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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Low-cost neurosurgery in India

Indian hospitals to offer low-cost neurosurgery in India

Neurosurgery in India is a very good option for abroad patients seeking low cost and safe surgical treatment for the correction of their disorders. Medical tourism in India provides very good assistance to international patients for their comfortable treatment in India. For neurosurgery, patients must find surgeons who are appropriately trained. Another factor to consider is cost and reimbursement. And finally, patients need to be aware that like any new medical technology, this surgery carries with it a certain level of unknown technical risks. SinceNeurosurgery  in india it is still a relatively new procedure in India with a certain level of risks. The cost of Neurosurgery in India is very less compared to that of its cost in other developed countries. Most advanced surgery hospitals for Neurosurgery  in India are in most prominent cities of India.

The large number of neurosurgeries in India enables Indian hospitals to offer low-cost neurosurgery in India. Further, cost of neurosurgery in India is amongst the lowest in the world.

The neurosurgeries performed at hospitals in India include the following

• ·         Surgery of the Skull Base

• ·         Micro Vascular Surgery

• ·         Brain Surgery for Epilepsy

• ·         Interventional Neuroradiology

• ·         Neurological Endoscopy

• ·         Non-Invasive Stereotactic Radiosurgery

• ·         Craniotomy

• ·         Surgery for DBS (Deep Brain Stimulation)

• ·         Spine Decompression Surgery

• ·         Spine Decompression with Fusion

• ·         Laminectomy

• ·         Spine Disc Replacement

• ·         Scoliosis Surgery

• ·         Endoscopic Discectomy

• ·         Spina Bifida

Neurosurgeons in India gravitate towards super specialisation in focus areas such as interventional neuroradiology, skull base surgeries, paediatric neurosurgery, etc. Unlike in the past when orthopaedic surgeons used to perform some spine surgeries, spine surgeries are now performed at leading hospitals in India exclusively by surgeons specially trained in spine surgery.
Success rates of Neurosurgery in India very often exceed international standards. Further, neurosurgery cost in India, is amongst the lowest in the world.

Cost of Neurosurgery in India

The cost of neurosurgery in India is truly economical. Some examples:
·         Neurosurgery cost in India for the removal of Pituitary Gland Tumour : Cost of Neurosurgery in India for the excision of pituitary tumour will involve an expenditure of US dollars three thousand to six thousand. The comparable cost of neurosurgery in the USA would be approximately 5 times as much.
·         Neurosurgery cost in India for Lumbar Spine Fusion: Cost of Neurosurgery in India for this procedure will be approximately US dollars 5000. The comparable cost of neurosurgery in the USA would be US dollars 20,000 at least
·         
Neurosurgery cost in India for spine decompression: Cost of Neurosurgery in India for this procedure would be between US dollars 6000; the cost of neurosurgery in the USA would be at least four times as much

Leading neurosurgery hospitals in India rank amongst the finest in the world. They combine the best of human resources in terms of highly qualified neurosurgeons, neurologists, interventional radiologists, interventional neuroradiologists and the best of material resources in terms of hospital infrastructure and medical equipment.

Why should you choose to get Neurology & Endovascular Neurosurgery in India?
Neurosurgery in India's top hospitals is extremely successful on account of the world class operation theatres and cutting edge technology that is available to neurosurgeons in India. For example:

·        Indian doctors are known all over the world for their skill and knowledge and have the experience of studying and working at the best neuron surgery hospitals in the world.·         Most advanced Technology Infrastructure - Blood Bank with 24 hour apharesis facility, advanced laboratory and microbiology (infection control) support, advanced cardiology, DSA and interventional radiology, portable and colour ultra-sonology, Liver Fibro-scan, 64 slice CT scanner, 3 T MRI, PET-CT and nephrology (including 24 hour dialysis and CVVHD).·         Neurosurgery Hospitals in India are equipped with the latest and high end technology.·         Cost of epilepsy surgery in India at best brain surgery hospitals in India is very low as compared to the cost at best hospitals in America or UK with the same level of care and services.

