The Role of a Comprehensive Stroke Care Center

January 06 11:26 2022 Print This Article

What is a Stroke?

Stroke can be best described as a brain attack. The brain needs a steady supply of oxygen-rich blood to function properly and this is supplied through an intricate network of blood vessels throughout the brain. In case this supply is disrupted for any reason, brain tissues don’t get enough blood or oxygen, and in the process start dying out. The damage may be temporary or permanent, causing death, disability or loss of one or more brain functions. The episode and the resulting condition are both called a stroke.

This sequence of events is exactly what happens in a heart attack too.

Types of Strokes

• Ischemic stroke: Here the blood supply is restricted because a blood clot or pieces of plaque, caused by atherosclerosis, becomes unstable and leads to formation of a clot (thrombus) which is blocking the blood vessel.
• Transient ischemic attack (TIA):TIA is similar to an ischemic attack but the problem is temporary and normal blood flow is restored within 24 hours, on its own. But this is a warning sign that a repeat stroke may occur.
• Hemorrhagic stroke: This occurs when a blood vessel in the brain ruptures and leaks blood (hemorrhage). The leaking blood increases pressure inside the cranial cavity and damages the brain or parts of it.Both ischemic and hemorrhagic strokes are divided into sub-categories depending on the mode of onset and location.

Stroke Signs and Symptoms

• Trouble speaking or understanding speech, slurring speech
• Vision problems such as trouble seeing in one or both eyes (darkened, blurred or double vision),
• Paralysis
• Numbness or weakness in the arm, face, and leg on one side of the body
• Confusion, dizziness
• Severe or sudden headache
• Fainting briefly
• Trouble walking and loss of balance or coordination

FAST recognition and do the following:

• Tell the person to smile. Does one side of the face droop?
• Tell the person to raise both arms. Does one arm drift downward / sags? Or is one arm unable to rise?
• Tell the person to say a simple sentence. Is his or her speech slurred or sounding strange?
• Every second counts, seek medical care immediately without any delay.

Risk Factors – ABCDD Score

If a patient presents with any of the symptoms mentioned above, the neurologist would calculate what is known as the ABCDD score. Even the common man can keep this in mind to get an idea of stroke risk.

• A – Age: Being over 60 years of age
• B – Blood Pressure: BP reading that is greater than 140 systolic
• C – Clinical deficit: Any impairment in speech, vision or hearing with weakness on one side of the body
• D – Duration: The aforementioned factors lasting for more than 10 minutes
• D – Diabetes: The person also has diabetes

With the above-mentioned risk factors, around 10% of patients would suffer a stroke within a year.

What Happens at the Center?

• As soon as the patient arrives, the stroke code is activated – the patient is seen at once and a CT scan is taken.
• While in some cases, the neurologist might want an MRI done, a CT scan is the more common of the two.
• This is because the scan takes a very short time and interpretation is also easy. Whether an MRI is done or not is decided on by the neurologist depending on the clinical profile of the patient.
• The CT scan will help the neurologist determine the type of stroke – this is of paramount importance as the treatment protocol varies depending on the kind of stroke the patient is suffering from.
• In the case of a blood vessel block i.e., an ischemic stroke, the block has to be broken down. If the patient is brought within the 4 ½ golden hours-time window and if the CT findings are conducive, drugs called RtPA or Tenecteplase might be given to dissolve the clot. This is called thrombolysis.
• If the treatment with drugs is successful, no other intervention is required.
• However, if the clot remains undissolved, the patient will be shifted to the cath lab. In the cath lab, the clot is localized and using a special catheter; the clot will be mechanically removed by a process called mechanical thrombectomy.
• This mechanical thrombectomy procedure is indeed a decisive intervention today in stroke treatment. It is available in all the comprehensive stroke care centers.
• In the case of an aneurysmal bleed, the aneurysm would be  occluded with a coil or its neck clipped in the cath lab. These two options are also available in a comprehensive stroke care center and make a world of difference to the patient.

