What is stroke or a brain attack?
It is a common notion among people that ‘brain attack’ or ‘stroke’ and ‘heart attack’ are one and the same. It is estimated that one person dies of stroke every 36 seconds in India. A STROKE is a blockage in an artery in the brain or neck that supplies blood to the brain. When a clot forms in one of those arteries and stops blood flow, a section of the brain begins to die. When those cells die, the person loses whatever function those brain cells controlled. This can present as sudden inability to move arm, leg or face. It may also cause aphasia or inability to speak. There is another category called the ‘hemorrhagic stroke’ in which a blood vessel bursts and bleeds in the brain.
Current Treatment Options
In a number of patients with paralysis due to stroke, the symptoms can now be reversed completely if treated
immediately. If you arrive at the hospital quickly, you may be treated with a drug known as ‘tPA (Tissue Plasminogen Activator). This drug breaks down the blood clots that cause an ischaemic stroke. It is very good at improving a person’s recovery after stroke but it can also cause bleeding in the brain. ‘tPA must be started within 4.5 hours of the stroke, after a CT scan, and can only be used where there are experienced doctors and specialist services. This drug is only useful for certain types of stroke (those due to blood clots) and is not suitable for everyone.
If drugs don’t adequately break up the clot, and if the stroke is localized to one area (acute), your doctor may perform angiography of blood vessels of brain, use a catheter to access the clot and remove it manually using specialized tools. The catheter is threaded through blood vessels towards the area where the clot is lodged. The clot is either removed by a corkscrew-like device attached to the catheter, or by clot-busting agents administered through the catheter directly to the clot. “The most important factor is seeking immediate treatment as millions of brain cells die with each passing second in patients with stroke”, says Dr. Sudheer Ambekar, an endovascular neurosurgeon who treats patients with stroke. The minimally invasive endovascular techniques allows for patients to be treated through a 1mm incision in the leg with no incisions in the head. While most conditions can be treated endovascularly, there are some cases are safer with surgery. He is also a specialist in pediatric vascular disease such as aneurysms and tumors, and treating children with surgical and endovascular techniques.
Depending on the damage to the vessel in the brain, surgery may be required after a hemorrhagic stroke. Surgery not only repairs damage, but also helps prevent future problems. If a surgeon can easily access the affected artery, they may surgically remove it. This can reduce the risk of future rupture. If the damaged artery is not easily accessible for surgery, catheterization is an option. Using a catheter, a surgeon may use a technique called coiling or aneurysm embolization. Once a surgeon finds the ruptured vessel, they release a coil into the area. The coil is made of soft platinum wire narrower than a strand of hair. This provides a type of net where blood can clot and seal off the hole from other arteries.
The comprehensive stroke service at Jaslok Hospital and Research Centre is one of its kinds in India where the patients are managed by a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, neurointensivists and rehabilitation specialists who provide expert diagnosis and medical, endovascular and surgical management of all cerebrovascular conditions.
Stroke Support and Post-operative Care
Brain injury due to stroke can change the way you move, feel, think, or speak. The effects are greatest right after the stroke. Over time, most people will make improvements. Stroke rehabilitation programs can help, though stroke rehabilitation will not “cure” or reverse brain damage. The goals of stroke rehabilitation are to help stroke survivors live as independently as possible while adjusting to new limitations.
Rehabilitation usually starts in the hospital, within a day or two of the stroke. Stroke rehabilitation may continue for months or even years after leaving the hospital. Patients begin working with occupational and physical therapists, and speech and language pathologists as soon as they are medically ready. If therapy is needed after discharge, we work with patients and their families to plan the best recovery strategies. The patients are followed up regularly in coordination with the patient’s general practitioner. Long term home health facilities are also available to the patients.