Brain Under Attack

High blood pressure, smoking, high cholesterol, diabetes and increasing age constitute the most common risk factors for stroke. It is important to eat right and have a healthy lifestyle to avoid occurrence of stroke
By Dr Rajul Agarwal

A stroke, also known as a cerebrovascular accident or CVA is when part of the brain loses its blood supply and the part of the body that the blood-deprived brain cells control stops working. This loss of blood supply can be ischemic because of lack of blood flow, or hemorrhagic because of bleeding into brain tissue. A stroke is a medical emergency because strokes can lead to death or permanent disability. There are opportunities to treat ischemic strokes but that treatment needs to be started in the first few hours after the signs of a stroke begin. The patient, family, or bystanders, should activate emergency medical services immediately should a stroke be suspected.
The types of strokes include Ischemic stroke (part of the brain loses blood flow) and hemorrhagic stroke (bleeding occurs within the brain). Transient ischemic attack, TIA, or mini-stroke (The stroke symptoms resolve within minutes, but may take up to 24 hours on their own without treatment. This is a warning sign that a stroke may occur in the near future.).
Always try to follow on the word FAST which stands for Face drooping, Arm weakness, Speech difficulty and Time to assistance if you think someone might be having a stroke. The causes of strokes include ischemia (loss of blood supply) or hemorrhage (bleeding) in the brain. People at risk for stroke include those who have high blood pressure, high cholesterol, diabetes, and those who smoke. People with heart rhythm disturbances, especially atrial fibrillation are also at risk.
Stroke is diagnosed by the patient’s symptoms, history, and blood and imaging tests. You can prevent stroke by quitting smoking, controlling blood pressure, maintaining a healthy weight, eating a healthy diet, and exercising on a regular basis. The prognosis and recovery for a person that has suffered a stroke depends upon the location of the injury to the brain.
How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability. Each year nearly 800,000 people experience a new or recurrent stroke.
As per an estimate, three adults suffer from a stroke every minute in India, though up to 80 percent of strokes can be prevented.A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include: You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities hampered by paralysis, such as walking, eating and dressing. A stroke may cause you to have less control over the way the muscles in your mouth and throat move, making it difficult for you to talk clearly (dysarthria), swallow or eat (dysphagia).
You also may have difficulty with language (aphasia), including speaking or understanding speech, reading or writing. Therapy with a speech and language pathologist may help. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts. People also may be sensitive to temperature changes, especially extreme cold after a stroke. This complication is known as central stroke pain or central pain syndrome. This condition generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments.
People who have had strokes may become more withdrawn and less social or more impulsive. They may need help with grooming and daily chores.In case of stroke, you may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you’re having a stroke.
Medical risk factors includes High blood pressure — the risk of stroke begins to increase at blood pressure readings higher than 120/80 millimeters of mercury (mm Hg). Your doctor will help you decide on a target blood pressure based on your age, whether you have diabetes and other factors.
Physical therapy may help you return to activities hampered by paralysis, such as walking, eating and dressing. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading or writing. Therapy with a speech and language pathologist may help. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts.
People also may be sensitive to temperature changes, especially extreme cold after a stroke. This complication is known as central stroke pain or central pain syndrome. This condition generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments.
Not all strokes affect the brain equally, and stroke symptoms and signs depend upon the part of the brain affected. For example, most people’s speech centre is located in the left half of the brain so a stroke affecting the left side of the brain would affect speech and comprehension. It also would be associated with weakness of the right side of the body. A right brain stroke would make the left side of the body weak. And depending on where in the brain the injury occurred, the weakness could be the face, arm, leg or a combination of the three.
The NIH Stroke Scale tries to score how severe a stroke might be. It also monitors whether the person’s stroke is improving or worsening as times passes as the patient is re-examined. There are 11 categories that are scored and include whether the patient is awake, follow commands, sees, moves the face, arms and legs and has normal body sensations or feelings, speech difficulties or coordination problems.