Stroke in India

• Stroke is among the top 3 causes of death in India.
• The number of young adults suffering from stroke is also more in India compared to Western nations.
• India has adopted a multi-pronged approach of awareness, early identification and intervention by trained personnel to manage the ever-increasing stroke burden.
• While prevention of stroke is what India hopes to aim for eventually, dealing with stroke in an efficient and timely manner is what is being focused on now.
• In this, a comprehensive stroke care center plays a the most significant role as prompt treatment given by experienced professionals that saves lives.
• Lives placed at great risk from a stroke can be saved if everyone is aware of stroke symptoms and knows where to take a person who is suffering from the onset of a stroke.

Stroke is a treatable medical emergency – Patient Testimonial

“It was a quiet day in the office and I was having lunch, when I suddenly felt my face go numb. My face started drooping and my speech was slurred. My colleagues rushed me to Kauvery and I was admitted to HASU. It was soon established that what I had was a stroke. Thrombolysis was done immediately but didn’t fetch desired results. Soon after, I was transferred to Cath Lab for Mechanical Thrombectomy and the clot was successfully removed. Today, I lead a perfectly normal life, because of the quick and effective treatment I received at Kauvery Hospital.”

– Mr. Sudhir Babu, 47 years

Prevention of stroke

• Quit smoking: Nicotine has a deadly effect on blood flow. For one, it acts as a catalyst for clot formation. Secondly, it thickens the blood and increases plaque build-up in the arteries leading to atherosclerosis, which is a huge risk for stroke.
• Reduce alcohol consumption: Interestingly, having one drink a day may reduce the risk of a stroke. But more than 1 drink a day increases the risk of a stroke due to several reasons.
• Reduce and maintain weight: A healthy body mass index reduces the risk for various ailments such as hypertension, diabetesand stroke. Eat in moderation and exercise regularly in order to maintain weight. Include cardio exercises like running, jogging, swimming, callisthenics, sports, intense cleaning, intense gardening, etc as these help burn fat faster.
• Eat a healthy diet: A healthy diet that is low on salt, cholesterol, trans-fats, and saturated fats, and rich in fresh fruits and vegetables helps prevent many ailments including stroke. Include a salad in every meal or at-least once a day. Include produce that are rich in potassium such as banana, avocado, dates, beetroot and cantaloupe (musk melon).
• Be active physically: This helps you maintain your weight, reduce BP and reduce cholesterol levels. It also helps burn food into energy better which regulates blood sugar levels. This in turn helps regulate insulin production in the body and prevent the onset of type-2 diabetes.
• Health checkups: Get regular health checkups that record your cholesterol and blood pressure levels. High blood sugar, cholesterol and high blood pressure are all “risk factors’ for a stroke.
• Discuss your medication: Some medicines may increase the risk of stroke, so mention the medicines you take every time you meet a doctor
• Address health issues quickly: If you suffer from any of these: atrial fibrillation, sickle-cell disease, anaemia, peripheral vascular disease, diabetes, hypertension etc, it’s advisable to go in for quick and definitive solutions.
• Maintain your brain health: Reduce stress through yoga and meditation. Keep your brain active in old age by solving puzzles, staying connected with friends and family, taking up a new hobby etc. These reduce the risk of stroke and prevent the onset of dementia of the commonest types of which is Alzheimer’s disease.
• Avoid HRT: Post-menopausal women should avoid Hormone Replacement Therapy and choose other means to maintain their overall health.

Frequently Asked Questions

 1. What is a stroke?

A stroke is a medical emergency where the brain’s blood supply is disrupted, leading to potential brain damage, disability, or death. It is often called a “brain attack.”

2. What are the main types of strokes?

There are three main types: ischemic stroke (blocked blood vessel), transient ischemic attack (temporary blockage), and hemorrhagic stroke (ruptured blood vessel).

3. What are common stroke symptoms?

Symptoms include trouble speaking, vision problems, paralysis or weakness on one side of the body, confusion, severe headache, and loss of balance.

4. How can I recognize a stroke using the FAST method?

FAST stands for Face drooping, Arm weakness, Speech difficulty, and Time to call emergency services. If someone shows these signs, seek medical help immediately.

5. What are the key risk factors for a stroke?

Risk factors include being over 60 years old, high blood pressure, diabetes, and having symptoms like speech, vision, or hearing impairment lasting over 10 minutes.

6. How can I prevent a stroke?

Preventive measures include quitting smoking, reducing alcohol consumption, maintaining a healthy weight, eating a balanced diet, staying physically active, and getting regular health checkups.