Stroke: Signs, Symptoms and Treatment in India

What is a stroke?
Are there different types of strokes?
Ischaemic stroke
Haemorrhagic stroke
What are the symptoms of a stroke?

• ability to perform movements — usually affecting one side of the body;

• speech;

• part of vision;

• co-ordination;

• balance;

• memory; and

• perception.

Are there any warning signs of stroke?
The warning signs

• Sudden weakness or numbness of the face, arm and leg on one side of the body.

• Loss of speech, or difficulty talking.

• Dimness or loss of vision.

• Unexplained dizziness, especially when associated with any of the above signs.

• Unsteadiness or sudden falls.

• Headache (usually severe and of sudden onset).

• Confusion.

A stroke (cerebrovascular accident, CVA, cerebral vascular accident or brain attack) occurs when a part of the brain is damaged or destroyed because it is deprived of blood.

There are 2 main types of strokes: ischaemic stroke and haemorrhagic stroke.

Ischaemic stroke is the most common type of stroke and is caused by a blockage of the blood vessels supplying the brain. This may be due to ‘hardening’ and narrowing of the arteries (atherosclerosis) or by a blood clot blocking a blood vessel.

One type of ischaemic stroke is a thrombotic stroke. This is caused by a blood clot (thrombus) in one of the arteries of the head or neck, which severely reduces the blood flow. The thrombus may be a result of a build-up of fatty deposits (plaques) in the blood vessels.

Another type of ischaemic stroke is an embolic stroke (or cerebral embolism), caused when a blood clot that forms elsewhere in the body (for example, the chambers of the heart) travels through the circulatory system to the brain. The travelling clot is called an embolus.

The most severe type of stroke is a haemorrhagic stroke. It occurs when a blood vessel in the brain bursts, allowing blood to leak and cause damage to an area of the brain. There are 2 types: subarachnoid haemorrhage, which occurs in the space around the brain; and an intracerebral haemorrhage, the more common type, which involves bleeding within the brain tissue itself.

The symptoms of a stroke usually appear suddenly. Initially the person may feel sick, and look pale and very unwell. They may complain of a sudden headache. They may have sudden numbness in their face or limbs, particularly down one side of their body. They may appear confused and have trouble talking or understanding what is being said to them. They may have vision problems, and trouble walking or keeping their balance. Sometimes a seizure (fit) or loss of consciousness occurs.

Depending on what function the damaged part of the brain had, a person may lose one or more of the following functions:

Some strokes are preceded by mini or temporary strokes — transient ischaemic attacks (TIAs). Mini strokes occur when there is a temporary blood clot and part of the brain does not get the supply of blood it needs.

Symptoms occur rapidly and usually last a short time, from a few minutes to a couple of hours. Like a stroke, the symptoms will vary depending on which part of the brain is affected.

While the symptoms of a TIA are similar to those of a stroke, they are usually temporary and reversible.

However, mini strokes should not be ignored as people who have had a temporary stroke are much more likely to have a stroke than people of the same age and sex who have not had a temporary stroke.

It is important that you see your doctor immediately when the warning signs of stroke occur. Your doctor will determine whether a stroke, a mini stroke or another medical condition with similar symptoms has occurred, such as a seizure or migraine.

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Types of Stroke and Treatment in India

What is stroke?

Stroke refers to a brain disease caused by either blockage of blood supply or rupture of a blood vessel to a particular part of the brain. This results in reduction of blood and oxygen supply to the affected part of brain resulting in loss of function

A stroke can be categorized into two types –

Hemorrhagic Strokes: This type of stroke occurs when a blood vessel bleeds and burst within the brain. This accumulated blood compresses the nearby tissues of the brain. This could be due to –

• A blood vessel on the brain surface starts bleeding in between the area of the skull and the brain.
• A blood vessel bleeding or bursting inside the brain

Hemorrhagic strokes has two main types –

• Subarachnoid hemorrhage: In this, there is bleeding in between the area of the brain and the thin tissues covering the brain.
• Intracerebral hemorrhage: This is considered as the most common type of hemorrhagic strokes. This occurs when an artery bursts inside the brain and resulting in the flooding of the nearby blood tissues.

Ischemic Stroke: This occurs when something is causing blockage in an artery which is carrying blood to the brain. The potential causes are –

• When there is a blockage in the small blood vessels within the brain
• When a blood clot develops in the main artery to the brain
• When an air bubble, a blood clot or fat globule develops in a blood vessel which is carried to the brain.

Causes

Some of the causes that can lead to a stroke are as follows:

1.       Ageing

2.      High blood pressure

3.      Diabetes

4.      Cardiovascular diseases

5.      High cholesterol

6.      Obesity

7.      Vitamin B12 deficiency

8.     Excessive alcohol and drug abuse

Symptoms:
Symptoms of a stroke occur suddenly. Symptoms vary depending on the location of the stroke. Each area of the brain is supplied by specific arteries. If an artery supplying the area of the brain that controls the left arm movements is blocked, that arm becomes weak or paralyzed.

The five most common signs and symptoms of stroke are:

1. Sudden numbness or weakness of the face, arm, or leg - like weakness of half of the body called as hemiplegia.
2. Sudden confusion or trouble speaking or understanding others called aphasia in medical terms.
3. Sudden trouble seeing in one or both eyes called as mono or binocular vision disturbance. This could be due a stroke anywhere in the visual pathway.
4. Sudden dizziness, trouble walking, or loss of balance or coordination, this is commonly due to posterior circulation strokes.
5. Sudden severe headache with no known cause is due to hemorrhage or sometimes infarction.

