Brain attack: Symptoms and why ‘time is brain’ for stroke
Time is brain for stroke  |  Photo Credit: Thinkstock
New Delhi: Stroke or a brain attack is a major global public health problem and still remains the second leading cause of death worldwide. Estimated incidence of stroke has increased more than 100% in low- and middle-income countries, including India, over the last five decades. According to the Global Burden of Diseases study, there was a 26 per cent increase in global stroke deaths during the past two decades. While there is limited data regarding stroke prevalence in India, estimated rate may range from 84-262/100,000 in rural and 334-424/100,000 in urban areas with incidence 119-145/100,000 population, say health experts.
The World Stroke Organisation (WHO) recently warned that one in six people in the world will suffer a stroke in their lifetime. Every 2 seconds, someone in the world suffers a stroke; every 6 seconds, someone dies of a stroke and every 6 seconds, someone’s quality of life is forever altered. While these are nerve-wracking statistics, there is little awareness about the disease. The fact that stroke is preventable offers some respite, however, some factors, such as recent demographic changes, limited awareness, sedentary lifestyle, smoking, obesity and hypertension challenge its prevention and treatment. In this article, Dr Gaurav Goel, Associate Director, Institute of Neurosciences, Medanta, explained in detail why time is brain when it comes to treating stroke. Read – Air pollution a major contributor to stroke: Know the risk factors and prevention
What is a stroke? Causes, symptoms
A stroke happens when a blood vessel in the brain is obstructed or get gets ruptured. Depriving oxygen and blood supply to the brain results in immediate cell microstructure change and it stops functioning. Once the impacted part of the brain stops functioning normally, it affects the areas of the body it controls. This is the reason why people experience symptoms such as sudden onset of weakness in arm or leg, face deviation and/or speech difficulty. If identified early, blood supply can be effectively restored within the limited time period, commonly called the window period. This is why stroke is both a medical and surgical emergency.
What are the major types of stroke?
The major types of stroke are ischemic and hemorrhagic stroke. The more prevalent ischemic stroke is an arterial occlusion caused by a clot which restricts blood flow. As fatal as the ischemic type, a hemorrhagic stroke occurs when an artery in the brain leaks or bursts. A blood clot usually develops in a narrowed artery caused by cholesterol plaque, or could travel directly from the heart (if the heart is not pumping properly, beating irregularly or has a dysfunctional valve) to an artery that supplies to the brain. Stroke affects the arteries which carry oxygen and other essential nutrients to the brain. Read – World Stroke Day 2018: FAST – 10 warning signs and symptoms of stroke
Stroke management – time is brain
In stroke management, time is most crucial, and time is also brain. Every passing minute following a stroke, millions of neurons die in the obstructed clot is not dissolved or removed, the lost neurons cannot be revived.
Classically, clots have been addressed with clot dissolving drugs. More recently, clots are being safely removed using neurointerventional and endovascular techniques using advanced devices. Endovascular mechanical thrombectomy is one such process in which a clot is removed using a small catheter which is introduced in the body through a very small incision in the groin region in short procedural time.
Most critical to a positive outcome with this procedure is the window period. Recommended window period for stroke intervention until recently was six hours. Latest randomised trials have however extended this to 24 hours in cases wherein the patient has salvageable brain tissue called penumbra. The American Heart Association and the American Stroke Association also endorse the expanded window period. The increased treatment window will consequently allow more lives to be saved, lesser suffering from life altering disabilities, and save families and society the burden of care giving.
A comprehensive stroke care program that includes intensive stroke awareness, effective stroke rehabilitation, and everything in between warrants collective commitment from public administration, health establishments, people participation, and is an immediate need.
Untreated stroke has long-term, often irreversible impact on normal body functions, individual daily activity and social participation. Keeping good health with regular exercise and maintaining optimal blood pressure, weight and cholesterol offsets the risk of stroke considerably. Early identification of stroke symptoms and prompt treatment at a comprehensive stroke facility is crucial to treatment and cure.