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Stroke Treatment in India

Stroke

Stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult (CVI), or brain attack, is when poor blood flow to the brain results in cell death. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. “Mini-strokes” or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted. This dead brain cells cause loss of the functions of the different body parts. Loss of feeling, reasoning problems, language problems, problems of visual and vision perception, speech problems, coma, swallowing difficulties, muscle weakness or paralysis are the problems caused by a stroke.

Types of Stroke

Hemorrhagic stroke

A hemorrhagic stroke is either a brain aneurysm burst or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain. There are two types of hemorrhagic stroke called intracerebal and subarachnoid.
Intracerebral Hemorrhage : The most common hemorrhagic stroke happens when a blood vessel inside the brain bursts and leaks blood into surrounding brain tissue (intracerebal hemorrhage). The bleeding causes brain cells to die and the affected part of the brain stops working correctly. High blood pressure and aging blood vessels are the most common causes of this type of stroke.

Subarachnoid Hemorrhage : This type of stroke involves bleeding in the area between the brain and the tissue covering the brain, known as the subarachnoid space. This type of stroke is most often caused by a burst aneurysm. Other causes include:

  • AVM
  • Bleeding disorders
  • Head injury
  • Blood thinners
  • Ischemic stroke

Ischemic stroke occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. This causes blood not to reach the brain. High blood pressure is the most important risk factor for this type of stroke. An ischemic stroke can occur in two ways.

Embolic Stroke : In an embolic stroke, a blood clot or plaque fragment forms somewhere in the body (usually the heart) and travels to the brain. Once in the brain, the clot travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. The medical word for this type of blood clot is embolus.

Thrombotic Stroke: A thrombotic stroke is caused by a blood clot that forms inside one of the arteries supplying blood to the brain.  This type of stroke is usually seen in people with high cholesterol levels and atherosclerosis. The medical word for a clot that forms on a blood-vessel deposit is thrombus.

TIA:

When blood flow to part of the brain stops for a short period of time, also called transient ischemic attack (TIA), it can mimic stroke-like symptoms. These symptoms appear and last less than 24 hours before disappearing. While TIAs generally do not cause permanent brain damage, they are a serious warning sign that a stroke may happen in the future and should not be ignored.

Causes of a Stroke

There are two main types of stroke – ischaemic strokes and haemorrhagic strokes – which affect the brain in different ways and can have different causes.

  • Ischaemic strokes
  • As you get older, the arteries can naturally narrow, but certain things can dangerously accelerate the process. These include:
  • smoking
  • high blood pressure (hypertension)
  • obesity
  • high cholesterol levels
  • diabetes

An excessive alcohol intake

Another possible cause of ischaemic stroke is a type of irregular heartbeat called atrial fibrillation, which can cause blood clots in the heart that break up and escape from the heart and become lodged in the blood vessels supplying the brain.

Haemorrhagic strokes

  • The main cause of haemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain and make them prone to split or rupture.
  • Things that increase the risk of high blood pressure include:
  • being overweight or obese
  • drinking excessive amounts of alcohol
  • smoking
  • a lack of exercise
  • stress, which may cause a temporary rise in blood pressure
  • Haemorrhagic strokes can also occur as the result of the rupture of a balloon-like expansion of a blood vessel (brain aneurysm) and badly-formed blood vessels in the brain.
  • Symptoms of a Stroke
  • The main stroke symptoms can be remembered with the word FAST: Face-Arms-Speech-Time.
  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped.
  • Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm.
  • Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake.
  • Time – it is time to dial 999 immediately if you notice any of these signs or symptoms.
  • Other possible symptoms
  • Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause different symptoms.

Other symptoms and signs may include:

  • complete paralysis of one side of the body
  • sudden loss or blurring of vision
  • dizziness
  • confusion
  • difficulty understanding what others are saying
  • problems with balance and co-ordination
  • difficulty swallowing (dysphagia)
  • a sudden and very severe headache resulting in a blinding pain unlike anything experienced before
  • loss of consciousness

Diagnosis of a Stroke

Diagnostic tests examine how the brain looks, works and gets its blood supply. They can outline the injured brain area. Most of them are safe and painless. Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan. A number of tests can then be carried out to help confirm the diagnosis and determine the cause of the stroke.

This may include blood tests to determine your cholesterol and blood sugar levels, checking your pulse for an irregular heartbeat and taking a blood pressure measurement.

The diagnosis includes

  • Blood Tests
  • Imaging Tests
  • CT Scan
  • MRI
  • Angiograpy
  • Ultrasound
  • Echocardiogram
  • Electrocardiogram

Treatment of a Stroke

There are several treatment options for stroke depending on the cause of your stroke. If you are having an ischemic stroke or a stroke that is caused by a blood clot your doctor may recommend drug treatment.

Drug Treatment

There is only one Food & Drug Administration (FDA) approved drug treatment for acute ischemic stroke. Tissue plasminogen activator (tPA) is given via intravenous therapy (IV) and works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. tPA should be given within three hours (and up to 4.5 hours in certain eligible patients)of the time symptoms first started.

Mechanical Devices

Some ischemic strokes are treated with small mechanical devices that remove or break up blood clots. If clot-busting drugs are ruled out, another option one of the many FDA approved mechanical devices. A surgeon inserts a small mechanical device into the blocked artery using a thin tube. Once inside, the tool traps the clot, and either breaks it up or the surgeon pulls it out of the brain, reopening the blocked blood vessel in the process.

A hemorrhagic stroke (sometimes called a bleed) occurs if an artery in your brain leaks blood or ruptures (breaks open). The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Some of the options for treatments include surgical clips or coils inserted in aneurisms (weaknesses in the blood vessel wall), controlling high blood pressure, and surgery to remove the bleeding vessel and blood that has spilled into the brain.

Medical advances have greatly improved survival rates and recovery from stroke during the last decade. Your chances of survival and recovery outcomes are even better if the stroke is identified and treated immediately.

The penumbra system (endovascular thromboaspiration) is 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.

Robot for Brain Stroke Patients

Doctors have always used their keen perception of human behavior to identify neurological impairments, and help diagnose brain disorders. A doctor will look at how a patient moves and interacts with them during a standard neurological exam. However to assess these functions, the doctor must rely heavily on their subjective estimate of the patient’s ability to perform behaviors that represent various functions. The robotic system helps to identify deficits that are sometimes difficult to pick up on a standard clinical exam, but are important for day to day function. With More Advanced development now A physician can “e reach” the patient’s bedside in remote areas to render immediate care. Robot enables the physician to check the crucial signs of the patient effectively and diagnostics can be provided within few minutes.

Hospitals in India are now equipped with such advanced robots and treatment can be done at very low price.