If detected with symptoms of stroke how can quick medical help save a life?
I would like to illustrate the importance of the life-saving possibilities by seeking prompt medical attention with two cases, both different in response to stroke, that came to Narayana Hospital during the Covid lockdown. A 60-year-old person was brought to us one evening during the lockdown period. On investigation, he was diagnosed with an evolving stroke, but his condition kept fluctuating at times making him feeling better. From the imaging, we could clearly see a possibility of evolving large stroke and advised for admission. But the family insisted on taking him home wanting to avoid hospital stay fearing the risk of contracting the contagion. Despite assurances of safe practices adopted by the hospital, they went against the medical advice and chose to take back the patient and manage from home. His brief stability was a deceptive condition and consequently the following morning he returned to us after a massive stroke. We tried to salvage the situation, but that was not enough and the day following his arrival to the hospital, he suffered fatal outcome.
In sharp contrast, another patient from nearby vicinity, who was working in the office when the strict lockdown was just imposed, showed signs of early symptoms of stroke. Not paying heed to suggestions of his office mates to go home, he insisted to be taken to the hospital as he was not feeling well and his colleague brought him to us in time. On investigation, we found that a big stroke was going to happen because of clot in the one of the major artery which carries a catastrophic outcome(nearly 100% fatality). We immediately did the procedure by which we removed the clot in the blocked vessel restoring the blood supply and the patient not only recovered, but is again back in office.
The situational responses to these two cases and its outcome convey the message that when any medical emergency occurs do not hesitate to report intimidated by the prevailing pandemic situation, instead rush to the hospital, especially in brain stroke. Our hospital and staff are committed to maintaining safe practices where the patients, their attendants and the medical team is ensured protection against risk of Covid infection. Consequently, we are getting good results. Swift response can save a life from stroke if rushed to the hospital.
Does Covid 19 in any way trigger strokes?
Since the outbreak of the contagion, many studies and findings were published in reputed medical journals. One such revelation in the Lancelot issue of July 2020, the data compiled, even if it is preliminary, from many centres including Wuhan in China, New York, Milan and other places ravaged by the pandemic, an increase has been observed of Covid positive patients suffering stroke, which is anywhere between 6 per cent to 30 percent. It was seen that Covid patients were largely elderly patients having co-morbidities. However, data from a few of cities like New York have shown the alarming trend of strokes happening in young Covid patients. Pathological examinations and its evaluations have revealed that it is because of an increase in thrombosis or blood clot formation in the small vessels, the reason why we immediately administer anticoagulants to such patients. In this condition, inflammatory reaction or changes occur in the lining of the blood vessel, leading to increasing tendency of clot formation in Covid patients raising risks of a stroke, heart attack, heart failure or pulmonary embolism.
What are the challenges in treating a Covid patient suffering a stroke?
Since the declaration of the Covid pandemic as a global health emergency, we have evolved in the last couple of months in managing patients suffering a stroke. Initially, the challenge was that when the stroke occurs, we were not aware of the status of the patient whether he/she is covid positive or negative, particularly in critical emergency cases when there is no time to evaluate the Covid status of the patient. So for all practical purposes, the patient reporting to the emergency was taken as a case of active infection unless and until proven otherwise. The process of managing patient with stroke has to be very well- coordinated as they have to go through a series of stages starting from the emergency to the radiology to the neuro cath lab, the critical care ICU as a result exposing so many stations, the unit staff, the doctors and paramedics to the risk of infection. Any negligence could put the entire team into quarantine. Though we have an adequate backup team, yet if the reserve depletes the programme could suffer. Our safety measures and precaution start from the moment the patient is brought into the emergency, and from there on every member of the medical team dealing with the patient at every stage is in complete safety dress code including PPE. The patient is brought from radiology to cath lab through a designated pathway. We also follow stringent disinfection process including sanitizing the scanners at the radiology and Cath lab sections. Constantly we have are evolving in understanding the scenarios as time passes by. We are incorporating newer guidelines and processes in planning of the treatment to cope with the situation in the pandemic while keeping everyone safe, like getting a chest CT scan to rule out the evidence of infection, doing rapid kit tests, fast-tracking the diagnostic tests for infection status, altering the DSA lab environment and practices to minimize the spread of aerosol spread and so on so forth.
What is your message to the people in the Covid pandemic times?
In stroke, if time is lost a life is lost, so rush the patient to the hospital. I have been repeatedly emphasising patients coming to us, their families and through several forums including webinars that in very critical emergencies seek immediate medical attention. Without any delay rush the patient to the nearest hospital which is adequately equipped and trained in dealing with stroke cases under the prevailing pandemic situation or else more complications and irreversible damage could happen risking the patient’s life. So be alert and we shall do our part to the best.
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