts off blood flow to an area of the brain resulting in damage to brain cells at the rate of a few lakh cells per hour.

According to the World Health Organization (WHO), stroke is one of the most common neurological conditions causing long-term disability. It has enormous emotional and socioeconomic consequences on patients and their families. In India, it is the second most common cause of death. And the rate of stroke patients is rising in the country.

Types

Different types of stroke occur and causes for each type are different too. Two most common

• types of stroke are ischemic stroke and haemorrhagic stroke.
• Ischemic stroke occurs when there is a blockage in an artery thus restricting the flow of blood to the brain.
• Haemorrhagic stroke is caused by Intracerebral bleeds. Nearly 30 to 60 percent of hospital admissions of stroke are because of the latter.

Signs & Symptoms

Symptoms can be easily identified as FAST, an acronym that explains the signs and symptoms.

• Facial Droops
• Arm Weakness
• Speech Difficulties
• Time- crucially important to take the patient to a stroke-ready hospital in time.

Stroke Diagnosis

Diagnostic tests to determine treatment could include:

• Neurologic exam
• Brain imaging tests (CT, or computerized tomography scan; MRI, or magnetic resonance imaging) to understand the type, location, and extent of the stroke.
• Tests that show blood flow and bleeding sites (carotid and transcranial ultrasound and angiography).
• Blood tests for bleeding or clotting disorders.
• EKG (electrocardiogram) or an ultrasound examination (echocardiogram) of the heart to identify cardiac sources of blood clots that could travel to the brain.
• Tests that measure mental function.
• Stroke Treatment
• Immediate medical care is important. New treatments work only if given within a few hours after a stroke begins. For example, a clot-busting drug must be given within three hours.
• Once the doctor completes the diagnostic tests, the treatment is chosen. For all stroke patients, the aim is to prevent further brain damage. If the stroke is caused by blocked blood flow to the brain, treatment could include:

Stroke Treatment

However, if someone is hit by stroke, the endovascular treatment has provided excellent results. If we remove the clot within 6 hours of stroke onset, the recovery of the patient is fast. After the recent DAWN trial, their treatment has been extended to 24 hours for some patient.

Treatment of Haemorrhagic Stroke

While Haemorrhagic Stroke is treated differently than Ischemic Stroke, surgical methods used by our team to treat hemorrhagic stroke include:

• Aneurysm Clipping - It consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of its attached artery and keeps the aneurysm from bursting or re-bleeding.
• Aneurysm Embolisation (coiling) - This involves using a catheter inserted into the aneurysm to deposit a tiny coil that fills the aneurysm, causing clotting and sealing off the aneurysm from arteries.
• Arteriovenous Malformation (AVM) Removal - A surgical procedure to remove usually smaller AVMs or AMVs that are in a more accessible portion of the brain in order to eliminate the risk of rupture.

Treatment of Ischemic Stroke

Our primary goal in treating Ischemic stroke is to restore blood flow to the brain. This is done using blood clot-busting drugs known as thrombolytics, such as aspirin, and heparin, that must be administered within 4.5 hours of the onset of stroke. In addition, surgical procedures may be performed that can open up or widen arteries. These include Mechanical thrombectomy: It involves the use of specialised devices to physically remove or break up the blood clot, restoring blood flow to the affected area of the brain. Carotid Endarterectomy: Removal of plaque and widening of the carotid artery.

Angioplasty: A balloon that widens the carotid artery is held open with a metallic mesh tube called a stent.