Brain Stroke

What is stroke?

Brain stroke or a Brain attack, is a medical emergency and one of the most disabling diseases and is preventable in many forms. It is said that 1 in 6 Indians or even more at risk and “time is brain” . 

Earlier, we used to see stroke in elderly but unfortunately now, we are seeing more of younger people also being affected. 

Stroke occurs because of stoppage of blood flow to a certain region of the brain which may be due to:

• Ischemic stroke: It happens when a blood vessel is blocked by a blood clot  or a buildup of fatty deposit and cholesterol.
• Hemorrhagic stroke: When a blood vessel bursts in brain it causes blood spilling into nearby tissues. Due to this, pressure builds up in the nearby brain tissue and the blood in the tissue even more damage and irritation is caused.

 Since constant blood flow is needed for brain cells (neurons), even a few minutes, as less as 3-5 minutes without adequate blood and oxygen to neurons can kill them. Due to neuronal death, the function they are responsible for is also lost.

It can affect the parts of brain responsible for essential functions like breathing and blood pressure control besides other vital control centers and thus, if they are involved, it can cause death, stroke being the second leading cause of death worldwide. While the number of people affected by stroke is increasing, the deaths are reducing in places with good medical care facilities. 

Who is at increased risk?

There are various factors which increase the risk for having a stroke:

• High blood pressure
• Heart disease
• Diabetes
• Smoking
• Medications like birth control pills
• High blood cholesterol
• Lack of exercise
• Alcohol and illicit drug use
• Hereditary causes or genetic mutations
• Older age groups
• Having a previous stroke
• Aneurysm in brain
• Arteriovenous malformation in brain
• Clot in veins of brain (Venous sinus thrombosis)

What does a stroke do?

The effects of stroke are wide depending upon the area of the brain affected and the severity of the stroke. It may impair your ability to:

• Move
• Speak
• Eat
• Think and remember
• Control your bowel and bladder
• Control your emotions
• Control other vital body functions

Other less common symptoms of stroke may include:

• Sudden nausea or vomiting not caused by a viral illness
• Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma
• Transient Ischemic attack (TIA), called a mini-stroke. A TIA can cause many of the same symptoms as a stroke. But TIA symptoms are passing. They can last for a few minutes or up to 24 hours. It may be a warning sign that a stroke is about to occur. But not all TIAs are followed by a stroke.

How to identify a stroke?

Unfortunately, life and optimum function can be saved in this catastrophic event only by early recognition followed by rapid and adequate treatment, at a center equipped for stroke with a well-trained stroke team. 

 The patients do not seek the medical attention on their own because they lose the appreciation that something is wrong with them or they lack the knowledge of how acute treatment can be beneficial for them. 

It is often a family member or a bystander who calls for help. Therefore, please recognize early signs, as it may help a victim in your known circle, or even a bystander. Remember, A stroke can happen to anyone at any time.

1. Imbalance 
2. Sudden blurring of vision
3. Asymmetric of face
4. Acute onset weakness of arm or legs
5. Slurring of speech

Add FAST image or cartoon with manipal helpline number

And a video as discussed with Arush just now

How do we treat stroke?

Dr. Vikas Gupta is leading the stroke team since 20 years now and has been one of the early ones to adapt newer scientific methods after worldwide trials ( to read more refer to N Engl J Med 2015; 372:11-20 “A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke” popularly called MR clean trial and many similar trials), to successfully treat the stroke which involves opening up blocked artery in a neurovascular cath lab to open the blocked artery in a ischemic stroke ( clot in artery) called mechanical thrombectomy or block the ruptured brain artery by filling it and blocking it with coils, flow divertors, flow disruptors. 

When a victim of acute stroke reaches in the window period, he/she is rapidly evaluated and various imaging and brain scans done using different modalities are employed to decide the appropriate therapy depending on the type of stroke (ischemic or hemorrhagic). The exact site affected is identified along with the blood vessel involved and the severity of the stroke. According to these factors and the standard scientific treatment guidelines, the patient is given intravenous thrombolytics (clot busting drug given via veins) or mechanical thrombectomy is done by an endovascular surgeon in the Neurovascular Cath lab. 

 Along with specific treatment, utmost care is taken by the specialized and dedicated team to prevent further damage to the brain by giving neuroprotective medicines, decreasing the increased pressure in brain and brain swelling, preventing seizures and taking care of vital functions like breathing (with help of a ventilator), blood flow across the body, blood pressure, fluid and nutritional needs of the patient. 

Timely treatment is a game changer in this disease with grave outcomes of probably a life of physical dependence or even death, to very gratifying outcomes.

Time being the key, the patient should reach the right hospital at earliest for the treatment to show optimum results. With every minute of delay, outcomes become worse. 

Life after stroke

Impact of a stroke depends on part of the brain affected and the amount of damage occurred. A team of different specialists including Physiotherapists, psychologists, psychiatrists, speech and language therapists, dieticians help the patient rehabilitate after the stroke.

Many people who have a stroke are left with paralysis of one of their limbs or improper speech. 

Other problems can include having trouble with:

• Thinking
• Speaking and understanding
• Reading 
• Eating by themselves
• Swallowing
• Doing simple calculations
• Dressing themselves
• Showering
• Going to the bathroom
• Control of bladder and/or bowel

Some people may need lifelong assistance to carry out their daily activities and take care of their personal hygiene.

My experience with stroke

(Add patient testimonials)

Manipal Hospital Helpline No: 011- 4040 7070