Overview

A stroke, also known as a brain attack or cardiovascular accident (CVA), occurs when there is a sudden cut off of blood supply into the brain. Stroke has been a significant global public health problem and remains one of the leading causes of acute mortality and morbidity worldwide.

Growing Incidences of Stroke in India

The estimated incidence of stroke has increased by more than 100% in low- and middle-income countries, including India, over the last four to five decades. The Global Burden of Diseases (GBD) study indicated a 26 per cent increase in global stroke deaths during the past two decades, a very alarming figure. Over the last few years, there has been a significant increase in stroke in young stroke incidence, which may be due to dynamic changes in our lifestyle, including sedentary lifestyle, stress, and pollution, in addition to the usual high-risk factors, which stand to urgent attention.

What is a Stroke?

A stroke occurs when the blood supply to the brain is disrupted, leading to damage or death of brain cells. It can result in various neurological impairments and complications.

A stroke (paralytic attack) can happen to anyone at any time in a fraction of a moment, and every day a happy life can become very challenging and devastating. This acute phenomenon can happen in two ways.

- Ischemic Stroke. The first and most common type (up to 75% to 85%) is arterial (blood-carrying vessel into the brain) occlusion by a clot (called ischemic stroke), and blood flow beyond this clot is restricted.
- Hemorrhagic Stroke. The second type is less common but as fatal as the ischemic type and occurs when an artery in the brain leaks or bursts (called a hemorrhagic stroke). Ruptured blood vessels causing brain bleeding can happen within the brain tissue (intracerebral haemorrhage) or over the brain's surface (subarachnoid haemorrhage).

Causes of A Stroke

A blood clot usually develops in a narrowed artery caused by cholesterol plaques or can travel directly from the heart (if the heart is not pumping correctly or beating irregularly or a heart valve problem) to an artery that supplies the brain. So, when one of those blood vessels in the brain is obstructed or ruptures, a stroke occurs.

Depriving the brain of oxygen and blood supply results in immediate cell microstructure change and stops functioning. Once the involved brain part stops normal functioning, it directly affects the areas of the body controlled, which leads to stroke symptoms appearance.

Symptoms of a Stroke

Early identification of stroke symptoms is crucial for potentially effective treatment. If we can recognise stroke early within the golden period (window period), treatment can significantly improve outcomes, and patients can ultimately improve. Symptoms like

- sudden onset
- slurred speech
- facial deviation
- drooping of the angle of the mouth
- arm or leg weakness

These symptoms can be remembered from the WSO-recognised simple acronym FAST (Face deviation/Arm weakness/ Speech difficulty/Time). “SAVE ME” is another catchy acronym to recognise stroke warning signs.

Prevention from a Stroke

Identifying these early symptoms is essential because if we can restore blood supply to the brain within that golden hour (window period), the brain tissue can be salvaged. That’s where the utmost importance of community awareness comes in. As stroke can happen to anyone, these early symptoms should be familiar to you, your nearer and dearer all. We usually ignore minor symptoms of paralysis, thinking the cause may be due to abdominal upset or gas, thereby missing the crucial golden period of treatment.

Abdominal gas problems usually cause aching pain in the upper belly and regurgitation symptoms, and cramps involving the limbs cause painful transient muscle spasms. Other symptoms like sudden unconsciousness, balancing problems while walking or sudden visual disturbances can also be due to brain attack. These sudden symptoms shouldn’t be ignored; you should seek urgent medical advice.

Treatment and Recovery from a Stroke

The advancement of stroke therapies and recovery efforts offer much-improved outcomes. Now, clots can be removed safely with the advanced device in addition to clot-dissolving drugs.

- Endovascular mechanical thrombectomy (taking out the brain clot using a small catheter passing through a tiny few millimetres incision in the groin or wrist region) within a window period is a crucial neurointervention AHA/ASA (The American Heart Association and the American Stroke Association) guidelines for stroke treatment.
- Team Approach. A “Team Approach” in a “Stroke Ready Centre” is essential for comprehensive stroke care. A complete team involves all members in a stroke pathway, including a neurologist, emergency physician, radiologist, intensivist, and technician, each executing a defined role for early & effective treatment of stroke.