Treatment of brain and spine disorders are becoming less invasive with the advent of better imaging and interventional technologies. Interventional neuroradiologists in India now offer a wide range of minimally invasive neurosurgeries through angioplasty, placement of stents, treatment of vascular tumors, large aneurysm, embolization for resolution of arteriovenous malformations, etc

Rehabilitation care at hospitals for neurosurgery in India:

In the aftermath of complex neurosurgery, several patients will require intense physical and neuro rehabilitation. Leading hospitals for neurosurgery in Indiahave specialised equipment as well as rehabilitation specialists. Rehabilitation post neurosurgery is targeted in the following areas:

• ·        Functional Therapy

• ·         Mobility of Patients

• ·         Enhanced Movement Therapy

Advantages of Endovascular Neurosurgery/ Interventional Neuroradiology in India

Endovascular neurosurgery, is the field of medicine that combines neurosurgery with interventional neuro- radiology and treats the diseases of blood vessels of the brain and spine. This is a minimally invasive technique which entails using catheters and embolic agents or clotting agents rather than open surgeries.

The procedures are done in angiographic suite (located in the x-ray department), rather than the operating room and is done within the blood vessels using catheters to fill blood vessel abnormalities with particles, polymers or stents.

Endo vascular neuro surgery treats a variety of cerebro vascular diseases which are untreatable through conventional surgery such as:

• Stroke
• Aneurysms
• Arterio-venous malformations
• IArterial stenosis
• Dural arterio-venous fistulas
• Vascular Tumours
• Carotid Cavernous sinus fistulae
• Cerebral revascularization after clotting
• Vasospastic arteries
• 
  

Advantages of Endovascular Neurosurgery/ Interventional Neuroradiology

The most important advantage of the endovascular approach for the treatment of aneurysms, AVMs and tumors of the brain is one, they can be treated, because sometimes they are considered inoperable or too risky to be operated and thus the patient goes without treatment. Endovascular neurosurgery is the procedure of choice in following patients:

• 
  
• Old age
• High risk patients with diabetes and heart disease
• Patients with contraindication for surgery or anaesthesia

Second, craniotomy or opening of the skull is avoided and thus the procedure is done through minimal invasive technique. 

This means:

• 
  

Minimal damage to the normal brain tissue
Almost no mortality
Minimal chances of complications
No brain or spinal cord tissue manipulation
No scarring, pain and least discomfort to the patient
No blood loss and need for blood transfusion
Short hospital stay and fast return to normal activities
Acute stroke patients can be treated even many hours after the stroke.
Can be used to stabilize the bones and reduce pain in patients with specific types of spinal fractures such as compression fractures and fractures caused by osteoporosis.

Why should you choose to get Neurology & Endovascular Neurosurgery in India?

·         Indian doctors are known all over the world for their skill and knowledge and have the experience of studying and working at the best neuron surgery hospitals in the world.

·         Most advanced Technology Infrastructure - Blood Bank with 24 hour apharesis facility, advanced laboratory and microbiology (infection control) support, advanced cardiology, DSA and interventional radiology, portable and colour ultra-sonology, Liver Fibro-scan, 64 slice CT scanner, 3 T MRI, PET-CT and nephrology (including 24 hour dialysis and CVVHD).

·         Neurosurgery Hospitals in India are equipped with the latest and high end technology.

·         Cost of epilepsy surgery in India at best brain surgery hospitals in India is very low as compared to the cost at best hospitals in America or UK with the same level of care and services.

Deep Brain Stimulation, Parkinson Surgery, Tremor, Dystonia, OCD Treatment at World Best Hospital in India

World-class Hospital with dedicated Neurosurgery and Neurology ICUs and centres of Specialisation for brain tumours, spinal disorders, stroke, epilepsy, movement disorders and headache.

Most Advanced Technology like Brain Suite, Biplane Neuroendovascular Angiography, Synergy S Linac System, S-7 Navigation System, Endoscopic Neurosurgery Theatre, 3 Tesla MRI, 256 slice CT scan, PET scan.

 Low Cost Treatment package which includes Airport Pick up and Drop from Airport in India, Hospital Stay, Testing/Screening, Deep Brain Stimulation Treatment, Consultations with Specialist Doctors , Nursing care, Surgeon Fee, Medicines and Consumables.

Experienced Team of professionals having a specialist Neurologist (Movement Disorder specialist), Specialist Neurosurgeon, Neuroradiologist, Physiotherapist and Dietary specialists who provide high-quality care

For more information visit:          http://www.medworldindia.com     
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Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.

Call Us : +91-9811058159

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Why should you choose to get Neurology & Endovascular Neurosurgery in India?

Deep Brain Stimulation Surgery uses an implanted, battery-operated medical device called a neurostimulator—similar to a heart pacemaker and approximately the size of a stopwatch—to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and Parkinson’s disease symptoms. The electrode is connected via a wire running beneath the skin to a stimulator and battery pack in the patient's chest. It is reversible—just turns off the current—and allows for precise calibrated symptom control. Before the procedure of Deep Brain Stimulation Surgery, a neurosurgeon uses magnetic resonance imaging (MRI) or computed tomography (CT) scanning to identify and locate the exact target within the brain where electrical nerve signals generate the PD symptoms. 

