Stroke Treatment in India

by Rishabh

What is a Stroke?

A condition when a burst or clogged artery interrupts the flow of the blood to the brain. This deprives the brain of food and oxygen and as a result of this brain cells begin to die. 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. A stroke requires prompt treatment in order to minimize the damage caused to the brain and also try to avoid its potential complications.

Types of Stroke

A stroke can be categorized into two types –

Hemorrhagic Strokes: This type of stroke occurs when a blood vessel bleeds and burst within the brain. This accumulated blood compresses the nearby tissues of the brain. This could be due to –

  • A blood vessel on the brain surface starts bleeding in between the area of the skull and the brain.
  • A blood vessel bleeding or bursting inside the brain

Hemorrhagic strokes has two main types –

  • Subarachnoid hemorrhage: In this, there is bleeding in between the area of the brain and the thin tissues covering the brain.
  • Intracerebral hemorrhage: This is considered as the most common type of hemorrhagic strokes. This occurs when an artery bursts inside the brain and resulting in the flooding of the nearby blood tissues.

Ischemic Stroke: This occurs when something is causing blockage in an artery which is carrying blood to the brain. The potential causes are –

  • When there is a blockage in the small blood vessels within the brain
  • When a blood clot develops in the main artery to the brain
  • When an air bubble, a blood clot or fat globule develops in a blood vessel which is carried to the brain.

There are two common types of ischemic stroke –

  • Embolic Stroke: This stroke occurs when other debris or a blood clot develops away from the brain. This mostly happens in the heart and is swept from the bloodstream into the narrow brain arteries. This kind of blood clot is known as an embolus.
  • Thrombotic Stroke: This occurs when thrombus (a blood clot) develops in one of the arteries which supply blood to the brain. This clot may be due to the accumulation of plague (fatty deposits) in the arteries that causes decreased blood flow.

When there is temporary blockage in the blood supply to the brain and there is a feeling of stroke for a little time. This entire process is termed as mini stroke or a transient ischaemic attack (TIA). A mini stroke is an indication that a part of the brain is not getting sufficient blood and this can result into a severe stroke in the future.

Causes of a Stroke

When there is bleeding in and around the brain –

  • Blood vessels inside the brain ruptures as diabetes, high blood pressure or aging have damaged them and weakened them.
  • Aneurysms (weak spot) on the brain arteries rupture that covers the brain with blood.

Blockage of blood vessels in the brain –

  • Arteriosclerosis (hardening of the arteries) can form clots in the blood vessels of the brain.
  • Clots may travel through the blood vessels of the neck or heart and lodge in the brain.
  • Diabetes or high blood pressure can damage and block the small vessels in the brain.

Symptoms of a Stroke

There are many signs indicating the occurrence of a stroke that largely depends on what part of the brain is affected. Its several symptoms include –

  • Headache with unknown cause
  • Trouble in seeing
  • Numbness that is limited to one side of the body
  • Difficulty in walking
  • Difficulty and confusion while speaking
  • Loss of balance
  • Difficulty in swallowing
  • Clumsiness
  • Difficulty in reading and writing
  • Changes in hearing
  • Dizziness or abnormal feeling of movement
  • Loss of coordination
  • Changes that affect touch and the ability to feel different temperatures, pressure or pain.
  • Lack of control over the bowels or bladder
  • Muscle weakness in the legs, arm or face
  • Mood, personality or emotional changes
  • Changes in taste

Diagnosis of a Stroke

A blood tests and a physical exam are performed for diagnosing stroke. Sometimes imaging is also used. CT scan or computerized tomography helps in determining whether a person has a stroke and also the type of stroke. The structures of the arteries can be viewed by performing a specialized CT scan where a dye is injected into the vein. In order to view the damaged brain tissue, MRI or magnetic resonance imaging test is performed.

The clotting in the carotid artery (a major artery that travels up the neck into the brain) can be indicated by performing a carotid ultrasound. Echocardiography ultrasound can be done presents the images of the heart that helps in determining whether the stroke is caused by an embolus.

Treatment of a Stroke

The treatment for both hemorrhagic and ischemic stroke is different.

The purpose of treating ischemic stroke is to restore the flow of the blood in the brain. Medications are given in the first four and a half hours of the stroke for destroying the clots in the blood vessels. An injection of tissue plasminogen (TPA) can also be given to a patient for improving the probability of a full recovery.

The main purpose of treating a hemorrhagic stroke is to stop bleeding and decrease the pressure on the brain. Instead of blood thinners, clotting drugs can be given. After the area has been healed and the bleeding is controlled, the damaged and leaky blood vessels are then repaired.

The first stroke device approved by FDA is Merci retriever. The aim of this device is to restore the flow of the blood in the neurovasculature by removing thrombus in those patients who have ischemic stroke.

The penumbra system (endovascular thromboaspiration) is the last FDA approved 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

Apollo Hospital Hyderabad launched a ‘stroke robot’ that helps in diagnosing and also recommends suitable treatment for brain stroke patients. A physician can “e reach” the patient’s bedside in remote areas to render immediate care.

Even if the patient can’t reach the hospital within 48 hours of stroke,RP-7 remote presence Robot enables the physician to check the crucial signs of the patient effectively and diagnostics can be provided within few minutes. By the means of this robot, a doctor can speak with the family member of the patient and simultaneously can also check ventilator and monitor settings also.The Apollo group has installed one system each in the neurology department at seven of its hospitals across the country.

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