Stroke Recovery with Narayana Superspeciality Hospital, Gurgaon

Keeping this in mind, we engaged in “Team NeuroSalvusta” - an inclusive team approach to stroke and neurovascular treatment. At Narayana Superspeciality Hospital, Gurgaon, an advanced “Stroke Ready Centre”, and we provide “24x7x365” comprehensive stroke care & a tertiary referral complete stroke care centre, including cutting-edged neuro-interventional & neurocritical care with a dedicated stroke helpline….!!!!

Prevention from a Stroke

Brain attack has harmful consequences for individuals, families, and society. It impacts all domains, including normal body functions, individual daily activity and social participation.

- Regular Exercise. So, being fit and healthy is the first step, along with regular exercise and checking blood pressure, weight, and cholesterol regularly.
- They are identifying Stroke Symptoms. Early identification of stroke symptoms and urgent reporting to a stroke-ready centre is crucial for a better tomorrow.
- Stroke Awareness. This year, the “World Stroke Organisation” campaign for stroke awareness is “Together we are #Greater Than Stroke”. Let’s call everyone – individuals, families, communities, health professionals and governments – to join the fight against stroke. Let’s drive awareness action and push for better access to stroke treatments.

Is Stroke Preventable?

Stroke is preventable, and we can recover entirely if we reach the “Stroke Ready Centre” within the golden hours. World Stroke Organisation organisation warned that “One in Four” of us will have a stroke, a wake-up red corner notice. Every 40 seconds, someone in India suffers a stroke, and every 4 minutes, someone dies due to a stroke, and every 6 seconds, someone’s quality of life will forever be changed due to a stroke. These nerve-wracking figures counsel us to understand about stroke in depth. We are facing significant challenges in preventing and treating stroke, mainly because of recent demographic changes, limited public awareness, sedentary lifestyle, smoking, obesity, hypertension, etc.

Time is Brain

For this, we need a comprehensive stroke care program that includes intensive stroke awareness and an effective stroke rehabilitation plan; these warrant a collective commitment from public administration, health establishments, and people's participation. The feeling good effect is that Stroke is “Preventable, Treatable”, and if timely taken care of within the golden period, there is a good chance of complete recovery. Stroke is a medical and surgical emergency. Time is very crucial (so we call it “Time is Brain”) in stroke management. We lose millions of neurons every crossing minute if an obstructed clot is not dissolved or removed. Once the neurons die, they cannot be revived, and clinical symptoms persist.

Recently, medical science has taken great leaps in this field. Multiple well-designed randomised trials (DAWN, DEFUSE-3) have extended the intervention window period (time duration from stroke clinical symptoms onset) from 6 to 24 hours in selected patients with salvageable brain tissue called penumbra, a welcoming treatment option, also highlighted in the AHA/ASA (The American Heart Association and the American Stroke Association) guidelines for stroke treatment.

When to Consult a Doctor

You can also get in touch with the expert cardiology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

Conclusion

Brain attack has harmful consequences for individuals, families, and society. It impacts all domains, including normal body functions, individual daily activity and social participation. So, being fit and healthy is the first step, along with regular exercise and checking blood pressure, weight, and cholesterol regularly. Early identification of stroke symptoms and urgent reporting to a comprehensive stroke-ready centre is crucial for a better tomorrow. This year, the “World Stroke Organisation” campaign for stroke awareness is “Together we are #Greater Than Stroke”. Let’s call everyone – individuals, families, communities, health professionals and governments – to join the fight against stroke. Let’s drive awareness action and push for better access to stroke treatments.

DR BIPLAB DAS MD (PGIMER, Chandigarh) Director & Consultant - Department of Neurology & Interventional Neurology Email: biplab.das.drr@narayanahealth.org Contact Number: 180 0309 0309

[caption id="attachment_23610" align="alignnone" width="1180"] Dr Biplab Das[/caption]