The most common risk factors for stroke are: high blood pressure, smoking, high cholesterol, diabetes and increasing age. Heart conditions like atrial fibrillation, patent foramen ovale, and heart valve disease can also be the potential cause of stroke. When stroke occurs in younger individuals (less than 50 years old), less common risk factors to be considered include illicit drugs, such as cocaine or amphetamines, ruptured aneurysms, and inherited (genetic) predispositions to abnormal blood clotting. An example of a genetic predisposition to stroke occurs in a rare condition called homocystinuria, in which there are excessive levels of the chemical homocystine in the body. Scientists are trying to determine whether the non-hereditary occurrence of high levels of homocystine at any age can predispose to stroke.
Strokes happen fast and will often occur before an individual can be seen by a doctor for a proper diagnosis. For a stroke patient to get the best diagnosis and treatment possible, they should be treated at a hospital within 3 hours of their symptoms first appearing.
Ischemic strokes and hemorrhagic strokes require different kinds of treatment. Unfortunately, it is only possible to be sure of what type of stroke someone has had by giving them a brain scan in a hospital environment.
There are several different types of diagnostic tests that doctors can use to determine which type of stroke has occurred like physical examination by checking blood pressure, listen to the carotid arteries in the neck, and examine the blood vessels at the back of the eyes, all to check for indications of clotting, blood tests to find out how quickly the patient’s blood clots, the levels of particular substances (including clotting factors) in the blood, and whether or not the patient has an infection.CT scan, and MRI scan – radio waves and magnets create an image of the brain to detect damaged brain tissue.
Treatment can begin with drugs to break down clots and prevent others from forming. Aspirin can be given, as can an injection of a tissue plasminogen activator (TPA). TPA is very effective at dissolving clots but needs to be injected within 4.5 hours of stroke symptoms starting.
Emergency procedures include administering TPA directly into an artery in the brain or using a catheter to physically remove the clot. Recent studies have questioned the effectiveness of these methods, and so research is still ongoing as to how beneficial these procedures are. There are other procedures that can be carried out to decrease the risk of strokes or TIAs. A carotid endarterectomy involves a surgeon opening the carotid artery and removing any plaque that might be blocking it.
Alternatively, an angioplasty involves a surgeon inflating a small balloon in a narrowed artery via catheter and then inserting a stent (a mesh tube) into the opening to prevent the artery from narrowing again.
Hemorrhagic strokes are caused by bleeding into the brain, so treatment focuses on controlling the bleeding and reducing the pressure on the brain.
Treatment can begin with drugs given to reduce the pressure in the brain, control overall blood pressure, prevent seizures and prevent sudden constrictions of blood vessels. If the patient is taking blood-thinning anti-coagulants or an anti-platelet medication like Warfarin or Clopidogrel, they can be given drugs to counter the medication’s effects or blood transfusions to make up for blood loss.
Surgery can be used to repair any problems with blood vessels that have led or could lead to hemorrhagic strokes. Surgeons can place small clamps at the base of aneurysms or fill them with detachable coils to stop blood flow and prevent rupture.
Keeping these mentioned things in mind,the author has special interest in neuro critical care, stroke, headache, epilepsy, abnormal movement disorder, neuro-rehabilitation and more. His personal and professional aim is to help people by giving them the best and most advanced treatment at affordable cost. Apart from his expertise in his field, his amiable nature has won many patients’ hearts.
Today neuro critical care and acute stroke case are more common. Patient coming with a stroke within 4-5 hours of the onset of symptoms receive injection RTPA, which has ability to open blood clot. Thrombolytic therapy and neuro critical care are very helpful for trauma cases.
It is not about success with one single patient. It is about sustained dedicated efforts day after day throughout the year. As soon as a patient arrives in casualty, he/she is seen immediately by neurology team and best treatment is given on an urgent basis. The patient is then shifted to neuro ICU and monitored constantly. The author is focused on providing the most advanced neurological care to our patients.
Over a period of time, our population is aging. The average life span of a human being has increased from 60 years to 80 years due to the advancement in medical science. When a person gets older, there are increased chances for him to be prone to neurological diseases like stroke, dementia and Parkinson diseases as well. It is very important that we preserve our body and have healthy aging. We should take care of eating habits and lifestyle and avoid smoking, drinking and fast food, which can adversely affect health. It is important to eat right and have a healthy lifestyle to avoid neurological diseases.

(The author is a Senior Neurologist, Sri Balaji Action Medical Institute, Delhi)