Deep Brain stimulation may be used in addition to therapy with levodopa or other drugs when drugs alone do not control symptoms adequately. This technique of Deep Brain Stimulation Surgery is the preferred surgical method of treating most cases of advanced Parkinson's disease. It does not destroy brain tissue and has fewer risks than older, more destructive surgical methods, such as pallidotomy and thalamotom

Deep brain stimulation (DBS) is a treatment where a part of your brain is stimulated, to stop you having symptoms of a particular medical condition. It’s called an interventional procedure. An ‘interventional procedure’ includes tests, treatments or surgery which involve making a cut to the skin. Surgery is needed to fit the DBS system.

There have been several studies where people with difficult-to-control epilepsy have had fewer seizures after having DBS surgery. 

• DBS will only be considered for people who can’t have their seizures controlled by epilepsy medicines or other types of surgery
• There’s not much good evidence about how well DBS works
• After two years, more than half the people who had DBS had fewer seizures than before the surgery
• If you are being considered for DBS, a team of specialist doctors will work together, to make sure you and your epilepsy are suitable for the surgery
• If you are offered DBS, you should be told that the benefits are uncertain, and the surgery has risks
• Your doctor should discuss the risks with you, and give you written information before you decide whether to go ahead with DBS surgery
• Risks include bleeding in the brain, infection, depression and memory problems

What surgery for DBS involves

The surgery involves having a DBS system fitted. The DBS system has three parts.

• A lead – this is a thin, insulated wire. It is put through a small opening in your skull, to reach the part of your brain where the epileptic activity happens. Electrical activity is happening in our brain all the time. A seizure happens when there is a sudden burst of intense electrical activity. This is often referred to as epileptic activity.

• An extension – this is an insulated wire that is passed under the skin of your head, neck, and shoulder. It connects the lead to the neurostimulator.

• A neurostimulator – this is a small device, similar to a heart pacemaker. It is usually placed under the skin near your collarbone, lower in your chest, or under the skin of your stomach.

Before the surgery, a brain surgeon will give you a magnetic resonance imaging (MRI) or computed tomography (CT) scan. This is to see the exact part of your brain where the epileptic activity happens.

At the start of the surgery, you will take some drugs to make you relaxed and sleepy, but you might stay awake. You might have a frame attached to your face. The frame will be taken away when the surgery is finished.

After the surgery, the surgeon may give you another CT or MRI scan, to make sure the DBS is in the right place.

What DBS does

Once the DBS is in place, electrical impulses go from the neurostimulator, along the extension wire and lead, and into your brain. These stimulate the part of your brain where there is epileptic activity, to stop your seizures happening. The surgeon will use a programming unit to turn the neurostimulator on, adjust the stimulation, and monitor activity. You will be given a hand held programmer or a magnet, so that you can switch the stimulator on and off.

Deep Brain Stimulation Surgery in India is being dealt by expert Neurosurgeons who have the expertise and many years of experience in performing complex Neuro surgical procedures and have hands on experience with the latest technological devices used to perform the most sophisticated surgeries. The hospitals catering Deep Brain Stimulation Surgery in India have network of hospitals which have dedicated state-of-the-art Neurosurgery operation theaters with semi-robotic microscopes, the neuro-navigation facility, cranial and spinal endoscopy, MRI and CT compatible stereotaxy for functional neurosurgery. It assists the surgeons in attaining precision while conducting complex neurosurgeries.

Why should you choose to get Neurology & Endovascular Neurosurgery in India?

• Indian doctors are known all over the world for their skill and knowledge and have the experience of studying and working at the best neuron surgery hospitals in the world.
• Most advanced Technology Infrastructure - Blood Bank with 24 hour apharesis facility, advanced laboratory and microbiology (infection control) support, advanced cardiology, DSA and interventional radiology, portable and colour ultra-sonology, Liver Fibro-scan, 64 slice CT scanner, 3 T MRI, PET-CT and nephrology (including 24 hour dialysis and CVVHD).
• Neurosurgery Hospitals in India are equipped with the latest and high end technology.
• Cost of epilepsy surgery in India at best brain surgery hospitals in India is very low as compared to the cost at best hospitals in America or UK with the same level of care and services.

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.

For more information visit:          http://www.medworldindia.com      
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Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.

Call Us : +91-9811058159

Mail Us : care@medworldindia.com