Diagnosis:

The diagnosis Is based on the symptoms and a good history given by the patient or an observer. Usually any neurologic symptom occurring suddenly in a neurovascular territory is attributed to a stroke. CT scan done immediately after a stroke is almost always normal in ischemic strokes. MRI with diffusion images is sensitive to diagnose acute infarction.

Treatment of a Stroke

The treatment for both hemorrhagic and ischemic stroke is different.

The purpose of treating ischemic stroke is to restore the flow of the blood in the brain. Medications are given in the first four and a half hours of the stroke for destroying the clots in the blood vessels. An injection of tissue plasminogen (TPA) can also be given to a patient for improving the probability of a full recovery.

The main purpose of treating a hemorrhagic stroke is to stop bleeding and decrease the pressure on the brain. Instead of blood thinners, clotting drugs can be given. After the area has been healed and the bleeding is controlled, the damaged and leaky blood vessels are then repaired.

The first stroke device approved by FDA is Merci retriever. The aim of this device is to restore the flow of the blood in the neurovasculature by removing thrombus in those patients who have ischemic stroke.

The penumbra system (endovascular thromboaspiration) is the last FDA approved device that has been primarily developed for removing a clot in the case of acute ischemic stroke. In order to eliminate or reduce the clot burden, this system uses dual approaches to clot extraction by using debulking and aspiration of the thrombus. Clot retrieval is then used where a ring device holds the thrombus by capturing it in clasps with a cylinder. This is then withdrawn at the time of flow arrest. This new aspiration device (the penumbra system) has an excellent safety profile and a high rate of ‘target vessel’ recanalization.

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Tips for Your Best Stroke Recovery : Rehabilitation is a crucial component of care following a stroke

Survivors have an increased risk for long-term disability and face challenges completing daily activities.

Rehabilitation is a crucial component of care following a stroke. At top stroke centers some form of rehabilitation begins virtually immediately after a patient is admitted to the hospital — to get them on the right path to the best possible outcomes.

However, there are several things patients can do to ensure they are maximizing their recovery starting the second they suspect a stroke. Here are 10 tips:

1. Seek urgent care immediately.

It is absolutely critical to seek emergent care when a stroke is suspected. Patients who arrive at the emergency department within 3 hours of their first symptoms tend to have less disability months after a stroke than those who received delayed care.  A stroke alert prompts a team of experts from our center to come to a patient’s bedside within minutes to confirm or rule out a stroke, allowing treatment and rehabilitation to begin as soon as possible.

If you’re worried about clogging the emergency room or just want to wait things out, you could be delaying life-saving care.

2. Keep your medical information handy.

A stroke can affect parts of the brain responsible for cognition and communication, leaving a patient unable to tell a doctor their medical history. That can be worrisome, because some stroke treatments can’t’ be given with other medications.

I urge people to carry with them a patient health profile that lists their medical conditions and any medications they’re taking. This piece of paper carried in your wallet might contain vital information that doctors can use to ensure you’re on your way to an optimal recovery.

3. Choose a top care center for your rehabilitation.

Whenever possible, you want a patient to be involved in acute inpatient rehabilitation following a stroke. Data suggest the more acute, intensive rehabilitation you get after a stroke, the better the outcomes.

4. Eat well.

A healthy and consistent diet is crucial when recovering from a stroke, from the hospital bed to your outpatient care at home.

One reason food choice is important is because patients in early stages of recovery may experience weakness or incoordination of the swallowing muscles. A care team might recommend soft foods or thicker liquids, because swallowing problems can lead to fluid aspiration which might lead to pneumonia.

Also, certain medications may interact with certain foods, so a rehabilitation specialist can direct you to the best choices.

5. Compliance is key.

I tell my patients if you don’t remember anything in the weeks you’ve been here as an inpatient, the one thing I want you to remember is to see your primary care doctor for regular follow-ups and checkups. Your primary care doctor is essential to your recovery from a stroke, and can make sure your medication needs and health issues are being attended to properly.

Some people may be in denial after a stroke and instead avoid their doctors. But poor compliance with physicians and medications may have got them into these health problems in the first place.

6. Exercise, but within your limits.

Safe levels of physical activity as prescribed by a physical or occupational therapist can go a long way when rehabilitating from a stroke.

What’s important though is you don’t overdo it. People may be excited by improvements in their ability to exercise, but falls are a very real risk following a stroke. That’s why it’s important to stick to your prescribed routine.

7. Limit stress.

I urge patients to keep their lives as stress-free as possible after a stroke. This is not meant to imply that leading a stressed life in some way contributed to their stroke in the first place, but keeping your life more balanced without undue psychological pressures is associated with better outcomes.

8. Stay positive.

It’s very common to have a negative attitude after a serious illness, and some patients experience depression after a stroke — sometimes weeks or months later. However, it is absolutely critical to keep a realistic or positive attitude during rehabilitation to maximize results. Psychologists, psychiatrists and other therapists, who are part of your care team, may recommend therapy and/or medication.

9. Do your homework.

For every stroke patient, treatment at a rehabilitation center eventually comes to an end. When you continue onto the outpatient setting, it is essential you do any homework — otherwise known as a home exercise program — assigned to you by one of your rehabilitation care specialists.

I can’t tell you how many times a patient comes back with a family member or partner to report they’re not getting better, only for a loved one to point out they’re not following their assignments.

It’s never fun to have a stroke or disabling illness, but even if it feels like it’s a grind, do whatever you can to stay up-to-date with your homework.

10. Stay vigilant.

Patients following a stroke face an increased risk of second stroke compared with the general population. Your brain helps you recover from a stroke by asking the unaffected brain regions to do double duty, which means a second stroke can cause far more dangerous effects.

If heaven forbid something gets worse again or you suspect you’re having another stroke, seek out medical attention immediately.