Attack the Stroke

Did you know that the predisposing factors for both heart attack and brain attack are almost the same and incidence and death rates are also similar in both conditions? Dr K. Hari Prasad, M.D., President Hospital Division, Apollo Hospitals throws light on the lesser known facts about brain attack or strokes.

So, What is a Brain Stroke?
A brain attack or stroke happens when blood supply to a part of the brain is either interrupted, reduced or stopped. This reduces the oxygen and nutrient supply to the brain, and causes the brain cells in the affected area to die.

Transient ischemic attacks is when blood supply to a part of the brain is temporarily causing problems. However, the patient recovers within a short period of time, as soon as the blood supply is re-established.

Ischemic stroke is caused by narrowing or blocking of blood vessels in the brain, resulting in reduced/stopped blood supply to a part of the brain. Unless treated aggressively, the patient does not recover from symptoms and often results in disability.
Haemorrhagic stroke occurs when a blood vessel in the brain bursts or leaks. It is important to differentiate between ischemic and haemorrhagic strokes as treatment is significantly different. A CT Scan and/or MRI can be used to identify the type of stroke.

What Causes a Stroke?
High levels of blood pressure, diabetes, altered lipid profile, smoking and stress are some of the causative factors. It is clearly documented that Indians are more prone to conditions like hypertension, diabetes and altered lipid profile. In many instances, when the stroke is identified early and treated appropriately, the patient gets back to normal without any disability. While symptoms of heart attack are very easily identified, symptoms of stroke are not.

Diagnosing Strokes
Stroke is a medical emergency — it occurs suddenly, without a warning. If the condition is not diagnosed and treated within the specified time, long term disabilities set in.  
While CT Scan and MRI are the standard diagnostic tools, other blood test, echocardiography, carotid doppler and cerebral angiography may be done on patients with indications of stroke. There are new tools which are currently being evaluated, such as the Stroke Finder Helmet. This device, with the help of microwaves, helps detect, locate and indicate the type of stroke. New smartphone apps are also being evaluated for early diagnosis of stroke in the community. Once the efficiency of these devices is validated, the diagnosis of stroke may become easier.

Can Strokes be Treated?
Treatment of stroke depends on the type of stroke. In an ischemic stroke, medicines, which breakdown the clot that has blocked a blood vessel in the brain, are administered.

Traditionally, Tissue Plasminogen Activator (TPA) is administered through a peripheral vessel. However, to enhance efficiency and improve outcomes, a catheter is passed into the vessel where the clot is present in the brain and TPA injected.

Procedures involving removal of the culprit clot using a catheter are also being performed now. In haemorrhagic strokes, the blood which has leaked out of the blood vessel causes pressure on the brain, leading to swelling of the brain cells. The initial treatment involves administration of medicines to reduce pressure on the brain. But when medical treatment does not suffice, surgery may be performed to relieve the pressure on the brain. Interventional procedures and surgery may also be performed to prevent bleeding or rupture of the blood vessels.

Rehabilitation plays a major role in patients who recover with deficits. Care of the bladder and bowels, inability/difficulty in moving due to weakness in the limbs, speech difficulties and disturbed sleep are some of the after effects. These conditions cause a serious socio-economic impact on the family. Regular rehabilitation over a period of time may improve these conditions.

 — As told to Usha Munshi