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Stroke- Time to Act

  • May-10-2017

Stroke is one of the major health burden of the society with long term social, financial, physical and emotional consequences. Stroke commonly known as “paralysis” is also one of the most sub-optimally treated debilitating illness. It occurs when blood supply to brain is interrupted either because of blockage of its blood supply (ischemic stroke) or rupture of blood vessels causing leakage of blood into the brain substance (hemorrhagic stroke). The worst part of stroke is that it leaves the person with lifelong neurological deficit. Despite being such a devastating illness majority of population seeks alternative means for its treatment.

What are the Symptoms of stroke?

The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause.  Majority of the population suffers from ischemic stroke or attack caused by interruption of blood supply. The symptoms of stroke at times occurs transiently, that means lasting for short duration and is termed as “transient ischemic attack” or “mini stroke”. Its importance lies in the fact that mini stroke serves as a warning signal for major stroke and should never be ignored. Rather an urgent consultation in emergency and treatment can prevent future serious stroke.

How can stroke be treated?

The treatment can be broadly classified into acute and post stroke rehabilitation.

The acute treatment of ischemic stroke earlier comprised only of medicines (antiplatelets , statins ) but now the treatment is available the dissolve the clot so that permanent damage to brain can be minimized. However this treatment can be given maximum 4.5 hours within onset of stroke, else the risk of bleeding increases.  Its important to realize that thrombolysis is effective if given within 4.5 hours of stroke, the sooner the better. Every minute delay can cause the brain to lose 1.9 million neurons.

The patients who receive thrombolysis have significant better neurological recover at 1 month and 3 month as compared to those who did not. Unfortunately not all the patients are eligible for lysis and only 15% of ischemic stroke patients are eligible to receive the drug.

In case of hemorrhagic stroke or bleeding in the brain, therapeutic options could be conservative or surgical, depending upon the site of bleeding, extent of bleeding and other risk factors associated with the patient. The control of blood pressure, blood sugars and hemodynamics are common in the treatment of ischemic or hemorrhagic stroke.

The post stroke rehabilitation starts in the acute stage and has to be continued in the post stroke period. It involves physiotherapy of the weak limbs, applying compression stockings to lower limb so that blood do not clot in lower limbs and other factors which needs to be individualized . The most important aspect of stroke treatment is that it has to be continued life time despite complete improvement as the underlying risk factors needs to be controlled, else patient is highly susceptible to repeat stroke.

The stroke prevention is partially possible by controlling its modifiable risk factors like hypertension, diabetes, any underlying cardiac condition, keeping lipid levels within permissible range, adopting healthy lifestyle and regular exercise.

At Sarvodaya Hospital we not only treat but also educate the patients for post stroke care at home. We follow the International protocol for the procedure and monitor the patient carefully during the procedure to maximize the benefit to the patient and to minimize the risk associated with thrombolysis.

By Dr Ritu Jha
Consultant, Neurology
 

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